Single Payer Summer

by: davidswanson

Sat Aug 01, 2009 at 21:00


( - promoted by Paul Rosenberg)

By David Swanson

The U.S. House of Representatives has committed to bringing single-payer healthcare to a vote following summer recess.  Stranger things have happened, greater obstacles have been overcome, than what would be involved in winning that vote, winning in the Senate, and compelling the president to sign the bill.  We have a moral responsibility to put everything we have into trying; and even a near-victory will advance the cause.
 

davidswanson :: Single Payer Summer
But it is important to recognize exactly how that promise of a floor vote on single-payer came to be, what else is at stake, and what we are up against.  Being properly informed, I think, will not diminish by one iota the ferocity of our campaign for justice, but it will alter our strategy by adding a secondary demand to it.  For those either too mentally feeble, or -- much more commonly -- who imagine their fellow citizens to be too mentally feeble, to keep two tiny things in their heads at once, I don't know what to say other than: please throw away your television.  

When Antonio Gramsci referred to the pessimism of the intellect and optimism of the will, I think he meant to renounce the idea that one can best campaign for justice if filled up with false beliefs that victory will be easy.  I think one can best campaign for justice if one knows exactly what one is up against but doesn't give a damn how grim that picture appears.

So, here's the truth.  Congress is not voting on single-payer healthcare purely because we forced it to, or because the bill is (prior to our shaking the country up this summer) even remotely likely to pass.  Our advocacy for single-payer has had an impact.  We're a big reason why some congress members are fighting for a public option.  Whether or not you consider any of the current versions of public option worth the paper they're written on, the fact is they'd be weaker without the public demand for single-payer, and were that demand stronger so would the public option be.  Our work has also led to passage in the House Education and Labor Committee of an amendment that would make it easier for states to create single-payer systems.  And our advocacy led to the promise of a floor vote on single payer in the fall.

But the floor vote was negotiated as an alternative to a vote in the Energy and Commerce Committee.  We lost the opportunity to have a vote there.  And the Democratic Party leadership, which largely takes its orders from the White House on this, was not so much afraid that single-payer would win on the merits, as that it would pass because Republicans voted for it purely out of spite.  The Democratic "leaders" badly wanted to get a bill out of that committee before August, a bill that would at least vaguely resemble the bills passed by two other House committees.  Rather than risk failing in that goal, they preferred to allow a floor vote later that would not interfere with the bill they want to pass, and which itself -- at least in their minds -- would be extremely unlikely to succeed.  

Allowing such a vote would have another positive side-effect from the point of view of those in charge: it would overwhelmingly distract attention from the state single-payer language passed by the Education and Labor Committee.  From their point of view, national single-payer will not pass on the floor this year, not with them whipping hard against it and the Republicans opposing it.  But if the language on allowing states to do state-level single-payer is left in the bill that they whip for and pass, it's unlikely to cost them any Blue Dog votes, and it's likely to result in a number of states fairly quickly taking actions that accelerate public awareness of the shortcomings of the federal reforms.  

From the point of view of people who really want to get our population better healthcare and who have not been purchased by insurance, drug, and hospital companies, lobbying for Yes votes on single-payer AND lobbying to leave the states language in the non-single-payer bill (or at least allow a vote on it) seems to make a lot of sense.  We're saying that we want single-payer nationally, but that if they won't give it to us right away, we at least want states to be left free to lead the way.  Canada arrived at its system after a province led the way, and the first state likely to create single-payer, California, is about the same size as Canada.  If Canada's system does so much good, why would we deny the same to California?

For those lobbying directly for a public option, it also makes perfect sense to demand freedom for states to do better faster.  If the goal is providing more people with better healthcare, if the goal is not to avoid making the federal government look second best, if the goal is not to achieve a perverse hyper-simplicity of "messaging," then including the state single-payer language in August demands is the way to go.

Does mentioning allowing states to do single-payer subtract from demanding that the nation do it?  I can't see how.  

Does avoiding the topic risk tossing aside our best chance at advancing the cause?  Absolutely.


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Single Payer Summer | 19 comments
Best explanation of the theatre I've seen, thanks. (4.00 / 2)
You might be interested in this post, too. I posted a somewhat Bowdelerized version here.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

I Definitely Think The State Single-Payer Is Pragmatically Our Best Bet (4.00 / 3)
And the chance to lobby for both at once is definitely a stronger hand.

Furthermore, if we get the state single-payer option passed, then that immediately becomes a top issue in the governors race here... oh, wait, I keep forgetting we outlawed rationality in state politics!

Sorry about that!

Guess we'll just have to break the law.

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3


It's certainly politically useful (4.00 / 2)
and Pelosi should get credit for realizing that.

It won't pass yet, for reasons Chris Bowers sketched out, but it's the best policy. Alas.  


[ Parent ]
Agreed, and especially important in CA... (4.00 / 1)
Because that looks like a whole lot of trouble.

Note that if you want to connect with single payer advocates, that press coverage is horrific, and sometimes you have to dig to find out what's going on.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Yes a Public Option victory with State Single Payer (4.00 / 1)
is the "most possible best victory" this time.

The example of California is more than a scholarly citation, it is, as has been said before, a place where it was essentially passed by the legislature of California, only to hav been vetoed by that troglodyte Schwarzenegger. And as Mr. swanson say so reasonably the fight there, with its national coverage  and its millions of families interaction accross the nation ("Dad you're not going to believe how easy it is to get help here") will be the first best doable example that can less easi;ly denied by the Versailles Press, the Republican machine, the "conservative" Democrats, the Insurance "industry" and the wacko-wackos.

I am in complete agreement with the article. Four to Swanson. And a four to lambert's citation of the path forward through California.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.


[ Parent ]
How is single payer defined? (0.00 / 0)
Probably this is a stupid question, so please bear with me.

When you say "single payer" do you mean a new government entity that exists along side Medicare? Or do you mean extend Medicare (or private label the VA program)?

I ask because the simplest single payer solution to advocate would be to lower the Medicare eligibility age by 10 years every year for the next five years. So 55+ next year, 45+ in 2011, 35+ in 2012, and so on.

I've not seen a clear definition of single payer as I have the public option. Lowering the Medicare eligibility age over time is easy to define. Is that what single payer means? Is that what will get a House floor vote?


There Are Various Possible Ways To Do It (0.00 / 0)
Enrolling everyone into Medicare is the easiest, as it already exists.  But if you only do it in one state, then that's out as an option.  The idea of phasing it in over time one way or another is also not essential to the concept, just a variant on how you handle the transition.  So long as you have something that functions like Medicare, but is for everyone in the jurisdiction covered, that qualifies as "single payer."

"You know what they say -- those of us who fail history... doomed to repeat it in summer school." -- Buffy The Vampire Slayer, Season 6, Episode 3

[ Parent ]
single payer means (4.00 / 1)
that no matter which doctor or clinic or health care provider you visit, they all bill the same "payer", a governmental or government-created not for profit entity.  Like Medicare.

Right now hospitals have entire wings devoted to billing, the myriad of private payers (insurance companies) employ their own bureaucracies to deny claims, along with changing their own billing protocols and procedures so as to have excuses to delay and deny payment.   Right now every medical practice with two physicians needs to have to have one full time person to handle the complicated billing.  

"If you want that good feeling that comes from doing things for other people, then you have to pay for it in abuse and misunderstanding..."
Zora Neale Hurston


[ Parent ]
Here's the FAQ (4.00 / 3)
John Conyers is the sponsor of HR676, the single payer bill.

Policy wonks and health care nerds tend to say "single payer"; people who focus on, like, real humans with health care needs tend to say "Medicare for All." Same deal.

The link above has a lot of great information; you might also check out the Physicians for a National Health Care Program. They've got lots of great research.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


[ Parent ]
Interesting and thanks (0.00 / 0)
It'll take 15 years to get HR676 implemented, BTW. I wish we had a media that would bother to dig into these issues. For example, how would lowering the Medicare eligibility age over time compare cost-wise to HR676 to doing nothing to the public option?

I'm amused that single payer is what I thought it was. That also highlights a problem with messaging.

Appreciate the links and responses.


[ Parent ]
Single payer, public option = gobbly gook.. (0.00 / 0)
No wonder nobody knows what the hell they are talking about.  It should be so simple:  "Medicare for all.  Everybody in and everybody pays, something."  I'd like to see anyone turn that into killing grandma.

What is going on in this country is an economic Katrina, and it belongs to the Democrats.  They have abandoned millions of unemployed people on the roof tops of their sinking homes, while they bailout Wall Street and support huge CEO bonuses.   Now they have another chance to do what is right, and they are pussy footing around with public options and other watered down bull shit.  If they cave in and bailout out WS again, they can kiss off 2010.  

Did we waste a mandate on this bunch or what.      

They're asking for another four years -- in a just world, they'd get 10 to 20. ~~ Dennis Kucinich  


[ Parent ]
It isnt goobly - its legislation. The rule of law. (0.00 / 0)
And small errors, like mistaking the founders desire for a self governing land with the right to bear arm,s, with the right to carry a gun into a bar, coming from not putting the damn right in the legislation in the first place.

That said: I also agree with you. I go so far as to say that a Right to Affordable Quality Healthcare is a very powerful tool that makes the damn enforceable.  

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.


[ Parent ]
Weiner discussed dropping the eligibility age for Medicare, by decades or (0.00 / 0)
all the way to birth.

When he discussed his substitution amendment on WNYC radio a while ago, he said it would be HR 676 that would be substituted.

Weiner will be on WNYC tomorrow morning on the Brian Lehrer Show, second segment, usually around 10:20AM, iirc.

It is live streamed on wnyc.org.

I hope to get the host to have Weiner firm up which version of single payer he intends to have brought to a vote -- and how much Pelosi can decide as to what is voted on.

Ah! The comments appear to be open now, so it appears one can go and leave questions now. Light registration required. This link is direct to the live stream...I think. Usualy listen on the radio.

This should be interesting....


[ Parent ]
The best thing about such a vote on the floor (4.00 / 1)
It provides a simple, easy-to-understand voter's guide.

Thank you... (4.00 / 3)
... for front-paging a Medicare for All story.

As Anthony Weiner says, "It's a better plan and now it's center stage" -- meaning that Speaker Pelosi will give Medicare For All (single payer) an up or down floor vote.

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


I linked to you on fp dailykos. (0.00 / 0)
Your post is exactly why I don't contribute to fund raisers on blogs.   Pragmatic my foot.  This isn't about being pragmatic.  This is about holding Washington accountable for dancing with those that brung em and pushing them as hard as we can to do what is right.  

They're asking for another four years -- in a just world, they'd get 10 to 20. ~~ Dennis Kucinich  

[ Parent ]
Yes, I saw that (0.00 / 0)
Thanks!

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  

[ Parent ]
Is there no such thing as an intelligent progressive who doesn't support single payer? (0.00 / 0)
For those either too mentally feeble, or -- much more commonly -- who imagine their fellow citizens to be too mentally feeble, to keep two tiny things in their heads at once, I don't know what to say other than: please throw away your television.

I want 100% health insurance coverage, better public health, focus on prevention, reduced cost both for individuals and as a % of GNP -- but I'm not convinced single-payer is the best way to get there.

I'd like to see a strong public option which instantly creates a fundamental shift in the incentive systems of the health industry, and then moves more incrementally toward a system like the French have.

So am I too mentally feeble, or what?

(To be clear, my point is not to debate policy, and I do think we should allow states to pursue single payer, but I think you're wrong to impugn the motives of people who probably share your goals, but not your tactics.)

Progressive Change Campaign Committee


Single Payer Summer | 19 comments
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