The Path to Single Payer Health Care

Rachel Maddow talks about Vermont's "Medicare for all" single payer plan. With a Democratic Governor, and a Democratic controlled Senate and House, Vermont is heading toward a "single payer" plan for healthcare. Essentially Medicare for all!!! WATCH:

Via Crooks and Liars:

Vermont is now moving towards passing a single payer health care plan in their state. President Obama recently stated his support for allowing waivers for states that want to implement single payer health plans before the date of 2017 called for in the Affordable Care Act. And as Rachel Maddow noted here, despite all of their rhetoric about how Republicans supposedly have better ideas for how to reform our health care system, we're not seeing any of these red states step up in the manner Vermont has and offer any alternatives like we're seeing in Vermont.

Let's hope other states follow Vermont's lead.

Another View of Healthcare

Roger Bybee says, "Health Insurers won the pot. Reformers need a new game." In his article, "Fixing the Big F*%#ing Deal," Bybee says that passing this comprehensive health plan legislation is a step forward. However, there is still much to do.

In a too-loud whisper to President Barack Obama, Vice President Joe Biden famously characterized the signing of the Patient Protection and Affordable Care Act as “a big f—-ing deal” at a triumphal White House news conference.

On a political level, the new law is indeed a “BFD.” But in terms of healthcare policy, many reformers believe that the law fundamentally reinforces insurers’ stranglehold on affordability and access. Consequently, the law will fail to restrain the market forces inexorably driving up healthcare costs, thereby forcing another confrontation further down the road as costs climb and coverage shrinks.

Still, America’s first comprehensive health plan represents a step toward establishing healthcare as a basic American right. The new law includes an extension of healthcare to 32 million uninsured people, some valuable protections against insurer abuses, and a badly needed expansion of Medicaid and community health clinics.

What about the pitfalls of the bill?

Whither single-payer?

Health Care for America Now!, a coalition of 1,000 organizations, views the Patient Protection and Affordable Care Act in distinctly positive terms. “First of all, the most important thing is that it establishes that people will get decent health coverage that they can afford, and that government has a responsibility to provide that,” HCAN Executive Director Richard Kirsch told In These Times. “That’s a fundamental transformation, from it being a privilege to a right.”

Kirsch ticks off some vital areas for improvement. “We will need to improve the affordability for many families in the exchange [a government-sponsored offering of insurance plans for the presently uninsured to choose from], especially those just above the Medicaid level and adding some more help for the upper-middle class.”

Insurance industry triumphs

Non-HCAN reformers are distressed by what they see as a fundamental defect with the new reforms: The new healthcare law enlarges and fortifies the throne from which for-profit insurers dominate the healthcare system.

Regardless of the policy differences among reformers, the law’s basic contours reflect the remarkable political power—exerted through campaign contributions, lobbying and television ads—of the for-profit insurance industry, according to Steffie Woolhandler of Harvard Medical School and Physicians for a National Health Plan, a 17,000-member organization advocating a single-payer or Medicare-for-all plan that would replace for-profit insurers with a single government entity.

“The big problem in this fight about trying to introduce the single-payer idea into the debate was actually the insurance industry and how they were allowed to write the bill and check the language of the bill throughout the process,” she told In These Times. Former WellPoint insurance company Vice President Liz Fowler, an “aide” to Senate Finance Chair Max Baucus (who ruled single-payer “off the table” early on in 2009), has been credited with writing much of the legislation.

Given the central role that the new law preserves for for-profit insurers, former Labor Secretary Robert Reich placed the new law in proper historical context when he cautioned in Salon.com: “Don’t believe anyone who says Obama’s healthcare legislation marks a swing of the pendulum back toward the Great Society and the New Deal. Obama’s health bill is a very conservative piece of legislation, building on a Republican [a private market approach much like Mitt Romney’s] rather than a New Deal foundation. The New Deal foundation would have offered Medicare to all Americans or, at the very least, featured a public insurance option.”

Consequently, the guiding logic of the current system—under which insurers maximize profits by minimizing care, and ever-expanding “provider chains” (hospitals, clinics and physician networks) seek to enlarge their revenues and market share without regard to health needs—will remain intact. “Most critically, the bill strengthens the economic and political power of a private insurance-based system based on profit rather than patient need,” says Rose Ann DeMoro, executive director of the National Nurses United union.

Is there a solution?

A single-payer future?

Developing a much stronger media operation to properly frame the healthcare players and issues will be just one of the challenges facing the reform movement. The upward trajectory of health costs and premiums may help to define the solution and to arouse a much broader swath of Americans in the next round of the healthcare reform fight. [...]

Some experts predict that the new law’s utter failure to rein in insurance premiums, trim the $400 billion dollar burden of insured-imposed administrative costs, and control the excess costs created by provider chains will ultimately make a Medicare-for-all or single-payer system unavoidable.

Writing in the New York Times , William F. Pewen, former senior health analyst for Sen. Olympia Snowe (R-Maine), put it this way: “When Congress next attempts reform, in a decade or more, health costs and the number of uninsured and underinsured will have escalated—and the likely outcome will be the single-payer system that Republicans most abhor.” 

Conflict over health care reform is morphing into the question of what system will work: a failed for-profit system or change in the form of not-for-profit health care. This article states that the "Patient Protection and Affordability Act falls woefully short of achieving the universality taken for granted in every other advanced nation." Hopefully real change will come in the form of a public option or a single-payer system.

Complete article is here.

Are We at the Point of Accepting the Unacceptable?*

Health insurance coverage is only one aspect of the health care crisis that Americans are facing. The healthcare legislation passed by Congress mandates insurance for every citizen. But questions still remain regarding what will be covered and if it is affordable.

Marcy Wheeler at FireDogLake looks at how this legislation will affect a family of four making around $66,000 a year (three times the poverty line).

Here’s a version of one family’s total household costs under the plan: a middle class family with two cars and some child care costs. Note, in this scenario, I’m assuming the middle class family will pay 7.9% of its income for health insurance premium, significantly less than the 9.8% the plan assumes that family could pay to get the subsidies available. This, then, shows what a family would be required to pay (or incur a penalty) under the 8% opt-out rule.

301% of Poverty Level: $66,370

Federal Taxes (estimate from this page, includes FICA): $8,628 (13% of income)

State Taxes (using MI rates on $30,000 of income): $1,305 (2% of income)

Food (using “low-cost USDA plan” for family of four): $7,712 (12% of income)

Home (assume a straight 30% of income): $19,275 (30% of income)

Child care (average cost for just one pre-school child in MI): $6,216

Health insurance premium: $5,243 (7.9% of income, max amount before opt-out w/o penalty allowed)

Transportation (assume 2 cars, 12,000 miles each, @IRS deductible cost of $.55/mile): $13,200*

Heat, electricity, water: $1,500

Phone, cable, internet: $1,200

Total: $64,276 (97% of income)

Remainder (for health care out-of-pocket, debt, clothing, etc.): $2,091

In other words, assuming this family had no debt (except for that related to the two cars), no clothing costs, and no other necessary costs–all completely unrealistic assumptions–it would be able to incur just $6,970 of medical care out-of-pocket costs before spending all that $2,091 and going into debt (the opt-out is based on an insurance plan that provides 70% of costs, so this assumes the family will pay 30% of health care costs). Yet that family would be expected to spend up to $5,882 more out of pocket before the “subsidies” started picking up its out-of-pocket expenses. (If the family paid the full 9.8% of its income on premiums–at which point it would become eligible for subsidies under the plan–it would have just $825 left to spend on all other expenses, including health care out-of-pocket expenses.)

This family couldn’t even go through a normal childbirth without going into debt.

Nate Silver at Five-Thirty-Eight takes issue with Marcy's analysis. He believes the healthcare plan passed by Congress will be beneficial to most low or middle income families.

First of all, several of of Marcy's cost estimates are on the high side.

As Marcy points out, her assumptions may be favorable to this family in other ways -- her family doesn't have any debt, for example. Nor do I doubt that there are some families who would fit Marcy's template almost perfectly (although they should still be able to take advantage of the significant tax breaks that Marcy hasn't accounted for). But in general, this is significantly more than most two-child families will be spending on these services -- probably by a margin of $10,000 or so.

Nevertheless, that's not really the most important point. Rather, what is this family spending on health care now? ...if the family isn't buying insurance, their health care costs certainly shouldn't be figured as zero.

Frankly, unless they're living in New York or the San Francisco Bay or some other place where the cost of housing is very high, the family that Marcy draws from -- one which pays $1,600 per month for rent but does not buy health insurance for themselves or for their children -- does not have a reasonable and responsible gameplan to begin with. If they can't figure out how to squeeze out $430 per month in insurance premiums, what are they supposed to do in the status quo when somebody actually gets sick? You can object to the Senate's health care bill on libertarian/paternalism grounds, but it will leave the overwhelming majority of low- and middle-income families better off.

Yet Jonathan Cohn at The New Republic looks at what families can actually afford. He believes that the Senate bill is worth passing yet the reform is not good enough. He supports his position by acknowledging the dichotomy of his assessment.

Without reform, this family would either be uninsured altogether or paying high premiums for coverage that is, most likely, far less comprehensive that what the Senate bill would guarantee them. [...]

Families dealing with serious medical problems, particularly chronic diseases that require ongoing care, have enough problems without having to sweat out every penny. And even the best insurance policies leave people on the hook for expenses that fall outside of covered benefits and, as a result, don’t even count towards out-of-pocket limits.

Making those two arguments simultaneously is not easy. It's the political equivalent of walking and chewing gum at the same time. But if progressives can figure out a way to do it, the people that already stand to benefit from reform will benefit even more.

The sad part about all this analytic journalism is that if you need to pick through and parse out the benefits versus the disadvantages of the bill, then maybe the complexity is itself a detriment of this legislation.

For progressives, the answer lies in the clarity and simplicity of a single-payer, not-for-profit system. Of course, a public option or Medicare for all would be acceptable. No matter how many ways you look at it, this healthcare bill is not!

*UPDATE!!!

J. Lester Feder at the Nation has a review of the pro & cons of the Patient Protection and Affordable Care Act passed by the Senate. The Senate's draft of the bill must be merged with the much more progressive version passed by the House. Feder believes that despite very serious shortcomings of the Senate bill, it is necessary to pass healthcare reform now otherwise "another generation may pass before another chance will come to try again."

Despite these very serious shortcomings, however, the bill the Senate passed would reduce the number of uninsured Americans by 31 million by 2019. The Medicaid program will be open to new ranks of the country's poorest residents, and the near-poor and middle class will get subsidies to buy insurance. The Senate also advanced some important delivery system reforms that could chart a path towards reining in costs.

As disappointed as progressives are with the compromises Democratic leaders made to get this bill through the Senate--and as tempting it is to believe they may have gotten a better deal if they'd pursued a more aggressive strategy--they are on the verge of doing many other lawmakers have tried and failed to do. And if this effort fails, another generation may pass before another chance will come to try again.

Lester's view is common among people who feel defeated on the healthcare issue but who think this is the best that could be achieved. The attitude is "something is better than nothing."

Was that Ben Nelson's attitude when he fought against abortion funding? Was that Joe Lieberman's attitude or Max Baucus' position when they fought against the public option?

Hell NO!!!

They stood their ground and fought for the position they were espousing.

There wasn't one Senator that stood his/her ground on support of the public option. They all caved in. Do you really think any of the Representatives in the House will fight for 'The People'? Or will they allow the bullies of Congress to dictate from the moneyed corporate pulpit?

A Message for Congress

In his article for OpEdNews, Rob Kall wants you to Tell Congress To Go To Hell With Their Current Health Reform.

I know some of my words are not nice--crude, vulgar--but if you're not thinking something like them, you don't get it. And if you have been thinking them, but don't want to say them, send your legislator my article.

Just thinking. The current legislation that the Democrats have celebrated in the house is a pile of shit, an incredible insult. People are dying.

Tell your legislators in Congress what you think of their health reform.

Flipping Congress the bird collage by Rob Kall

People are enslaved in jobs they hate, abused by employers, because they can't afford to leave because they'd lose healthcare coverage.

What have they offered us?

-a four year wait for a plan that affects hardly any Americans.

-no controls on drug costs, and every likelihood that co-pays will go through the roof, since raising co-pay is one way to cut monthly insurance rates.

-We should expect rates to go up and benefits to keep shrinking.

-The current version is a horrific affront to women-- the 60+% of whom voted for Democrats-- that they would have rights to control their bodies and abortion rights. Disgusting. It's amazing Pelosi not only allowed the amendment to reach the house floor, but that she celebrates any legislation that cuts women's rights.

There are a handful of legislators who are calling for single payer. That is the only legislation worth talking about. The majority of the population wants it. America desperately needs it. I can't see myself voting for anyone who doesn't support it.

So, when the senate starts working with the house's bit of garbage health reform, let your senator know that anything less than single payer is an insult and a shameful failure to do what needs to be done.

Let him or her know that waiting four years is obscene.

Make it clear to all your legislators that what they've done so far is not enough.

There are teabaggers (see the wikipedia explanation of Teabagging) who oppose single payer. I can see legislators opposing it because they are whores who have sold out their constituents to health care companies. But the grassroots idiocracy is another story. These are the dumbest, most deluded, mislead lemmings in American history. They will be remembered as a movement of fools and idiots, dupes who bought the lies of Sarah Palin, Glen Beck, Fox News and the right wing echo chamber that was used by corporatists to take America from First to Third world status.

History does funny things. If the teabaggers win, which is possible, then they will be lauded as rescuing America. That will be history written in the US of Teabaggery. But outside the US, where truth may still see daylight, they will be seen as the moronic idiots that they are.

It's time to remember that health care is a human right, a civil right, and those who block it are no different than those who have engaged in blocking other human rights. It's time to remember that even after 40 years of equal rights for blacks, there are still tens of millions of racists. The toxic dregs of humanity don't go away. They linger, putting brakes on human progress. Now we face a new challenge to fight these dark forces. It will take the same kinds of strategies that freedom riders and protesters who supported Martin Luther King in the sixties south and those who supported the fighters against Apartheid in South Africa used.

Congress must be told that their best so far is not even close to good enough. The current incarnation of the public option is a sham. It will set back progress. Tell your legislators. Raise your voice. Let them know that they are not even close yet. Tell them to find their spines.

I agree! If you aren't completely appalled then you haven't been paying attention!!

Sen Bernie Sanders Unfiltered

On Healthcare Reform

One of the reasons that I am a strong proponent of a single-payer, Medicare-for-all proposal is that it is much less complicated than what we are going to end up with in Congress. A single-payer approach saves hundreds of billions of dollars a year because you don’t end up with thousands of different health insurance programs appealing to all different kinds of people and costing a fortune to administer. I am going to continue the fight for single-payer. I am cautiously optimistic that we may end up with legislation that will allow states to go forward with single-payer if they want to.

The Benefits of Single-Payer Health Care

The Republicans have equated single-payer healthcare with "socialism". The insurance companies are trying to kill any system where they are not the sole insurer. The Democrats are afraid of raising the issue of a single-payer system. The Blue-Dog Democrats are joining forces with the Republicans on the issue of insurance reform. The "gang of six" really wants the status quo.

We know that our present healthcare system of private insurance doesn't work. Now Rep. Anthony Weiner of New York has even gotten Morning Joe, Joe Scarborough, to admit that a single-payer system of healthcare has virtues.

As Weiner acknowledges, there two powerful forces against change are the status quo and the insurance lobby. The real question is "why we do we have a private plan."

The Nation's Leslie Savan has noted:

Something rather remarkable happened on Tuesday's Morning Joe. Rep. Anthony Weiner of New York pointed out that the health insurance industry has no clothes, and Joe Scarborough, after first trying to spin it some gossamer threads, broke down and said, By God, you're right, this emperor is a naked money-making machine!

Well, he didn't use those exact words, but Joe did seem to finally get that America has granted insurance companies the right to create bottlenecks in the financing of healthcare in order to extract profits out of the suffering of ordinary people--without providing any actual healthcare whatsoever.

"Why are we paying profits for insurance companies?" Weiner asked Scarborough. "Why are we paying overhead for insurance companies? Why," he asked, bringing it all home, "are we paying for their TV commercials?"[...]

"It sounds like you're saying you think there is no need for us to have private insurance in healthcare," Joe asked at one point.

Weiner replied: "I've asked you three times. What is their value? What are they bringing to the deal?"[...]

Maybe the real turning point came when Weiner asked, "How does Wal-mart offer $4 prescriptions?"

Watch these 2 videos of the show:

Rep. Anthony Weiner Discusses Public Option Health Care Reform on Morning Joe - PT 1


Rep. Anthony Weiner Discusses Public Option Health Care Reform on Morning Joe - PT 2