Small Biz Likes Hillary, But

Last Friday, masslib posted this diary titled "Hillary Favored by Small Business Leaders". masslib had picked up this story about MarketTools Inc.'s Zoomerang online survey of small business leaders. And the diary was quite right that Hillary Clinton was favored for President by 22% of the survey respondents with Rudy Giuliani coming in second at 17%. That diary drew quite a number of comments (90 as of this writing).

However, I found the press release on the Inc.-Zoomerang Entrepreneurial Report. And to my mind, there is much bigger news in this report than the fact that Hillary is first choice of 22% of the survey respondents.

How can that be, you say? Follow me below the jump...



Some of you of you may remember that I have advocated before that small business leaders are a constituency for the taking for Democratic candidates. In my diary last year, How to Talk to Small Business People , I wrote:

Small Business People also vote overwhelmingly Republican. They are mistaken in their understanding of what the Republican Party stands for (by its deeds, not by its words).

Well, this survey indicates that small business people are finally getting it! Here is the subtitle to the aforementioned Zoomerang press release:

Independent Voters and Health Care
Put Republicans at Risk of Losing Traditionally Loyal Constituency

In fact, the survey numbers show Republicans and Democrats in a dead heat for the votes of small business leaders. Considering that a US Chamber of Commerce survey taken in the lead-up to the 2004 election found that

77% of small businesses said that re-electing President George W. Bush would have a positive impact on their businesses

running neck and neck with the Republicans at this stage is huge.

But the news for Democrats gets better yet. This constituency is there for the taking. All they need is someone to talk to them. Again from the Inc.-Zoomerang Entrepreneurial Report:

85 percent believe that the current crop of presidential candidates do not focus enough on their issues.

and

80 percent of the business leaders surveyed feel that government doesn’t do enough to help growing business and is more focused on big business.

Small business people are finally getting it. They now are starting to understand that the Republican Party is and always has been the party of big business, not small business. Here's another tidbit from the survey that is very enlightening - 71% of small business leaders surveyed believe that aggressive corporate lobbying hurts competition.

Democratic candidates need to speak directly to the concerns of these small business leaders. Look at this from the Inc.-Zoomerang press release:

In another surprising turnaround, the report shows that this traditionally anti-tax and anti-regulatory constituency today chooses health care as the number one issue impacting their vote. A majority, 57 percent, say that a regulated health care system would be good for growing businesses.

Now there's an issue that belongs to the Democrats if there ever was one.

How to Talk About Universal Health Care Insurance: Part 2

In How to Talk About Unviersal Health Care Insurance: Part 1 I talked about how the main crisis is not health care delivery, rather it is health care insurance.

This conversation was sparked by the response to another diary of mine published in December, How to Talk to Small Business People . Almost all the responses from small business people mentioned health care. They told me they are looking for a good way to get affordable health care insurance for themselves, their families and their employees. Of course these responses came from small business people who are progressive enough to comment and / or post on Daily Kos.

This diary is for people who want to advance the cause of Universal Health Care Insurance by persuading others. So let's get started...


If you have seen any of the other How to Talk to diaries, then you know the drill. If you are new to this, here is how we go about the task of talking to people already on our side. The purpose is to give them the tools to persuade people who should agree with us, but don't, that our ideas are the better ones.

The first thing to do is to define the values that relate to the task at hand. Here is my list of values applicable to this subject:

• Community
• That the promise of America is equal opportunity for all and special privilege for none
• Mutual Responsibility
• Inclusion
• Work and Family

We then have to incorporate those values into an argument that fits into these tasks:

Define the Overarching Strategy

Define the Terminology

Mangle the Memes

We start with the strategy.

Define the Overarching Strategy

When you talk to the other side, you should start with your goal in mind. So first, you need to define your goal. Only then can you determine the best overarching strategy to achieve your goal without compromising your values.

As in most of these tasks, our goal is to persuade people who should agree with us but do not yet. We need to do this in a way that does not lose our audience at hello. The target community must receive our message in a way that resonates with them on a personal level. This can best by done by research and real world examples. First, some research.

Some of the best and most persuasive resarch done in this field has been has been done by physicians%20themselves.%20 This research covers topics ranging from the huge administrative cost of our current system, taxes and who actually pays for these costs, and the sad fact that we already pay for national health care insurance, but don't get it.

If that isn't impressive enough, consider the research done by medical students . If the physicians already working in the health care delivery system and the medical students working to join them are in agreement, why would anyone else tell them that they are wrong?

Define the Terminology

Defining the terminology is akin to choosing the battlefield. If you let the other side define the terminology, you will be fighting your battle on the other guys’ battlefield. Any tactician will tell you that he who determines the battlefield has the much better chance of winning the battle.

We also must remember our audience. We are not preaching to the choir here. Out goal is to reach out and create a majority coalition in support of Universal Healthcare Insurance. Our target audience to get this coalition into the majority is twofold:

• Small Business people who already know how hard it is to obtain affordable health care insurance in the current inefficient market.
• Middle class taxpayers who mostly already have health insurance through their jobs.

The best way to reach this audience is to craft arguments where our values intersect with theirs. As we saw in Part 1, the census bureaus's research brought us these two telling tidbits:

• 73% of the uninsured in the workforce worked sometime during the year.
• 63% of the uninsured who worked during the year worked at companies with fewer than 100 employees.

This data give us the first things we can say about Universal Health Care Insurance - Most people who are uninsured are actively in the workforce. We are not talking about some giveaway program going mainly to those who are unwilling to work. We are talking about folks who work for a living just like you and I. Also, nearly 2/3rds of the uninsured in the workforce work for small businesses. This is just one more area where small businesses get the short end of the stick in this country.

So who are the uninsured? They are folks in our community who mostly work for small businesses. One would think that in a country that values entreprenuership, work and family, that we would take care of our workers and their families by making sure they all have equal opportunity to access quality, affordable health care no matter the size of the business they work for.

The other argument that should resonate particularly with small business people is the inefficiency of the current system. Health care insurance is ridiculously expensive, particularly so for folks who are not part of large byuying groups (big business, unions, professional associations, etc.). One of the reasons for the heavy cost is that the private insurance delivery system is incredibly inefficient in delivering the product. Small buisness people know better than most how crucial it is to control costs. The big business of health insurance delivery seems to believe thay can just pass these cost along to us.

What most of us don't know is that the government is already paying the lions' share of health insurance costs in this country.

the amount of public health spending in the U.S. is greater than the combined public and private spending of nations which provide universal comprehensive health insurance. A single-payer system could provide such coverage to all Americans with no need for additional health dollars.

So we could provide equal opportunity for an all inclusive health care insurance sytem without spending additional tax dollars. Is that not a win-win for middle class taxpayers and small business people?

So why do we not already have such a sytem?

Mangle the Memes

The first thing to understand is that there is a powerful lobby in this country that is determined to maintain the status quo. One of the main ways this lobby goes about maintaining the status quo is by demonizing the alternatives. So let's talk about what we are not suggesting.

We are not talking about socialized medicine. Remember, this discussion is about health care insurance. The main problem is not with our health care delivery system. So do not let anyone get away with telling you that it is.

We are not talking about some inefficient government bureacracy deciding who gets what health care procedure and when. In fact, an efficient health care insurance system will put even more of the choice for health care decisions back into the hands of the doctors and their patients. Doctors and patients will take back the decision making from some faceless private insurance bureaucrat.

How do we do that? With a single payer universal health insurance plan, we would wring the waste out of our health care insurance delivery system. Turns out this is a case where private industry is less efficient than government.

administration consumes 31.0 percent of U.S. health spending. Average overhead among private U.S.
insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer
system and 3.6 percent for Medicare.

Who would have thought that the US government provides health insurance administration at one third the cost of private insurance?

We have a mutual responsibility to include working families in the health care insurance system. Healthy communities are productive communities. W can provide equal opportuity for access to affordable health care insurance at no additional costs to taxpayers. Ultimately we will have the luxury of seeing health care insurance costs falling for everyone.

So, get away from the keyboard and get out into your communities. Deliver thse messages to your elected officials and other opinion leaders in your community. A concerted netroots / grass roots campaign for single payer universakl health care insurance could get this issue past the tipping point.

What are you waiting for, someone else to do it? Start today.

How to Talk About Universal Health Care Insurance: Part 1

A few weeks ago I posted a diary titled How to Talk to Small Business People . So many of the comments were about health care issues that it become apparent that this was a topic in desperate need of further conversation. So instead of "How to Talk To..", today it is "How to Talk About..."

Usually you will see this subject discussed using the short hand of "Universal Health Care" as if that were the issue. That is not the issue. As we will see below the fold, we already have Universal Health Care. What we do not have is Universal Health Care insurance.

So follow along and we'll see what can be done about this situation.

We need to make one thing perfectly clear right from the start. That is that we do not have a health care crisis in this country. We do have a health care insurance crisis. No one in need of care who presents themselves for treatment is denied treatment. Ok, almost no one. But the general rule is that if you present yourself for health care, you will receive it. From VOANews.com:

Karen Davenport, executive director of health care policy for the Centerfor American Progress:"The ones that are probably of greatest concern would be the people who areuninsured who delay care and who end up using not just emergency room services,but more complex, more complicated, more intensive services when they do getcare," she said.

Since they are uninsured, these patients run up bills that they are unable to pay. More from VOANews:

"I think that we provide a high amount of uncompensated care here at Children's National Medical Center, anywhere from $28 and $30 million a year that we report that is provided as uncompensated care," noted Chavanu. "And that's really approximately eight to ten percent of our population."
According to the American Hospital Association, hospitals doled out $27 billion in uncompensated care in 2004.

Like any other business, hospitals pass along the cost of bad debts to their other customers in the form of higher prices. Unlike other businesses, hospitals are not able to control their credit risk. They treat whoever shows up. We all wind up paying for this in the form of higher hospital bills which ultimately turn into higher health care insurance premiums. So what can be done to alleviate this situation?

MALCOLM GLADWELL lays out some of the facts about our current health care system in this article in the New Yorker:

Americans spend $5,267 per capita on health care every year, almost two andhalf times the industrialized world’s median of $2,193; the extra spending comesto hundreds of billions of dollars a year.

<snip>

The United States spends more than a thousand dollars per capita peryear—or close to four hundred billion dollars—on health-care-related paperworkand administration.

Other countries pay around 30% of what we spend on health care related adminstrative overhead. Between the uncompensated service hospitals provide and the excess cost of administration, there is about $300 billion needless spending in our current health care system. That comes to more than $1,000 per year for every man, woman and child in this country.
So we have plenty of room for improvemnt in the administration of our health care delivery system. There is one other myth to bust about health care in this country. We already have a working model for a single payer health care system up and running in the United States. It is called Medicare.

So who are the uninsured? The Census Bureau provides us with this information:

• In 2004, 45.8 million people were without health insurance coverage, up from 45.0 million people in 2003.
• The percentage and number of children (people under 18 years old) without health insurance in 2004 was 11.2 percent and 8.3 million.
• With a 2004 uninsured rate at 18.9 percent, children in poverty were more likely to be uninsured than all children.
• The uninsured rate and number of uninsured in 2004 was:
• 11.3 percent and 22.0 million for non-Hispanic Whites, and
• 19.7 percent and 7.2 million for Blacks.
• The number of uninsured increased in 2004 for Hispanics from 13.2 million in 2003 to 13.7 million; their uninsured rate was 32.7 percent.

These figures show us that an undue burden is placed on people of color, who also tend to be at the lower levels of the socio-economic ladder. Blacks and Hispanics make up 46% of the uninsured population. They account for only 19% of the total population.
How about some characteristics of the uninsured? Again, from the Census Bureau :

• 73% of the uninsured in the workforce worked sometime during the year.
• 63% of the uninsured who worked during the year worked at companies with fewer than 100 employees.
• 62% of the uninsured in the workforce had a high school diploma or less.

It turns out that the uninsured are not only the unemployed. In fact, nearly 3 out of 4 uninsured in the workforce had been employed during the year. Of this group, nearly 2 out of 3 worked for small businesses (less than 100 employees.) And nearly 2 out of 3 uninsured in the workforce had only a high school diploma or less.

Some of the issues and makeup of the health insurance problem have been laid out. This is the first step. In Part 2, we will talk about some proposed solutions and how to talk about them.

In the meantime, talk amongst yourselves. But be gentle.