Why Not Just Do Single-Payer?

by: Matt Stoller

Fri Sep 21, 2007 at 09:42

All the candidates except Obama have proposed what is essentially the same health care plan; we'll mandate that you buy health insurance from an insurance company and give some people and companies tax credits to do it, along with regulating private insurance more aggressively.  I've been thinking about this, and these plans don't actually make any sense. 

Matthew Yglesias hits on something important, but I think is slightly off on the politics of filibustering and how they relate to health care.

This is why I'm skeptical that any of these big picture health care reforms can possibly pass. It's going to be very much in the interests of the Republican to block ay such proposals -- irrespective of their content -- and the rewards to wavering Democrats for abandoning the reform side will be large.

There's another possibility, which is that the best parts of the plan get removed in a compromise and we end up with something like the Massachusetts monstrosity where everyone has to buy expensive bad health care plans and then it all collapses.  This is the most likely scenario, since insurance companies would prefer it to the current model, the Democrats are going to want to 'do something' about health care, and gravity will take over.

A mandated premium is the same thing as a tax, only it goes to private companies instead of the government.  Redstate makes the appropriate argument by pointing to this passage.

[Clinton] said she could envision a day when "you have to show proof to your employer that you're insured as a part of the job interview like when your kid goes to school and has to show proof of vaccination," but said such details would be worked out through negotiations with Congress.

First of all, that's awful.  We already have an IRS, we don't need another one.  Second of all, how is that going to get 60 votes in the Senate without some huge subsidies to the insurance industry?  It won't, unless the next President proposes it, Congress won't act, and it becomes a voting issue in 2010 and the public crushes the opposing members in Congress.  And if that's the only scenario to put forward this kind of health care plan, why not just do single payer?

Matt Stoller :: Why Not Just Do Single-Payer?

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well (0.00 / 0)
While I agree with you on single payer (we have to simplify the system, not complicate it), just this month I had to show that my car is insured to register it.  I would have to certify to my employer that my wife can not get health insurance in order for her to be covered. My county is requiring my town to hire someone to inspect my house so that they can tax it.  I have to cut my lawn and clear snow off the sidewalks -- and the elderly people in my neighborhood have to hire someone to do those things.  None of these examples involve the IRS. 

I think you are buying into some right-wing frames here.

New Jersey politics at Blue Jersey.

buying into right wing framing (4.00 / 1)
If Stoller is buying into it it is a good sign that the rest of middle america will buy into it as well.  The people that need to sign onto it.

Besides there is just no good reason for it.  We shouldn't be putting in regulation to make people's lives harder.

[ Parent ]
All of the plans (0.00 / 0)
and they seem very similiar make sense until you talk about the funding mechanism, which looks like a Rube Goldberg contraption.

It depends (0.00 / 0)
on the political dynamics of 2009, most importantly how many Senators Dems actually have in office. Even if we're short of 60, if we're in the high 50s and have an effective messaging campaign to sell the bill, the pressure on vulnerable Repubs to cut some kind of deal may become too high.
There is one other option, though, something we considered and abandoned for multiple reasons in 1993: because there are so many tax and budget issues involved, we could put this in the omnibus spending bill which would only require 51 votes. 

...and have an effective messaging campaign (0.00 / 0)
Is this the bizarro democratic party?  When is the last time the dems didn't get beaten by the republicans on a messaging campaign on anything?  I guess they won on Social Security privitization.  But it seems like they need some issue where 75% of the population disagrees with the republicans in order for them to successfully get a message out. 

I'm just honestly sick of this.  The leadership needs to start really berating senators that shit on us on core issues.  I don't give a damn if you want a slightly less crazy tax structure if you're pro-war and anti-abortion. 

[ Parent ]
Absolutely something to research, but... (0.00 / 0)
If we get a Dem trifecta elected in 08, there will certainly be a huge reconciliation bill in 09 just to deal with what one might call ordinary budget issues.

My sense is that there is a good deal of institutional resistance in the Senate to expanding the use of reconciliation bills to cover something like healthcare reform.

(Byrd (as Apps Chairman) was apparently the guy who stymied Clinton's attempt to use reconciliation for his healthcare proposal.)

So - analogously with cloture reform in the days of Jim Crow - you may get a bunch of senators who support healthcare reform, but who will vote against a reconciliation bill because they think it's the wrong mechanism to use (even if a regular bill would be doomed to failure).

Plus a bunch of other senators who will use the tradition of unlimited debate and like bollocks as a pretext to block a healthcare plan they don't like.

So (perhaps) - Catch-22: the only way decent healthcare reform might pass is via a route that will draw incremental opposition sufficient to sink the reform!

Plus - abstracting from all these procedural difficulties, I think we're miles short of 51 votes for a single payer scheme. Perhaps we're into double figures, perhaps not.

[ Parent ]
Byrd (0.00 / 0)
was the biggest reason we didn't try this in 1993. There are lots of barriers to it, but I think if it's the only way to get something this done, it's still worth serious exploration and discussion.

[ Parent ]
Thanks for pointing this out Matt.... (4.00 / 4)
And no this isn't right wing framing. This is issue is yet another dying canary in the coal mine we live in. I recommend visitors here check out 'Collapse' by Jared Diamond as a good primer on the danger we now face.

We have worse than political gridlock. The inmates are running the asylum. Healthcare, like The MeatGrinder decaying infrastructure education civil defense and a host of other issues, are caught in the dominant 'conservative' frame that it is absolutely wrong for government to even attempt to address these issues.


Because there is profit to be made on supplying these services to the public. Naomi Klein has a great article on what has come to be called 'Disaster Capitalism' in the latest Harper's. Read it.

What's my point?

Not so simply this: Our government is incapable, and unwilling, to do it's traditional job, protecting the citizenry from dangers they are unable to deal with as individuals.

Healthcare is a perfect example. Despite the public, and now many large businesses, perception that the 'healthcare' system in America is irretrievable broken and needs to be completely overhauled one group, the healthcare insurance industry, is able to effectively veto any action to remedy this problem. Current rates of inflation of healthcare costs project that spending on same will consume the entire GDP by 2050. Think about that for a minute. Then think about the fact that no candidate, except possibly Edwards, has put forth a plan, even though the experience of other countries shows such plans exist, that will do anything about this.

All parties continue to act as if there was no problem; as if 'politics as usual' will address this issue.

If looks like a certainty that nothing is going to be done until a catastrophe, for healthcare perhaps a new influenza pandemic, occurs.


The citizens start demanding that the broken systems be repaired by government not 'private contractors'.

Whew...sorry for going on so long about this. But folks...

We have big trouble in this country and the idiots inside the beltway have neither the intelligence nor the desire to see that.

It's gonna come down to us to change that.

Peace, Health and Prosperity for Everyone.

It won't be the Republicans blocking health care (4.00 / 2)
Just as we've seen in several other issues, the blue dog democrats will be the ones who block health care. For any progress at all we need quite a few more progressive Democrats.

If we lost half the blue dog seats to Republicans, and gained the other half for progressives, we'd be a lot closer to having a progressive Democratic Party.

Without a stronger progressive caucus, the path of least resistance is the standard bandaid I call SICK (Save Insurance Companies Kiesters).

So wait (4.00 / 2)
People DON'T think that there should be a federally mandated fee for being alive?

John McCain opposes the GI Bill.

Options (4.00 / 2)
One of the best parts of Hillary's plan is that it let's individuals under 65 buy into Medicare (3% overhead) instead of buying a crappy HMO (20% overhead).  Single payer is available as an option, in fact the only reasonable option.  That alone will let the insurance companies sweat plenty. 

Another benefit is that banning people due to pre-exisisting conditions becomes "extremely difficult."  I am not a lawyer and this sounds good but a bit over complicated.  Why can't it be banned straight out.

Of course any good plan would also prohibit the large discounts given to the largest of the corporates at the expense of everybody else.  Duh.

I never heard any real person talk about the Harry and Louise ads at the time of the last try on universal health care but it was all over the Tv "news" coverage and presented as an overwhelming force.  Anybody wonder whether self-interest in the form of continuing insurance company ad revenue shaped the coverage? 

Hillary, of course, cut a deal with the insurance and business groups and they still stabbed here in the back.  The self-interest of the Republicans who did not want to compete against another popular program like social security and medicare was obvious.  It was scorched earth baby.  The hypocrisy of the insurance companies who had yet to unleash full force managed care and HMOs on most of the population and kept harping about maintaining choice of doctors, etc. when it was the insurance companies that would soon restrict coverage to doctors in the plan was just breathless.  No wonder everybody hates them (remember the scene in the Woody Allen movie where Woody is sent into a sweat box to listen to an insurance agent?).

This will get through if we just show some guts.  I would think the fall back is not a Mitt plan but universal coverage for kids and seniors.  Not logical but the kids part is cheaper than handling seniors and does fill in part of the gap.

That is an advantage of Hillary's plan (4.00 / 1)
and it's a nice wedge to transition to single payer.  Once you get people buying in to Medicare, you can subsidize it more and more, and grow the rolls of Medicare until it just becomes a single payer system.

[ Parent ]
It's also an element of Edwards' plan (0.00 / 0)
Your analysis is right on.  While the full force of the insurance industry would come against a straightforward single-payer plan, this sort of mechanism, allowing people to buy-in to a government program, is a sort of back door to single-payer.  Even if people choose not to buy in, it creates a good check on insurance companies and will keep them from going nutso on premium increases like they do now.

[ Parent ]
Did people here NOT know that??? (0.00 / 0)
If even informed political junkies like readers of this blog are calling the option to buy into government coverage "Hillary's Plan", then Edwards really IS in trouble.

And apparently Stoller didn't even know that key element was in ANYONE'S plan!

Doesn't anyone pay attention anymore? I guess not, or there would be more outrage, right?

[ Parent ]
Thanks for pointing this out... (0.00 / 0)
...I was waiting for someone to raise this issue.

The public option (which was conveniently ignored by Matt, I wonder why?) was the most important feature of John Edwards' plan. Now that Hillary has put her name behind it as well, it is likely to remain a feature of any Democratic health reform proposal.

This is very significant, because the public option is the back-door path to single-payer. Pragmatic supporters of single-payer ought to be promoting this feature of the Edwards and Clinton plans, not ignoring it - because when the legislative fights come, we will need to make sure the public option remains intact in the final legislation.

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[ Parent ]
the thing is (4.00 / 1)
buy into the public plan for how much? and with what money? oh, THERE's that extra $600 a month, it was in my other pants all along.

these kinds of things always sound nice when they're vague. but what seems like a "reasonable" cost to US Senators, who are all a bunch of moneybags to be blunt about it, is somewhat different from what seems "reasonable" to questionably employed people like me and my friends. we don't have employers but we're not really businesses - not yet, anyway.

the alternative seems so simple and easy to explain.

you send everyone a card in the mail and say, "show them this when you get sick." we don't need an elaborate system of subsidies and credits to help pay for it. we already have one of those, it's called the federal tax system.

i am not interested in insurance, i want health care. why i should put my effort into fighting the insurance companies for the right to subsidize them with my taxes is just not clear to me.

not everything worth doing is profitable. not everything profitable is worth doing.

[ Parent ]
Dennis Kucinich offers a Single-Payer plan (0.00 / 0)
So Matt, you can't say "all" of the candidates except Obama.  Dennis' plan: http://www.dennis4pr...

May you could have said "all top-tier" candidates. 

There is no way I would support any plan other than single-payer, and let the insurance companies, HMOs, etc. get the hell out of the way of our health care.

We don't have a health care system now -- we have a sick care system that puts care of the stockholders ahead of care of the sick.

Why would we not support Kucinich in this endeavor?  Because he's not "top-tier" ? Or are there other Kucinich issues not agreeable to progressives?  I'm just wondering, because I don't know and as I've said before, I'm very new to the scene of politics and the netroots.  Thanks.

He's not running. (0.00 / 0)
He's not raising money.  He's not really visiting the early states.  He's not polling well.  There are over 100 declared candidates for president.  Saying that you're running for president does not a presidential candidate make.

[ Parent ]
Debate participant (4.00 / 1)
I haven't seen those "over 100" declared candidates participate in the debates.  He is campaigning in Iowa and New Hampshire.  And it's unfortunate that it's all about how much money someone is raising, regardless of their message.

I'm not saying I've chosen Kucinich as my candidate, but  I think he has some good ideas.

[ Parent ]
He is nominally campaigning in New Hampshire (0.00 / 0)
By no measure does six visits constitute campaigning in Iowa.  Money isn't everything, certainly.  But he should at least be willing to get on the phones with the people who contributed to him last time.  He hasn't even matched his contributions from his 2004 campaign.  Why should he be taken seriously?  Just because he's been in the debates?  That's more a decision by the organizers of the debates than anything else.  He is a marginal candidate.  His sudden, complete, reversal on the abortion issue makes him look pandering.  His constant whining about not getting enough attention is obnoxious.  He is "running" to get attention. 

Even Dodd and Biden, also marginal candidates, have made five times the campaign stops and are raising much more money and have many more contributors. 

[ Parent ]
Agreed (0.00 / 0)
I have my own problems with the guy, and wouldn't vote for him in the primary, but I do think it does a disservice to progressive causes to refuse to take seriously the only guy promoting them.

I support John McCain because children are too healthy anyway.

[ Parent ]
Obama's SP plan? (0.00 / 0)
What, are you saying Obama did offer single payer? Or that he doesnt have a plan?

[ Parent ]
Unlikely (0.00 / 0)
Unfortunately, only 33% of Americans agree with the concept of a single-payer health-care system while 42% oppose it (as of February; this may have changed somewhat by now).  There is room for growth, as the remainder (25%) are unsure; however, it is not an issue that can be pushed in the immediate future.


Poll Doesn't Tell Us Much (4.00 / 1)
Since most people have no idea what a "Single Payer National Health Plan Overseen by the Federal Government" is, I'm not surprised by the results of this poll. This sounds expensive and bureaucratic, so anyone not paying much attention would probably say "forget it."

I think this poll mostly shows that progressives have only organized 33% of the population so far. But if a prominent Democratic presidential candidate would actually put forward a single-payer plan ("Medicare for everyone" or "the same as the healthcare system that Congress has") and pointed out that it would cost less than our current system, there would likely be greater support.

As always, our "leaders" wait for us to do all the heavy lifting before they get out front.

[ Parent ]

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