ChrisWeigant.com

Single-Payer Sea Change

[ Posted Monday, September 11th, 2017 – 16:47 PDT ]

In two days, Senator Bernie Sanders is going to introduce a single-payer healthcare bill in the Senate. This bill already has the support of some major Democratic senators, and it will move the single-payer debate further forward than any other legislative effort to date. But it will also move the debate from the abstract to the concrete, if Bernie's bill provides the proper level of detail. Because average Americans are going to be considering the concept through the filter of: "How is this going to affect my pocketbook?" Democratic supporters need to be ready with solid, easy-to-understand answers to this basic question. Hopefully, Sanders will provide these answers on Wednesday, so the public can truly begin to make an informed choice on the matter.

It is interesting to note how far the Democratic Party has come on this issue in a relatively short period of time. Eighteen months ago, during the 2016 Democratic presidential primary season, Bernie Sanders was building support for single-payer while Hillary Clinton heaped scorn on the idea and used scaremongering against it. To her, it was just one more "free pony" that Bernie was offering up that he (in her opinion) could never deliver for the American people.

This is not an overstatement of her position at all. Clinton tried to equate Bernie's support for single-payer with the Republican "repeal and replace Obamacare" efforts (which, at the time, were mostly just "repeal" efforts). She tried to paint Bernie's position as one of first destroying Obamacare, and then entering into a congressional debate about single-payer -- which she warned would leave millions in the lurch. Sanders had never advocated such a strategy, but that didn't stop Clinton from essentially putting these words in his mouth. Here is Clinton from an Iowa campaign event, at the end of January, 2016:

I want you to understand why I am fighting so hard for the Affordable Care Act. I don't want it repealed. I don't want us to be thrown back into a terrible, terrible national debate. I don't want us to end up in gridlock. People can't wait. People who have health emergencies can't wait for us to have a theoretical debate about some better idea that will never, ever come to pass.

Hillary then shamelessly used a mother of a child with brain cancer to make this point, inviting her onto the stage to talk about how Obamacare's end to "pre-existing conditions" had saved her daughter's life. Clinton then added:

People can't wait. Your daughter calls and says she has a mass in her forehead, you can't wait. You quit your job to take care of your sick daughter -- something I think a lot of us can relate to -- you can't wait.

Clinton used the fear of a "terrible, terrible national debate" to imply that Bernie's first step would have been to end Obamacare -- a position he never held. She used more fear to imply that children with health emergencies would have to "wait" while the "theoretical debate" caused "gridlock." She darkly warned that single-payer healthcare would "never, ever come to pass."

That was then. This is now. Five Democratic senators have already co-sponsored Bernie's single-payer bill: Cory Booker, Kamala Harris, Jeff Merkley, Elizabeth Warren, and Sheldon Whitehouse. Also, Kirsten Gillibrand has endorsed the concept of "Medicare For All" but has not yet signed on to Bernie's bill. The Washington Post today pointed out how many of these people have shown an interest in (or widespread support for) a 2020 presidential run. A year and a half ago, the Democratic frontrunner said single-payer would never, ever come to pass, and in less than two years there will be a Democratic presidential primary contest underway. The issue is fast becoming if not the default Democratic position, at the very least a big litmus test. That is a remarkable evolution in attitude in such a short time. In the same week that Hillary Clinton will release a book decrying Bernie's "free ponies," Sanders will be introducing the biggest progressive change of them all in the United States Senate. And he's already garnering support from some of the people most interested in running to defeat Donald Trump next time around.

Of course, as always, the devil is going to be in the details. Single-payer would be a massive change the entire country would have to go through. Monthly premiums to insurance companies would somehow become taxes paid to the government -- which would affect everyone's paycheck in some way or another. The level of taxation required for single-payer to be successful is the biggest unanswered question. The answer to this question will allow the public to see how many people would benefit from the change and how many people would wind up paying more.

The Sanders bill needs to answer all the big single-payer questions, in detail. Although the bill is not going to get a floor vote for a long time to come, it will be the benchmark for any future legislation, and it will also provide all the talking points for the opposition to use for years to come. So the details are going to be critical, and they better be honestly laid out for the public to consider.

Single-payer is a great concept, and right now the American public is more inclined to at least consider the idea than they've ever been before. In January, a Pew poll showed 60 percent of the public agreed that "the government has a responsibility to provide healthcare coverage for all." This was up from 51 percent last year, showing the public may be moving as fast as the Democratic Party candidates on the issue.

However, few Americans really understand what changes single-payer healthcare would require. There has been no concentrated advertising campaign against the idea (or for it, for that matter). Republicans have their own internal problems with healthcare (their failure to "repeal and replace Obamacare"), and so they haven't spent any energy attacking single-payer. All that may be about to change in a big way, once Sanders releases a concrete plan.

Single-payer has been seriously proposed in two states (that I am aware of), Vermont and California. In Vermont, they gave up because they considered the tax it would require to be too high (or, perhaps more accurately: "too high a price to pay politically"). In California, they didn't even get that far because the bill that emerged from the state senate didn't even attempt to show how it would be paid for. Which is why Bernie's bill better have a solid financial foundation, laying out exactly what will be required to pay for such a system -- both from the government, and from people's paychecks.

The single-payer debate is about to begin in earnest. Bernie Sanders laying a proposal on the table will be a milestone in this debate. It will be used as a marker in future negotiations over details, so it better lay all the details out.

This debate is well worth having. As single-payer proponents love to point out, the entire rest of the developed world manages to provide single-payer healthcare to its citizens, so there is no real reason why we should not be able to do the same thing. But proponents should be ready to explain the changes that it will necessitate, because there will be an enormous political push against the idea, led by the insurers and the drug companies and all the rest of the usual suspects. Single-payer needs to be debated in real-world terms, and not just the abstract. Single-payer proponents should welcome this debate, if they have the courage of their convictions. But they better be ready to forcefully defend all aspects of the idea, because while the attacks probably won't be coming from a Democratic presidential frontrunner next time around, they will be coming nonetheless. Hopefully, Bernie's bill will provide the rhetorical ammunition for single-payer proponents to successfully repel such attacks.

-- Chris Weigant

 

Cross-posted at The Huffington Post

Follow Chris on Twitter: @ChrisWeigant

 

26 Comments on “Single-Payer Sea Change”

  1. [1] 
    Chris Weigant wrote:

    Note:

    The site has been having minor shutdowns today, this is likely due to thunderstorms temporarily knocking out my local ISP. Thunderstorms are a rarity out here, so that's my best guess.

    In any case, the interruptions in service seem to be fairly temporary, so just keep trying...

    Thanks.

    -CW

  2. [2] 
    Elizabeth Miller wrote:

    Chris,

    Are legislators looking into how the rest of the civilized world pays for it?

  3. [3] 
    Elizabeth Miller wrote:

    I don't see any reason why your federal and state governments can't take all of the 'best in class' concepts from other single-payer systems - including your own Medicare - and develop a strategy to move from what you have now to the best single-payer, government-run healthcare system in the world.

    In any event, it won't be easy to implement a big change like this. But, it's a change that has to be made if cutting costs and providing universal coverage is what Americans want.

  4. [4] 
    John From Censornati wrote:

    All of the Dems who don't sign on to Bernie's bill should be given the MDDOTW. They should already be there. What is the downside? Trumpthugs (R) will call them socialists? Zzzzzzzz. Oh right. Big Money. At least they're not Republicans.

  5. [5] 
    John From Censornati wrote:

    LizM [2],

    Why should the exceptional care about how the unexceptional do their unexceptional stuff?

  6. [6] 
    Elizabeth Miller wrote:

    What?

  7. [7] 
    John From Censornati wrote:

    The Republicants already know all about the socialism. No need for "looking into" it.

  8. [8] 
    TheStig wrote:

    Liz-2

    "Are legislators looking into how the rest of the civilized world pays for it?"

    How much looking can you do when you spend 50% of your working day on the phone raising money for your next election? Then there is the matter of who you are calling...insurance companies and drug manufactures:marketers are generous when it comes to campaign donations.

    I think it fair to say that most legislators have taken a furtive glance at what other countries are doing ...but only when they think nobody is looking...and then they clean the history on their browsers.

    You can see the impact of insurance and drug industries on one nifty little site:

    https://www.opensecrets.org/

    Liz-3

    "I don't see any reason why your federal and state governments can't take all of the 'best in class' concepts from other single-payer systems - including your own Medicare - and develop a strategy to move from what you have now to the best single-payer, government-run healthcare system in the world."

    Greed and a greed friendly political system.

    "How can people live on 13 cents a day???!!!"

    "We try not to pry into the private lives of our employees"

    -old Bob and Ray paper clip factory routine

  9. [9] 
    Elizabeth Miller wrote:

    I think it's going to be a very big challenge just to get people to discard the idea of having their healthcare insurance provided by their employer ...

  10. [10] 
    TheStig wrote:

    Liz-9

    Fifteen yrs ago I would have agreed with you. Fewer companies are offering the benefit to their employees and when they do, the cost subsidy is less and less.

    The whole notion of getting health insurance through your employer is a vestige of Second World War price and wage controls.

    An excellent thumbnail history of US health care:

    http://www.npr.org/templates/story/story.php?storyId=114045132

  11. [11] 
    Elizabeth Miller wrote:

    Well, that's good news, then ... it will make it easier to make such a huge transition.

  12. [12] 
    Don Harris wrote:

    Stig (8)-
    Do you realize that that is the same answer that I was going to provide for Liz's question?
    Well done.

  13. [13] 
    Elizabeth Miller wrote:

    I knew that, Don. :)

  14. [14] 
    Don Harris wrote:

    CW-
    Another issue that has changed dramatically in public support in a short amount of time. But it is still just a distraction issue to keep people from focusing on the possibility of achieving structural electoral reform and getting the Big Money out of politics.

    Even if this becomes an actionable issue by 2020 if we haven't solved the problem of Big Money in politics we won't get a proper solution to health care (see Stig, comment 8).

    So please start the real conversation that we need to have NOW while it can still effect the 2018 elections.

    We need to have a Sea Change on campaign financing if we want to SEE Change on health care, climate or any other issue.

  15. [15] 
    John From Censornati wrote:

    I would say that a large percentage of upper income Republicans still get heavily-subsidized, employer-group health insurance and that's a yuge obstacle.

  16. [16] 
    John From Censornati wrote:

    The junkie Trumpbart Republicans are on Medicaid.

  17. [17] 
    John From Censornati wrote:

    MeriKKKa already has the most beautiful, terrific healthcare in the world. MAGA.

  18. [18] 
    TheStig wrote:

    Liz-11

    "Well, that's good news"

    In roughly the same sense that The Black Death in 14th Century England dramatically increased the wages of surviving agricultural laborers. :) No pain, no gain.

    Do Canadian primary care physicians establish a long history with individual patients? This getting very rare in the US, as private practices are being replaced by larger corporate practices. My doc went corporate (his practice was bought out) about 10 years ago. Every year gets a bit more corporate. For the last three years I've endured a lot of unnecessary procedures because the practitioner on call for a non-routine visit doesn't understand my medical history like my long term doc does. My medical history is never flagged to alert them about it, and the triage team never pays any attention to my heads up anyway. Insurance covers most of the waste, which is passed on to me and Medicare.

  19. [19] 
    TheStig wrote:

    Jarhead Kushner is IN THE NEWS again, which is never good for the Trump Team. Advisors want Kush to resign, but the President is just a guy who "cain't say go" to family.

    Put a $1500 suit on this Simpson character and you basically get the Kush.

    https://www.youtube.com/watch?v=mBec9vGdjEU

  20. [20] 
    John M wrote:

    Irma UPDATE:

    Yes, I survived Irma. All is well. The storm started hitting here in Tallahassee in earnest between 4 and 5 am Monday morning. We lost power sometime after that before daybreak. Power was just restored around 3:30 am this Tuesday morning. So we were without not quite about 24 hours. Winds here were about 60 miles an hour like I thought. We just hunkered down in place and rode it out. Basically just a tropical storm. Live Oak, Lake City, and points east like Jacksonville got hit worse than we did. It wasn't even as bad here as Hermine was last year. Unlike south Florida, we here in the north seemed to have dodged the bullet for the most part.

    Thanks to all who expressed their concern. It was much appreciated.

  21. [21] 
    Elizabeth Miller wrote:

    Glad you are well, John!

  22. [22] 
    Elizabeth Miller wrote:

    Do Canadian primary care physicians establish a long history with individual patients?

    Depends on the patient's preference these days as people change doctors as they move or become dissatisfied or whatever. But, there are many who have been with their 'family' doctors for a very long time, until the doctor retires.

    However, in many places, it's not that easy to find a new doctor who is accepting new 'patients'.

    Of course, all of our medical records are pretty much all on computer now so that eliminates a lot of issues like you describe when patient history is not readily at hand.

    Corporate doctors - that's a new term for me, haven't heard of it before and I guess that is a feature of the kind of system you have down there that would presumably and inevitably change when you switch over to single payer.

    This getting very rare in the US, as private practices are being replaced by larger corporate practices. My doc went corporate (his practice was bought out) about 10 years ago. Every year gets a bit more corporate. For the last three years I've endured a lot of unnecessary procedures because the practitioner on call for a non-routine visit doesn't understand my medical history like my long term doc does. My medical history is never flagged to alert them about it, and the triage team never pays any attention to my heads up anyway. Insurance covers most of the waste, which is passed on to me and Medicare.

  23. [23] 
    Elizabeth Miller wrote:

    The above was in response to TS, Do Canadian primary care physicians establish a long history with individual patients?

  24. [24] 
    Elizabeth Miller wrote:

    Also, the last paragraph in #22 is all TS - I just forgot to delete that part. :)

  25. [25] 
    Kick wrote:

    16

    The junkie Trumpbart Republicans are on Medicaid.

    Sad but largely true, particularly with Medicaid expansion in many states under the ACA/Obamacare. How fortunate for the "Trumpbarts" that there are enough Democrats and just enough Republicans in the Senate in order to stop "their voice"... also known as BLOTUS... from throwing them under the bus in order to provide himself with a huge tax cut via abolishing the Alternative Minimum Tax. Who knew healthcare was so complicated?

    I do hope tax cuts are equally complicated because if "their voice" endeavors to do away with the AMT and slash corporate taxes at the expense of the middle class, shame on them: NOPe... Not One Penny!

    It's high time the vast majority of Americans stopped getting trickled down on.

  26. [26] 
    Kick wrote:

    JM
    20

    Yes, I survived Irma. All is well.

    Oh, good. :)

    Hopefully the U.S. is out of the path of any more hurricanes for a very long time, but somehow I don't feel optimistic.

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