The Push for Single-Payer Healthcare Is On. Democrats Should Get on Board or Get Out of the Way.

Following the stunning collapse of Trumpcare, Bernie Sanders is leading the fight by progressives to win single-payer.

Miles Kampf-Lassin March 27, 2017

A single-payer plan would mean the United States would finally join the rest of the developed world in guaranteeing healthcare to all citizens. (Photo by Ronen Tivony/NurPhoto via Getty Images)

Update: On Mon­day, July 17, the Repub­li­can health­care plan in the Sen­ate was effec­tive­ly killed when enough GOP sen­a­tors announced their oppo­si­tion to the bill to ensure it would not pass, caus­ing Major­i­ty Leader Mitch McConnell to pull the bill from con­sid­er­a­tion.

Making single-payer a demand can provide a clear message of where politicians stand—and call out the hypocrisy of Trump, who as a candidate promised “insurance for everybody.”

The fail­ure of Trump­care to pass the House on Fri­day was a dev­as­tat­ing defeat for both the nascent admin­is­tra­tion and the GOP. For sev­en years, Repub­li­cans railed against Oba­macare, promis­ing to repeal and replace” the law as soon as they could. Trump him­self pledged to do so repeat­ed­ly on the cam­paign trail and from the Oval Office.

Yet despite con­trol­ling both hous­es of Con­gress and the pres­i­den­cy, Repub­li­cans could not get a bill through their own cau­cus in the House. Speak­er Paul Ryan, one of the bill’s archi­tects, admit­ted, This was a dis­ap­point­ing day for us.”

Democ­rats under­stand­ably respond­ed with glee. How­ev­er, besides Bernie Sanders, their side of the aisle offered lit­tle in the way of a counter pro­pos­al for how to address the very real prob­lems with Obamacare.

Trump and Ryan cor­rect­ly pre­dict that the issues with the cur­rent health­care sys­tem — from ris­ing pre­mi­ums to insur­ers pulling out of exchanges — are only going to get worse over the com­ing months and years.

Part of the rea­son is that Repub­li­cans will do every­thing in their pow­er to make sure these prob­lems inten­si­fy. Health Sec­re­tary Tom Price, a long­time oppo­nent of Oba­macare, has con­sid­er­able lever­age to dis­rupt the already frag­ile sys­tem set up by the Afford­able Care Act.

But the fun­da­men­tal fail­ures of Oba­macare stem from the law’s reliance on the pri­vate mar­ket. Why are insur­ance com­pa­nies such as Humana and Aet­na flee­ing the exchanges? Why are pre­mi­ums spik­ing for many mid­dle-class Amer­i­cans? Because pri­vate com­pa­nies are respond­ing to the log­ic of cap­i­tal: Max­i­mize prof­its while reduc­ing costs.

When Repub­li­can gov­er­nors reject Med­ic­aid expan­sion, more sick, low-come peo­ple require insur­ance cov­er­age — the health­care con­sumers who are the most expen­sive to treat. This, in turn, cre­ates a dis­in­cen­tive for insur­ers to offer afford­able plans through the exchanges, and, as a con­se­quence, providers pull out of mar­kets and costs rise for everyone.

This trend is sure to con­tin­ue if noth­ing is done to fix the sys­tem, and the only fix that will work is to expand the risk pool and include every­one. With such a sys­tem of uni­ver­sal cov­er­age, costs would be spread out even­ly and ill­ness would no longer be seen as a lia­bil­i­ty in deter­min­ing the costs and ben­e­fits of care.

Any real long-term solu­tion must take this ques­tion of the mar­ket head on by mov­ing to elim­i­nate the pri­vate health­care insur­ance industry.

The real alternative

So how can Democ­rats respond to the prob­lems with Oba­macare and the com­ing sab­o­tage? The answer is sim­ple, and incred­i­bly pop­u­lar: Push for a sin­gle-pay­er, Medicare-for-all system.

Bernie Sanders, the most pop­u­lar politi­cian in Amer­i­ca and open demo­c­ra­t­ic social­ist, plans to intro­duce leg­is­la­tion cre­at­ing a Medicare-for-all sys­tem in the Sen­ate in the com­ing weeks. Demo­c­ra­t­ic Nation­al Com­mit­tee Deputy Chair Kei­th Elli­son, a co-spon­sor of a Medicare-for-all bill in the House, has reit­er­at­ed his sup­port for the mea­sure. And as Dave Weigel reports at the Wash­ing­ton Post, more Democ­rats are com­ing around to the idea. Even Nan­cy Pelosi, who recent­ly said of Democ­rats, We’re cap­i­tal­ists, and that’s just the way it is,” is voic­ing sup­port for single-payer.

A sin­gle-pay­er plan would mean the Unit­ed States would final­ly join the rest of the devel­oped world in guar­an­tee­ing health­care to all cit­i­zens regard­less of their income. And it would great­ly reduce costs.

Plus, as Medicare for All orga­niz­er and long­time pris­on­er jus­tice advo­cate Mari­ame Kaba recent­ly explained, it direct­ly speaks to the needs of work­ing peo­ple by build­ing off of an already incred­i­bly pop­u­lar program:

What you need in an orga­niz­ing sense is you need an issue to be able to appeal to peo­ple. Medicare is what we have that is the most close to a kind of social­ist pol­i­cy in place around health­care. It’s the one that peo­ple under­stand, that they already have…You orga­nize around the things that have mate­r­i­al, direct, and urgent impact on people’s lives, and then you push those peo­ple through that fight into fight­ing for oth­er things together.

The bar­ri­ers to pass­ing sin­gle-pay­er in the cur­rent polit­i­cal ter­rain are sig­nif­i­cant. Repub­li­cans want to move in pre­cise­ly the oppo­site direc­tion, sep­a­rat­ing gov­ern­ment from health­care. And mod­er­ate and con­ser­v­a­tive Democ­rats have his­tor­i­cal­ly been resis­tant to such a plan.

But fol­low­ing the spec­tac­u­lar fail­ure of the Repub­li­can bill, momen­tum is on the side of the oppo­si­tion. This cre­ates an oppor­tu­ni­ty that pro­gres­sive groups are hop­ing to seize.

Orga­ni­za­tions such as Nation­al Nurs­es Unit­ed, the Work­ing Fam­i­lies Par­ty, the Demo­c­ra­t­ic Social­ists of Amer­i­ca and the Pro­gres­sive Cam­paign Change Com­mit­tee all hope to orga­nize the grass­roots in order to take advan­tage of this new­found push for single-payer.

From demand to reality

Much report­ing on the GOP fail­ure to pass Trump­care has focused on Repub­li­can infight­ing, but the mas­sive out­pour­ing of resis­tance from the pub­lic played a crit­i­cal role. Phone calls from con­stituents went 50 – 1 against the bill, and recent con­gres­sion­al town halls have been mir­ror images of those crashed by Tea Par­ty pro­test­ers dur­ing the fight over Obamacare. 

A con­tin­u­a­tion of this cit­i­zen engage­ment will be need­ed to move the coun­try clos­er to a sin­gle-pay­er sys­tem. In states such as Rhode Island and Cal­i­for­nia, local activists are push­ing pro­pos­als for sin­gle-pay­er. And while the bills sup­port­ed by Sanders and Elli­son are unlike­ly to pass now, they pro­vide Democ­rats with a ral­ly­ing point to demand a tru­ly uni­ver­sal health­care sys­tem — a propo­si­tion sup­port­ed by 58 per­cent of Americans.

This would also open the door to pro­pos­als that lay the foun­da­tion for sin­gle-pay­er, whether it’s allow­ing the import of cheap phar­ma­ceu­ti­cals from Cana­da and oth­er coun­tries, intro­duc­ing a pub­lic option on the exchanges or low­er­ing the Medicare age to 55 — a pop­u­lar idea that near­ly became law with the pas­sage of Oba­macare before it was tor­pe­doed by then-Sen. Joe Lieber­man. Low­er­ing the Medicare age would clear the path for even­tu­al­ly tak­ing it all the way to zero.

The crash­ing and burn­ing of Trump­care will ben­e­fit mil­lions of Amer­i­cans. Yet mil­lions con­tin­ue to live with­out afford­able health­care. Mak­ing sin­gle-pay­er a demand pro­vides a clear mes­sage to politi­cians: Where do you stand? It also pro­vides an oppor­tu­ni­ty to call out the hypocrisy of Trump, who as a can­di­date promised insur­ance for everybody.”

Sin­gle-pay­er would do that, and it would cost con­sid­er­ably less than the cur­rent sys­tem. That is a clear and sim­ple mes­sage, and it’s a win­ning one for 2018 and beyond.

Miles Kampf-Lassin, a grad­u­ate of New York Uni­ver­si­ty’s Gal­latin School in Delib­er­a­tive Democ­ra­cy and Glob­al­iza­tion, is a Web Edi­tor at In These Times. Fol­low him on Twit­ter @MilesKLassin

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