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Fighting For Our Health Blog

The Capitol Pressroom with Susan Arbetter

“First of all, I can't put this book down. Usually…I'm being totally honest…'Oh a policy book. Oh yay' let me just leave it 'til the morning before I have to interview the person. But this is great. It's a memoir. You're funny. You're a great writer. And it's fascinating reading.”

For the full show go to:

January 5, 2014
Harold Pollack, The Washington Post, WONKBLOG

Host Harold Pollack interviews Richard Kirsch. The group that got health reform passed is declaring victory and going home.

To read to the blog go to:

February 9, 2013
Ian Williams,

Host Ian Williams interviews Richard Kirsch.

To listen to the podcast go to:

July 23, 2012
Cyruss Webb, Conversations LIVE

Host Cyrus Webb welcomes Richard Kirsch of Healthcare For America Now back to Conversations LIVE to discuss the Supreme Court's historic ruling on the Affordable Healthcare Act and his book FIGHTING FOR OUR HEALTH.

To listen to the podcast go to:

May 30, 2012
Scott Harris, Between the Lines

Millions of Americans' Access to Health Care Hinges on Supreme Court's Affordable Care Act Ruling. Interview with Richard Kirsch, author of the book, "Fighting for Our Health", conducted by Scott Harris

To listen to the podcast go to:

May 22, 2012
Inside Out Radio

We discuss the fight for the Affordable Care Act with the former national campaign manager for Health Care for America Now and the author of “Fighting for Our Health”

To listen to the podcast go to:

May 7, 2012
Patrick O’Heffernan, host of the The Fairness Doctrine, Blogtalk radio

“One of the best blow-by-blow descriptions of how a bill gets written and becomes law… It’s the kind of book you can start at the beginning of an airplane flight, be three hours late and not even notice it.”

To listen to the podcast go to:

April 26, 2012 - Special Battleground Wisconsin Podcast News-maker Interview
Richard discussed how to restore economic opportunity and revitalize the middle class. In addition, he discussed his new book which offers an inside look at the epic battle for health care reform, Fighting For Our Health (Rockefeller Institute Press, 2012).

March 29, 2012 - Alan Chartock...In Conversation with Richard Kirsch
Alan is joined by Richard Kirsch, a senior fellow at the Roosevelt Institute and the author of Fighting For Our Health: The Epic Battle to Make Health Care a Right in the United States.

March 21, 2012 - The Economic Question at the Core of the Individual Mandate
by Richard Kirsch for The New Deal 2.0 and The Huffington Post

Even if the Supreme Court strikes down the Affordable Care Act, it won’t change the fact that health care is a public good that must be provided to all Americans.

It is fitting testament to the fundamental problem with our health care system that the key legal question the Supreme Court is considering today is whether the requirement that most people have health coverage is a violation of the commerce clause. The legal issue is whether the act of not buying a product constitutes commercial activity. Opponents question whether the government could require people to buy any product, with broccoli as the favorite example. (Do people really hate broccoli that much?) The underlying premise of the challenge is that health coverage is a commodity, not a public good.

In defending the individual mandate, the government argues that health care is not like other commodities. As NPR’s Julie Rovner reported last May when a federal appeals court in Virginia was considering the issue, “[Acting U.S. solicitor general Neal] Katyal drove his point home repeatedly: Health care is not like any other product; everyone consumes it, whether they buy insurance or not. ‘That is a virtually universal feature of human existence,’ he told the judges. ‘Everyone is going to seek health care. Nobody can know precisely when.’”

Candidate Obama made the same point during a memorable moment of a debate with John McCain in October of 2008. When NBC’s Tom Brokaw asked the candidates, “Is health care in America a privilege, a right, or a responsibility?” Obama’s answer was crystal clear: “I think it should be a right for every American.”

In economic terms, the point that both Obama and Katyal are making is that health care is a public good, not a private commodity. As I write in Fighting for Our Health:

The theory that health care is a consumer good like any other commercial product and that health care markets work like other markets is pure fantasy, at odds with everything we know about how health care is actually consumed. Health care markets violate the fundamental tenets of market economics…

Health care is a public good, not a commodity. The reason that other developed countries spend so much less on health care, and cover all their people and deliver higher health quality care, is that these countries recognize this fact. As a public good, health care must be made available on an equitable basis to all, and prices and supply must be regulated. In the rest of the developed world, almost everyone has their health coverage supplied by the government or by a regulated nonprofit insurer, and the coverage comes with very low out-of-pocket costs. In other words, other developed countries follow the exact opposite course recommended by conservatives and achieve systems that are much more efficient economically.

The passage of the Affordable Care Act sets the United States on the course to making health care a public good, which is why conservatives are so deeply opposed to it. For the first time, the government has a legal obligation to make health care affordable. The ACA accomplishes this in a uniquely American way, a combination of a big expansion of public coverage through Medicaid, financial penalties for employers who do not provide coverage for their workers, and income-based government subsidies for people to buy regulated private insurance.

The individual mandate is a key component of that last measure. Without the mandate, the regulated market would fail, since allowing people to buy coverage only when they need it drives up costs for everyone else and leaving people without coverage shifts the costs of their care to others. In short, a private decision not to buy a public good has substantial public consequences.

The great irony of the conservative challenge to the individual mandate is that there is no credible legal challenge to the concept that the government could raise taxes to provide public health coverage to everybody. Because both conservatives and those who profit from the health care industry have opposed a national insurance system, the ACA was developed first in Massachusetts and then nationally as a grand compromise. If the Supreme Court were to rule against the individual mandate, the only remaining constitutional course to provide coverage to everyone is through national health coverage.

Regardless of what the Court rules about the constitutionality of the individual mandate, health care will still be a public good, even if our health care system continues to have a schizophrenic relationship with the economics of health care, treating it like a public good and a commodity at the same time. In the long run, the only way to achieve a health care system that provides quality care that is affordable to the nation will be for the system to recognize that health care is a public good. The ACA is a major step in that direction and would be so even without the mandate. The expansion of Medicaid, the incentives for employers to pay for coverage, and other features of the law that regulate insurance rates and change the way Medicare pays providers all treat health care this way.

If the Supreme Court rejects the mandate, millions of people will go without health coverage, thousands of them will continue to die prematurely each year because they lack coverage, and tens of thousands will continue to suffer from crippling medical debt. Still, the economic pressures and tragic personal pain caused by our current health care system will continue to drive the United States in the direction of making health care a right. That will be true even if the Supreme Court decides that health care is more like broccoli than clean water and air.

March 21, 2012 - In Defense of 'ObamaCare'
by Richard Kirsch for The Nation

When President Obama signed the Patient Protection and Affordable Care Act (ACA) into law on March 23, 2010, the United States finally joined the rest of the developedworld in making access to affordable healthcare a government obligation. Although the ACA is under GOP fire in Congress and on the campaign trail and will need to be strengthened to reach the goal of affordable health coverage for all Americans, it could do more to restore faith in government than any other social program since the passage of Medicare in 1965.

The huge contradictions in the American healthcare system—the pressures on business, families and government from the highest costs in theworld, tens ofmillions uninsured, millions more going medically bankrupt and growing questions about quality—led Obama to make healthcare a core issue in his campaign for election. The pressure of these systemic issues also convinced the health industry that reform was inevitable and that would be better to be part of the solution. A core part of the resulting bargain with industry was preserving the current health insurance system: private health insurance offered at work or purchased by individuals; Medicaid and Medicare. Tradeoffs made in passing the law provide hospitals, health insurersand drug companies with new customers in return formodest cuts in their reimbursements. Although insurance companies reversed course midway though the legislative process—deciding that the new consumer regulations they would have to endure were not worth the new customers—they were too late and isolated to kill the bill, in no small part because of the well-organized grassroots campaign backing the legislation.

Ideological opposition to government action was as vehement as ever, even though the most controversial part of the new law, the mandate for most people to purchase private insurance, is straight out of the conservative playbook. While it would be easy to dismiss conservative opposition to ObamaCare as being purely political—and certainly hyper-partisanship plays no small part—one of the core concerns of the opposition is an appreciation that the ACA has the potential to join Medicare and Social Security as one of the pillars of government- guaranteed social insurance. Rick Santorum makes no bones about why the right is so intent on killing the promise of good healthcare for all, telling listeners on the campaign trail: “ObamaCare is a game-changer that makes every single citizen dependent on the US government for their life.”

The ACA takesmajor steps towards reversing the failures of our market-driven system. The central feature of the new law addresses fears that losing a job, retiring early or starting a small business could result in being denied access to affordable health coverage. It does this by providing tens ofmillions of Americans with income-based subsidies to purchase coverage from regulated private insurance companies and by dramatically expanding public health coverage for the working poor in Medicaid. The legislation also requires employers to contribute to coverage and sets higher minimum standards for employer coverage.

The new law begins to tackle the problem of high healthcare costs by making changes in how Medicare reimburses providers. In Massachusetts, RomneyCare—structurally almost identical to ObamaCare—is beginning to demonstrate that the overall architecture of reform can play a catalytic role in controlling healthcare costs. Massachusetts is using the power to restrict the entry of insurance companies into the new health market—called “exchanges” in the federal law—to negotiatewith these insurance companies for high quality coverage at lower prices. The pressure to control expenditures created by the state’s new responsibility to help pay for the uninsured led Governor Deval Patrick to squeeze the insurance companies. They, in turn, are leaning hard on the big academic medical centers, which are the major drivers of costly and often wasteful care. With 95 percent of Massachusetts residents now insured and likely to have a primary care provider, emergency room use is starting to decline.

The ACA will be a huge boon to tens of millions of Americans, but there are still flaws. The act does not require employers to pay a big enough share of employee health premiums, or to provide comprehensive coverage; thus, it has the potential to force employees of low-wage firms to paymore than they can afford for lousy health insurance. In addition, the subsidies to purchase coverage are not enough to make it affordable to some middle-income families. As a result, such familieswill be facedwith payingmore than they can afford for coverage or remaining uninsured— and sometimes having to pay a penalty. Fixes will require overcoming two big political challenges in coming years: standing up to the business lobby and increasing federal spending. But the failure to do so is likely to provoke a backlash from the people who are harmed.

Another important step to achieve the goal of universal coveragewould be automatic enrollment of people who are uninsured, either in Medicaid or in the new healthcare exchanges. If the Supreme Court overturns the mandate, auto-enrollment could go a long way to solving the gap in coverage that would be opened.

The states will be a major battleground for implementing the ACA. Unless they punt the responsibility to the federal government, states will be in charge of setting up the new healthcare exchanges. As we see happening in Massachusetts, states can use the power to control entry into themarkets to negotiate for lower insurance premiums and improve quality. But insurance industry lobbyists and free market purists are pushing for loosely regulated markets, which will leave consumers facing higher premiums. The Department of Health and Human Services will face the same decisions in 2013, when it establishes a federal exchange to begin operating on January 1, 2014. This is one of a number of important implementation decisions that HHS and state governments are now making.

States also have the authority to resurrect a public health insurance option, which could compete with private insurers to offer coverage in the exchanges. Preferably, states would join together to form a public insurer that would operate in several states. Or, starting in 2017, they could emulate Vermont, which has voted for a single-payer public insurance plan.

With three days of Supreme Court hearings this month, a decision expected by late June and the elections in November, the ACAwill remain at the front and center of American politics. Republicans and the right will continue their aggressive attack, intent on stopping a government guarantee of affordable health coverage from becoming reality. Rather than shrinking from the debate on the act, the president should embrace it as a strong contrast between his vision for the country and the Republicans’ “on your own” philosophy. Grassroots supporters should champion the ACA as a key remedy to the squeeze on the middle class and the continued economic uncertainty facing most American families. If ObamaCare makes it through the gauntlet, it will prove to Americans that their government can assure a human right.