Selling Single-Payer As A Hassle-Free Option

[ Posted Thursday, August 31st, 2017 – 16:44 UTC ]

Senator Kamala Harris is in the news today because she just announced at a town hall that she will be co-sponsoring the single-payer healthcare bill that Senator Bernie Sanders will soon unveil. Harris has previously been lukewarm towards single-payer (according to her critics on the left), so this was seen as a big political step for her to have taken. Read another way, though, it seemed more that Harris is moving with an abundance of caution rather than being in any way against the concept of single-payer healthcare.

Harris, her critics will point out, didn't take a stand on a recent single-payer bill in California. The Democratic leader of the state assembly is also getting grief for refusing to bring the single-payer bill the state senate passed to a vote. But in this case, the bill was (at best) only half a bill. It completely dodged the question of how to pay for the new system, meaning it wasn't a viable or complete plan. So Harris not taking a stand on it while expressing support for the overall goal of single-payer was probably the wisest course of action to take. It's hard to take a position when the basic question "How will it be paid for?" is not even answered in the bill, in other words -- since you'd be buying a pig in a poke.

Kamala Harris is getting such scrutiny because she is a rising Democratic star and many expect her to make a run for the presidency in 2020. And single-payer healthcare is becoming a litmus test for many in the Democratic rank and file. But as California's experience has shown, it's a lot easier to be for the concept of single-payer than it is to hammer out all of the incredibly complex details needed to put together a real plan to achieve it. Even defining exactly what "single-payer" means is tough to do. A British system? Or one more like the French? The Swiss model, or perhaps the Japanese? There are multiple ways of implementing single-payer, some with private health insurance as a partner and some without. And that's before you even address the question of implementation, or how we get from where we are to the new system.

Supporting the single-payer concept right now is rather risk-free for a Democratic politician. Perhaps a Republican opponent running for your office will try to use it against you in ads, but for Democrats with solid-blue constituencies this isn't much of a problem. Democrats, being in the minority in both houses of Congress, know full well that any single-payer bill they now support is never going to see a floor vote. It's akin to Republicans voting on all those "repeal Obamacare" bills, confident that they would never actually become signed into law.

Sooner or later, though, these bills will become closer to actual legislation. If the Democrats take the House in 2018, then a single-payer bill could be passed by at least one house of Congress. This will make what is in the bill a lot more important, as the details will receive much more scrutiny than ever before.

This is where Democrats will face the big job of selling the idea to the public. While the concept polls pretty high right now, it will doubtlessly be attacked ferociously by Republican opponents. As both Bill Clinton and Barack Obama found out, when healthcare reform is attacked, spurious and fantastical charges (such as the mythical "death panels") can actually turn public opinion in significant ways (even if they aren't true). If we ever do get close to a vote on single-payer healthcare, these attacks will become relentless.

The Washington Post has a good article today laying out these challenges and what Democrats might want to think about doing to address them. While the article is full of good advice, I would add two items to the list: transition to universal single-payer by making it strictly optional, and use "hassle-free" as the biggest selling point around.

"Medicare For All" is a fine slogan, but at the risk of being too wordy, I have always pushed for it to instead become: "Medicare For All Who Want It." This, I believe, is a crucial distinction to make. It's a whole lot easier to sell the plan if you aren't forcing everyone into it all at once: "Scared of single-payer? Then don't sign up for it! Want to buy in to Medicare? Now you can -- if you choose to!"

Purists will scoff, but beginning as an optional transition is going to be key to gaining public support. It's a lot easier to accept change if the option of each person retaining their own current status quo still exists. This leaves it up to each individual to decide whether to try the new system or not. Not forcing people onto it also blunts many of the counterarguments that will be made, since you can just say: "If you don't like it, then you don't have to join it, period."

Some proponents of single-payer see this as only half a loaf, or incrementalism. They shouldn't -- at least not if they have the courage of their own convictions. If single-payer is so superior to the current system, after all, then that fact will become apparent to more and more people over time. The marketplace will react positively as more people see the difference. If single-payer is so superior, then this gradual movement towards it will be all but inevitable. Arguing that single-payer cannot compete with the current system is in essence arguing that it would be a worse system -- the exact opposite of what its proponents should be arguing.

But what is really missing from the debate -- even from Bernie Sanders, for the most part -- is selling the notion of "hassle-free." There will be lots of arguments about whether health insurance will get more (or less) expensive to individual families, and lots of arguments about how to pay for it. But so far, I haven't heard anyone put forth what could be one of the most convincing arguments in the idea's favor, namely: "You won't have to hassle with your insurance company anymore." Aside from the financial arguments about how much it will cost and how it will be paid for, the argument that people can save time, energy, and peace of mind also needs to be made.

Few Americans joyfully greet the "open enrollment" season, when they are expected to read thick booklets of fine print in an attempt to figure out which insurer has a better or more-affordable plan for their family. Nobody looks forward to insanely complex hospital bills and arguing with their insurance company about what is covered for what price. Health insurance in America is a gigantic headache for millions and millions of people. If single-payer is a whole lot easier and a whole lot more understandable, then that is a major selling point right there, even before the conversation about finances begins.

So why don't Democrats make this argument, for the most part? I have no idea. The idea of forever jettisoning all the hassle involved with health insurance companies should be near the top of every single-payer proponent's list of talking points, but from what I've heard so far, it isn't. Occasionally the point is touched upon, but no forceful case is ever really made. Single-payer means getting rid of for-profit insurance companies from the pipeline of healthcare, but the positive effects on people's lives of doing so are rarely stressed.

As I said, sooner or later this conversation is going to begin in earnest. Currently many Democrats support (in the abstract) single-payer healthcare. Some concretely support actual bills in Congress, but these bills are never going to pass (at least until the power in Congress shifts). Democrats should be using this time to hone their arguments and work out some of the complexities. This way, when they do have a chance of presenting a viable plan to the public that has a chance of passing, they will have worked some of the problems out.

What I hope is that when that point is reached, Democrats will have decided on introducing single-payer as the "public option" -- something nobody's going to force you to sign up for, but also something that will set a benchmark that all other health insurance will be measured against. If single-payer truly is superior in every way, then people will eventually flock to it (this is the fear that caused the health insurers to kill the public option in Obamacare in the first place, after all). And one of the biggest benefits will be the hassle-free nature of the plan. Democrats need to realize that this is going to be one of the biggest selling points possible, and start to make this case explicitly when supporting single-payer plans.

-- Chris Weigant


Follow Chris on Twitter: @ChrisWeigant


8 Comments on “Selling Single-Payer As A Hassle-Free Option”

  1. [1] 
    Elizabeth Miller wrote:

    And one of the biggest benefits will be the hassle-free nature of the plan. Democrats need to realize that this is going to be one of the biggest selling points possible, and start to make this case explicitly when supporting single-payer plans.

    Absolutely, positively, unequivocally!!!

    As a Canadian, I spend zero time and energy on my superior healthcare and my income tax takes care of the cost end of things. Nothing could be easier that provides this kind of service.

  2. [2] 
    TheStig wrote:

    Private insurance already plays a big role in Medicare. My own plan is administered through a Blue Cross Blue Shield subunit and most of my medical care is through a private network. Sign up requires teading through some thick manuals and which plan is best for any one indiivdual is somewhat pobablistic.

    I go completely out of network for some precription drugs. For example, I buy my statin through an online "coupon system" completely independent of my medicare plan. It costs about 1/3 less than through my Medicare tier, and avoids any "doughnut hole" (an awful neologism) liability. This definitely isn't always the best way to go, so due diligence is required.

    I get a couple of pages of Medicare summary paperwork in the mail each month, but my network is rapidly trying to get completely on line. The system isn't exactly care free. Still it's extremely good coverage considering how little I pay (bigger subidy than
    Obama Care) and premiums are simply deducted from my monthly social security check.

    Bottom line, Medicare isn't exactly socialized medicine and it doesn't fly hands off. For all practical purposes, it alteady offers users a lot choices from different for profit providers.

  3. [3] 
    Elizabeth Miller wrote:


    Choice is not always a good thing.

    Offering choice in healthcare betrays a fundamental misunderstanding of what healthcare is, who needs it, and why private insurance companies are lousy providers.

  4. [4] 
    TheStig wrote:


    There are actually relatively few choices, and a lot of middlemen. The quality is ultimately high, but efficiency is low. Costs are 2 to 3 times that of other deveoped nations offering comparable care. Medicare gives me a big susidy, so I'm shielded from the costs. In that sense, and practically only in that sense, it is socialized medicine. ..or if you prefer, it spreads risk across generations. I subsidized my parents during my peak earning years, my kids subsidize me now.

  5. [5] 
    Elizabeth Miller wrote:


    There are actually relatively few choices, and a lot of middlemen.


    With a good single-payer system there are no middlemen and everyone is covered for everything, with just a few exceptions like, in the case of Canada, dental care (basic dental care should be included in your coming single payer system if you want to be the best), eye care (basic eye care should be included in your single payer system if you want to be the best), chiropractor, you know, that kind of thing.

  6. [6] 
    Elizabeth Miller wrote:

    It always comes back to the money, doesn't it, Don.

    Which is why what you are advocating is such an important part of any political discussion.

    I'm surprised that it doesn't get more traction here ...

  7. [7] 
    taztunes wrote:

    Jerry Brown made it known that he didn't want to see SB562, the Healthy California Act reach his desk. He even threatened legislators that if they voted for it, he would veto bills they sponsored. Even so, it sailed through the state senate. The intention of the Campaign behind the bill was for all the details about how to fund it (and there are very comprehensive details to this effect) would be added when the bill reached the Assembly Appropriations Committee. The bill's backers were readying all these amendments when Speaker Rendon put the bill on hold (essentially killing it - or at least putting it to sleep for a long time).

    Rendon didn't do this because the bill is "woefully incomplete" - plenty of bills, including Jerry Brown's pet bill for Cap and Trade, go from one statehouse to another with details yet to be added - that's the job of legislators.

    He put the bill on hold to provide cover to a number of other state representatives who like him, get a lot of donations from the Health Insurance and Pharmaceutical Industry. These members of the "Mod Squad" would be vulnerable to primary challenges is they were to vote against Single Payer. Because Rendon is such an able fundraiser, it was thought that he could better withstand a primary challenge, so he agreed to take the hit on the bill.

    All of the establishment Democratic Party talking points are just talking points. After 2017, the ACA allows states to try other ideas for extending healthcare to their citizens - and gives them freedom to determine how to apply Medicaid dollars to such programs. The Cap and Trade bill just signed doesn't require a certain amount of money raised to go to education as Prop. 98 demands, because of the way it was written. The Assembly could easily have SB 562 function similarly.

    Rendon's hope is that the backers of the Healthy California Act will be forced to make it a ballot measure, where it will go up against hundreds of millions of dollars from the corporations that currently serve as the middlemen between us and our doctors. Prop. 61 prompted Big Pharma to spend $130 Million for its defeat. A bill that eliminates Health Insurance corporations and the upwards of 30% of our healthcare dollars that go to "administrative costs," advertising and executive compensation, is going to unleash an even bigger onslaught of cash to defeat it on the ballot. That's why the best place to achieve Universal, comprehensive, single-payer insurance is the state legislature.

    Even if the Republicans in Washington can't get it together to all-out repeal the ACA, Donald Trump and Tom Price are undermining it to the point where we're going to witness huge premium increases and various insurance companies bailing from the various state exchanges. Now is the time for California to move on to a Plan B that is smarter than just trying to keep the ACA in place. Now is the time for California to join the rest of the civilized world and also to lead the rest of the US by passing SB 562 and getting single-payer healthcare to all Californians!

  8. [8] 
    Chris Weigant wrote:

    taztunes [8] -

    My apologies for the inexcusable delay in posting your comment. Your first comment was held for moderation, but you should be able to post comments and see them instantly from now on, as long as you don't post more than one link per comment (multilink comments are automatically held for moderation to cut down on comment spam). And welcome to the site!

    As for your comment, sure there is plenty of blame to go around, but if the senate had done the hard work -- rather than punting it to the assembly -- then it wouldn't have been an issue in the first place. If the senate had constructed a complete plan, then we could evaluate it adequately. Because they didn't, we can't.

    What is stopping the senate from going back and fleshing out their own plan? If they voted to defy other Dems in CA, then they can do so again. But they'd have to vote for both the candy and the vegetables this time, and show us all how it would be paid for. When they do reach this point, then I'll jump on the bandwagon decrying other Dems for not supporting it, but not until.

    Half a plan is not a plan.


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