As A Voter, How Important Is Single Payer-- Medicare-For-All-- To You?

Last night we embedded a graphic from the ABC News poll showing that although a growing number of Americans really don't like Trump at all, a majority and disappointed that the Democratic Party doesn't stand for anything other than opposition to Trump. Now, they're not talking about people like Bernie Sanders, Elizabeth Warren, Ted Lieu, Pramila Jayapal, Raul Grijalva-- or any of these House incumbents-- but they are very much talking about the party leadership. Let's turn to single payer healthcare as the perfect example.

John Conyers' Medicare-For-All bill was introduced January 24 and Conyers had gathered 51 other co-sponsors, primarily progressives. More progressives piled on the next few days and by the time political opportunists like Greg Meeks (New Dem-NY), Tulsi Gabbard (HI), Gene Green (TX) and even corrupt Blue Dog Lou Correa (CA) signed on, it was clear than a majority of House Democrats were willing to co-sponsor Medicare-for-All... at least while Paul Ryan could be counted on to make sure it was never voted on. Last week Pelosi ally Nita Lowey (NY) became the 115th co-sponsor. Right before her two very ambitious Pelosi allies, California New Dem (and "ex"-Blue Dog) Adam Schiif and designated next-leader former New Dem chairman and easily the most corrupt and untrustworthy individual in the House, Joe Crowley, signed on too-- Schiff because he wants to run for senator and Crowley because he needs to be elected House Democratic Leader when Pelosi and Hoyer go bye-bye. Pelosi and Hoyer, I might add, have adamantly refused to sign onto Crowley's bill. (Even they have more integrity than Crowley, yes even Hoyer!)

Don't kid yourself about conservative Democrats like Crowley, Schiff, Darren Soto (New Dem-FL), Jim Cooper (Blue Dog-TN), Vicente Gonzalez (Blue Dog-TX) or another dozen opportunists supporting a real Medicare-for-All bill any more than California Governor Jerry Brown or California Assembly Speaker Anthony Rendon did when the rubber hit the road.

Progressive activists nationally are up in arms over the betrayal by the California super-majority in the California legislature. People who campaigned on single payer refuse to lift a finger to make it into a reality. It's one of the questions Blue America screens our candidates on-- but it's not a yes or no answer. We want an in-depth explanation. One clown looking for our endorsement didn't even know what single payer is and asked if we could-- and I mean this literally-- talk about the two issues that he said motivated him to run-- protecting the Second Amendment and expanding the use of the death penalty. This is a Democrat asking for the endorsement of a progressive political action committee. Just on a level of commonsense this guy flunked on the spot! On the other hand, El Paso congressman and Texas Senate candidate Beto O'Rourke persuaded us that he has legitimate questions about Conyers' bill but that he does support single-payer and will work towards it if he beats Ted Cruz next year.

I have seen a number of centrist candidates trying to play word games about single payer to lure progressive voters to their cause. In her NY Times OpEd yesterday, Suzy Khimm recognized that for grassroots Democrats the issue has become a litmus test for candidates. Bernie won on this one-- and the Clinton wing of the party lost and is still losing.

During the 2016 campaign, Andrea Barton Gurney thought that single-payer health care was simply out of the question. A self-described moderate, Ms. Gurney, 56, assumed that Hillary Clinton and the Democrats would keep trying to make the Affordable Care Act work.

Now she has changed her mind. She believes the best solution to America’s health care woes is government-financed coverage for everyone. “I wasn’t thinking big enough,” said Ms. Gurney, a marketing professional from New Jersey. “I don’t see anything else that’s going to get us out of this.”

Single payer is now poised to become the standard position for the Democratic base. More elected Democrats are following suit as Republicans struggle to get their deeply unpopular health care bill past Congress. The prevailing assumption is that the G.O.P. effort will ultimately implode, clearing the way for a bold alternative. Senator Dick Durbin, the upper chamber’s second-highest-ranking Democrat, told me that he’d happily sign onto a single-payer bill-- and might even bring one to the floor himself.

But while liberals have spent decades pining for single payer-- Ted Kennedy drew up a bill in 1970-- there are surprisingly few detailed proposals.

...Single-payer advocates believe that radical change is necessary, pointing out that the United States spends more on health care than any other wealthy country, with some of the worst health outcomes. But many advanced, industrialized democracies with universal coverage don’t have a pure single-payer system. France, for instance, has health care for all that is largely state-financed, but most people also buy private supplemental coverage.

While “single payer” has become an effective political rallying cry, advocates still need to figure out what it would mean for one of the largest, most complex health care systems in the world. Senator Sanders himself is preparing to introduce a single-payer bill that will be “far more detailed than the campaign plan” and include changes to address cost concerns, said a spokesman, Josh Miller-Lewis.

...It’s unclear how receptive the base would be to incremental reforms. They could be a reminder of what’s hamstrung Democrats in the past: ceding ground to centrists who insist on largely unobjectionable-- and uninspiring-- white papers. Jeff Hauser, a progressive strategist, argues that the movement should come before the details. “You don’t build a political coalition around wonks,” he says.

What Democrats need to emphasize above all, Mr. Hauser argues, are big ideas that can energize their supporters. More than anything, “single payer” has become shorthand for the notion that everyone deserves health care. “Health care should be a right. It should never be a privilege,” Senator Kirsten Gillibrand, Democrat of New York, and a potential 2020 presidential candidate, recently asserted. “We should have Medicare for all in this country.”

But the more political headway that single payer makes, the more supporters will need to explain how it could actually work in practice. Otherwise, Democrats risk making the same mistake on health care as Republicans: big promises without a plan to follow through.

The Blue America candidates you'll find by clicking on the thermometer on the right are all Medicare-For-All proponents. And we know that not just because they ticked off a box on a questionnaire. Take David Gill for example, a lifelong progressive running for a seat in central Illinois occupied by Paul Ryan rubber-stamp Rod Davis, who blithely voted for TrumpCare. The very first thing on Gill's website page about issues is Single Payer Healthcare. No one has to ask. "Healthcare is a human right, not a privilege. Dr. Gill has been a member of Physicians for a National Health Program for over 25 years, a group that advocates for a single-payer healthcare system in the United States. In addition, society benefits economically when everyone has access to quality healthcare. Moving to a single-payer system will save the United States nearly $1 trillion each year and cut the cost of health insurance for working families. Dr. Gill looks forward to leading the charge to a single-payer system when he gets to Congress." And no built in wiggle-room. Right now we're in the process of vetting almost two dozen candidates. None of them are going to appear on that page attached to the thermometer until we're sure they're for Medicare-For-All. We're sure Utah progressive Democrat Kathie Allen, a physician and a congressional candidate, is. In her own words:

Healthcare is one of the prime reasons I am running for office; this is of pressing concern to Utahns (Americans) and it is a “can’t sleep” issue for many. The United States taxpayer pays $9000 per person per year for an inefficient system that denies coverage to many. This is more than twice as much as the #2 country. Our standing in the world in terms of successful outcomes is embarrassing. Our life expectancy is less, and our maternal and infant mortality rates are higher than that of most other developed nations.

We must remove the profit motive from health care to insure that everyone is covered at an affordable rate and in an efficient manner. A basic taxpayer-funded plan covering the same, or similar, 10 essential services as the ACA should be offered, as it is in virtually ever other developed country. Costs can be contained by removing unnecessary regulation and keeping the administrative costs to below 2%, as is the case with Medicare Part A & B. Some people might actually pay less under a government mandated system when one considers the elimination of premiums, deductibles, and the costs of medications and supplies. Removing CEO salaries which average around $27 million a year, removing the need to pay dividends to investors of for-profit insurance companies, and removing duplicative costs between multiple insurers doing the same tasks can bring the administrative costs down from around 20% to the level of Medicare. A private plan can be offered for so-called “cadillac” services.

There are also many ways to reduce the cost of prescription drugs, including allowing importation from other countries, allowing more competition in the generic market, and removing patent protections that allow Big Pharma to keep extending patents year after year for basically the same chemical.

Because any reform will disemploy large numbers of people in the insurance market, we must be careful about how it is employed. This is one of the factors that makes the discussions complicated. I envision a think tank of providers, patients, disability advocates, actuaries, bioethicists, and economists sitting together for however long it takes to provide healthcare for every single American in an affordable and efficient manner. In the meantime, what the Congress is trying to do right now is basically repeal Medicaid. It's as simple as that. The will of the people is for the ACA to be fixed, not for this atrocious piece of legislation called the BCRA to pass. Let's pursue comprehensive solutions in a bipartisan manner, employing the expertise we need, to bring about lasting change and Healthcare For All.