Single Payer on The March

By Lambert Strether of Corrente.

Last week was quite a week for single payer advocacy; I haven’t been this encouraged for some time. Volatility, as I keep saying, creates opportunity. I’m not going to speculate on what Trump’s replacement plan might be — apparently he’s decided against punting after all[1] — except to point out that ObamaCare is already a Republican plan, and that the most the Republicans can do is send more people to Pain City instead of HappyVille than are already headed there; the effects of any replacement, that is to say, will be marginal (which isn’t the same as insignificant) because that’s what shifting from the mandate to a continuous coverage requirement, for example, is: Tinkering with the Rube Goldberg device at the margins. Now, I personally don’t see how Republicans do even that without losing voters they need in counties in swing states in 2020, but then four years is a long time in politics. And maybe they can gerrymander the coverage so their own constituents skin by.

What encouraged me? Two things: First, Jessi Bohon’s advocacy of Medicaid for All from a Christian perspective at a Tennessee town hall; and California’s introduction of a single payer bill, with the support of National Nurses United. I’ll look at those two topics, and then turn to consideration of how the Women’s March and the Resistance Manual’s prioritize single payer as a policy issue.

But first, a word on the politics of single payer. As as is well-known, single payer is very popular. Pew Research in January, 2017 gives the trendlines:

You’ll notice that support for “government responsibility” — presumably this means single payer, as opposed to a national health service, not on offer anywhere — peaks in 2006 at 64%+, gradually diminishes to a trough of roughly 50% from 2009-2015, and then rises steadily back to 60% in 2017. It’s not too far-fetched, I think, to attribute the 2006 peak to the Democrat takeover of the House and Senate, with people believing the Democrats couldn’t possibly screw up a no-brainer like Medicare for All — that was one reason I felt OK going to Maine and “going naked” without health insurance what I thought would be a year or so, until the Democrats replaced MaineCare with a Medicare for All; can you believe I was really that stupid? — with the subsequent decline happening as people became disillusioned by the various betrayals involved in ObamaCare’s passage, and then by how crappy it was. Then along came 2016, and — nobody could have predicted this — Sanders’ energetic advocacy lifted single payer’s support right back up to normal. So who are those supporters? Pew once more:

More than eight-in-ten Democrats and Democratic-leaning independents (85%) say the federal government should be responsible for health care coverage, compared with just 32% of Republicans and Republican leaners…. The belief that the government has a responsibility to ensure health coverage has increased across many groups over the past year, but the rise has been particularly striking among lower- and middle-income Republicans.

The survey also finds continued differences on this question by race and ethnicity as well as income. A large majority of blacks and Hispanics (85% and 84%, respectively) say the government should be responsible for coverage, while non-Hispanic whites are split on the issue (49% agree, 49% disagree). And while about three-quarters of those with family incomes of less than $30,000 per year (74%) say the government should ensure coverage, only about half (53%) of those with incomes of $75,000 or higher say the same.

So, if you squint hard and envision the Democrat Party as it used to be, instead of the party dominated by smug squilllionare-servicing professionals it is today, you can see that not only is the Democrat base for single payer, but Republicans are there for the taking as well (and remember how tight 2016 was; the Democrats wouldn’t need to pick up very many).

Jesse Bohon and the Christian Case for Single Payer

A word about “the Christian case”: In the steam-powered era of blogging, 2003-2006, I, and many many other “progressive” bloggers, did a good deal of mocking and shaming of Christianity and Christians; that was one aspect of snark. And the Pharisees of the Bush administration richly deserved it! But deserved or not, the bottom line is that the mocking and shaming — a precursor, or even an earlier brand, of today’s “callout culture” — simply didn’t work politically; Bush, after all, won two terms, started (with Democrats’ help) the Iraq War, and laid the foundations (with Democrats’ help) for the surveillance state that Obama consolidated and normalized. I don’t know what the opportunity cost of the immense mental and verbal effort sunk into snark was, but it’s certainly possibly the cost was connecting with voters. So today, I don’t much care what route people take to supporting universal programs that provision concrete material benefits for everyone, especially the working class. If their path lies through faith, then so be it. That said, here’s the video (which I ran in Water Cooler as soon as it crossed by Twitter feed). Jesse Bohon at a Tennessee town hall:

Here’s the transcript. Marie Claire:

My name is Jessi Bohon and I’m in your district. It’s from my understanding the ACA mandate requires everybody to have insurance because the healthy people pull up the sick people, right? And as a Christian, my whole philosophy on life is pull up the unfortunate. So the individual mandate, that’s what it does. The healthy people pull up the sick. If we take those people and put them in high-risk insurance pools, they’re costlier and there’s less coverage for them. That’s the way it’s been in the past, and that’s the way it will be again. So we are effectively punishing our sickest people. And I want to know why not, instead of fix what’s wrong with Obamacare, make companies like Aetna that pulled out and lied to their consumers about why they pulled out, and said they pulled out because Obamacare was too expensive, but they really pulled out because of a merger. Why don’t we expand Medicaid and have everybody have insurance?

Bohon’s question went viral. CNN, amazingly, or not, proved that they are owned by the looting professional classes by simply erasing the key part of Bohon’s question, helpfully underlined above). The Atlantic, however, used the video as a story hook to highlight the political opportunity:

A Political Opening for Universal Health Care?

The political appeal of a single-payer, universal health-care system is perhaps best outlined by Jessi Bohon, a high-school teacher who attended a raucous and often angry town hall with Republican Representative Diane Black in Murfreesboro, Tennessee, last week.

[I]n the turmoil over the fate of Obamacare, the idea of universal health care has emerged as a third way among voters in both parties. The health system the mainstream GOP opposes most is now one some of its voters support—potentially making Price’s task of replacing Obamacare all the more complicated.

Were they to take the plunge, Democratic candidates could run as challengers in upcoming elections on a third way of health reform: neither extending unpopular pieces of a program nor rolling back coverage, but giving everyone Medicare. And if the Democratic Party were to support universal health care, that might put pressure on Republicans, who wouldn’t want to lose voters who fear loss of coverage or doctors under a massive repeal.

Thus the precariousness of the Republicans’ position.

Slate inadvertantly gives the cultural reasons, if I may so dignify them, why Democrats might find this hard to do. But first the headline:

Meet the Teacher Whose Powerful, Christian Defense of Obamacare Made a GOP Town Hall Go Viral

Note that the editor who presumably wrote the headline was just as dishonest as CNN; the headline, too, erases the key part of Bohon’s question. To be fair, the reporter doesn’t erase it, and draws Bohon out as follows:

Yet when I ask Bohon what she hopes people get out of her burst of viral celebrity, she doesn’t mention religion or health insurance. She returns to her childhood, to the stereotypes Americans have of Appalachia and the South. ‘There are people in Tennessee, there are people from these little rural areas, that are different than they are categorized to be.’ And what might that be? ‘Hillbilly dumb.’ That’s wrong, she says. ‘I learned everything about taking care of your community growing up there.’

If the Democrats really want to use single payer as the road back to poltical power, therefore, they are also going to have to give up the snarky insults about how stupid everybody else is. That will be hard for them. It will be especially hard for them if the Clintonites maintain their death-grip on the party leadership positions, since insulting non-Clintonites is their stock in trade. Bohon, for example, could be said to “cling to” her religion. Eh?

Finally, here’s Bohon’s Op-Ed in the Washington Post, where she reflects on the town hall and advocates for single payer directly:

As a Christian, I defended Obamacare. But I really support single-payer

But the truth is that I do not actually believe that the ACA is the best way to insure people. In fact, I am ashamed and afraid that this video might have done more harm than good. In my view, Christians shouldn’t be satisfied with health-care policy that leaves anyone out, especially those who need care most but can afford it least. Christians should support a universal, single-payer system.

If I had a chance to address our leaders directly again, I would say this: Christianity demands that we make sure all people have health coverage. In other words, I would have focused instead on the Christian case for universal, single-payer health insurance, which would protect all Americans. And if Republicans want to campaign as Christians, they should lead the way.

In my view, it is immoral for health care to be a for-profit enterprise. Insurance companies are making enormous sums of money off the sick while people are struggling to pay their medical bills. Patients even die sooner when nonprofit hospitals switch to making money.

Preach! As we say.

California Introduces Single Payer Legislation

From the San Jose Mercury News:

SACRAMENTO — In a surprise move made in response to President Donald Trump’s push to repeal and replace the Affordable Care Act, two California lawmakers Friday introduced legislation to replace private medical insurance with a government health care system covering all 38 million Californians — including its undocumented residents.

“We’ve reached this pivotal moment and I thought to myself: ‘Look, now more than ever is the time to talk about universal health care,'” one of Senate Bill 562’s authors, Sen. Ricardo Lara, D-Bell Gardens, said in an interview Friday.

The Healthy California Act, co-authored by Sen. Toni Atkins, D-San Diego, was submitted just before the deadline for new legislation. It doesn’t yet offer many specifics other than the lawmakers’ intent: to create a so-called single-payer system that would pay for coverage for everyone.

In other words, the best defense against Trump is a good offense. (I view including illegal immigrants in the program pragmatically; if that’s what’s needed to secure passage, then so be it. If it’s a dealbreaker, dump it. Separately, it makes sense to get illegal immigrants into the system for vaccination, transmissible diseases, and to manage epidemics.) Of course we’re going to need to see the details, but California’s GDP is about the size of France’s, so there’s absolutely no question of scale, as there was with Vermont (and possibly Colorado).

Happily, National Nurses United is strongly in favor of the bill:

RoseAnn DeMoro, executive director of National Nurses United, the largest U.S. organization of registered nurses, said the union would mount a “major mobilization” to try to enact a single-payer system in California.

She said she believed it had a better chance than in years past because of President Trump’s efforts to overturn the Affordable Care Act, a more active political base, and a new crop of state legislators who are younger and more open-minded.”It is one of the most salient issues of our time,” she said.

At this point, it’s important to remember that establishment Democrats — hold on to your hats, here, folks — worked to prevent single payer from passing in Colorado. Democrats also sabotaged previous efforts in California. Health Care Now:

Though it’s passed the legislature twice before, a bill to establish a single-payer universal health insurance system in California failed in the state senate in January.

Not surprisingly, the bill received no Republican votes, but it fell just two votes short of passage when two Democrats voted no and four Democrats failed to vote, despite intense lobbying efforts by community and some labor health care activists.

Angry activists pointed to the fact that five of the six errant Democrats had received money from the insurance industry and Big Pharma, ranging from $100,000 to over $250,000. Three of the six senators had been endorsed by the California Labor Federation which, along with unions such as the Service Employees and AFSCME, was on record supporting the single-payer bill. The California Democratic Party was also on record supporting it.

But when Congress passed federal health reform in 2010, defending that bill, as well as President Obama, became paramount for many Democrats. It became more difficult for legislators to vote for a single-payer bill that might be interpreted as deserting the president, and the Democratic leadership refused to put the bill up for a final vote in the Assembly.

In other words, ObamaCare did exactly what Heritage Foundation designed programs like it to do: Obstruct single payer, because markets. But that was 2010. This is 2016. In 2010, we had no experience with ObamaCare. Now we know all about it.

I’m really starting to take a “Silence = Death” view of single payer. #SaveTheACA is not enough, not nearly enough. In fact, merely saving the ACA is not only political malpractice, it’s a failure to act in solidarity with the (predominately female, and female-led) National Nurses United, it’s a failure to stop throwing hundreds of billions of dollars yearly down the open maw of the health insurance industry, and it’s a failure to prevent tens of thousands of excess deaths yearly (Blacks being especially hard hit by the absence of universal coverage).

Bringing me to the #TheResistance. They’ve been contacting a lot of Congress Critters, and making a lot of calls. What are they saying about Medicare for All?

Where’s the #TheResistance on Single Payer?

Let me caveat that when I say the #TheResistance, I mean the national leadership; #TheResistance to which Neera Tanden proudly belongs. I would be very, very happy to hear about local resistance efforts on behalf of single payer. So, first let’s look at the Women’s March. There’s no action that has anything to do with single payer, so we’ll have to rely on their miserably inadequate and mealy-mouthed Principles:


We believe in an economy powered by transparency, accountability, security and equity. All women should be paid equitably, with access to affordable childcare, sick days, healthcare, paid family leave, and healthy work environments. All workers – including domestic and farm workers, undocumented and migrant workers – must have the right to organize and fight for a living minimum wage.

What does “access to” “health care” even mean? (In my reading, “affordable” applies only to “childcare,” and isn’t distributed over all the programs advocated, because “[affordable] sick days” makes no sense.) Apparently, therefore, a program even worse than the “Affordable Care Act” would comply with the Principles. And then:


We firmly declare that LGBTQIA Rights are Human Rights and that it is our obligation to uplift, expand and protect the rights of our gay, lesbian, bi, queer, trans or gender non-conforming brothers, sisters and siblings. We must have the power to control our bodies and be free from gender norms, expectations and stereotypes.

An LGBTQIA with a $10,000 deductible who can’t afford care can hardly be said to have control over her own body, surely? Were I inclined to adopt the language of identity politics, I’d go so far as to claim these Principles are coming from a place of privilege!

And now the Resistance Manual. To be fair, they mention HR 676:

And they mention PNHP on their health care organizations page:

But when it comes to action… Well, here’s the original:

Since the Resistance Manual is a wiki, I set up an account and made some changes, helpfully highlighted:

The changes are now awaiting approval. It will be interesting to see what happens! Readers, if you can, would you monitor the page?


This #SaveTheACA bushwa has to stop. It may be necessary, but it’s not sufficient. #TheResistance at all levels should stand in solidarity with National Nurses United and support Medicare for All, and demand it in their calls and contacts. The Neera Tandens of this world should swallow hard and do the right thing. The opportunity is there, as the Sanders campaign proved. As do viral videos like Jesse Bohon’s.


[1] One might speculate that Trump is pandering to the market fundamentalists in the Republican establishment, whose votes he will need in case of impeachment.

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


    1. susan the other

      ditto Lambert; this is a great piece. we all suspect anything named “#resistance” has gotta be pure pharma/insurance propaganda – now we’ve got the evidence and the names behind it. And all the other ACA support nonsense. Notice how exploitative it is, using the identity politics factions they created to vote for something in confusion and enthusiasm which is bad for them. These guys are pros, very dangerous ones.

  1. LT

    “continuous coverage” should set off alarm bells for Californians, even those who support Obamacare.
    A few years ago, auto insurance companies tried that on a ballot initiative and failed.
    Although there are insurance mandates for auto drivers in Cali (but remember transportation has public options, ride sharing and other kinds of options), they immediately saw through the “continuous coverage” idea as a way to raise rates.

  2. JCC

    I just went to the site… the first bullet point under “How You Can Resist” now says:

    “Call your member of Congress by dialing tel:844-6-RESIST and tell them to vote against repealing Obamacare.”

    Someone dropped the second part of the sentence, “as a first step toward Medicare For All”

    That was fixed nicely… Medicare For All seems to be out!

  3. allan

    Some parts of the professional left [sic] might be starting to get the message.
    I recently received a hardcopy fundraising appeal from Public Citizen
    that was completely about Single Payer,
    not like anything that I had seen from a D.C. organization in my mailbox before.

    1. Katharine

      This is certainly not because it’s a new issue for them. It doesn’t seem fair to talk about their starting to get the message when they were among the earliest messengers.

      Starts with:


      Public Citizen’s Health Research Group affirms that access to high-quality health care is the right of every citizen. “A major effort must be devoted to insuring high quality health care as the right of every citizen.”
      -Address by Dr. Sidney M. Wolfe, director of Public Citizen’s Health Research Group, to the Third National Consumer Health Conference – Feb. 25, 1972, Boston, Mass.

      1. allan

        Thank you for pointing that out, and kudos to Public Citizen for having been one the case for so long.
        I was making more of a comment about what messages fundraisers in D.C.
        currently think will resonate with possible donors.

  4. dcblogger

    The Sanders campaign transformed the politics of single payer. No longer possible to be marginalized. Any many online activists who were fooled by the “public option” have clued in and are calling for single payer.

  5. Knifecatcher

    This fits nicely with an epiphany I had the other day: the Republicans haven’t been able to propose a replacement for Obamacare precisely because Obamacare incorporated all of the Republicans’ proposals on how to fix health insurance. It’s Mitt Romney’s program!

    The nice thing about this formulation is that it’s an equal indictment of the Dems and the Repubs.

  6. different clue

    The #theResistance is a Clinton-Obama front group. As such, it lives to muddy the waters and divert, pollute and destroy anyone else’s drive to Single Payer.

    As such, genuine legitimate improvement groups will have to secure themselves against Clinton-Obama infiltration and subversion coming from #theResistance and from un-named and under-cover sources. Such genuine improvement groups will have to think of something else to call themselves.

    I offer a few ideas just to stimulate thought.
    #ClintonWatch ( devoted to naming, outing, doxing every Clintonite personnel wherever they are working or hiding.
    #ObamaWatch (devoted to naming, outing, doxing every Obama personnel wherever they are working or hiding.

    If anyone wants to use any of those #phrases, I give them away for free. If anyone DOES want them, better grab them beFORE Clintonite and/or Obozoid agents squat-grab them for “false-flag” confusion operations.

    1. Ivy

      #TheResistance is likely just #TheConductance under a misleading name.

      From our friends in the electrical engineering and physics worlds: Ohms for resistance, Mhos for conductance.

      What are the front groups really conducting, and for whom?

    1. Spring Texan

      I’m hesitant on this because yes though Clinton, Obama and their cronies ARE the enemy, MANY of their innocent and hoodwinked followers are NOT and are good earnest people who want the same things we do. I think we need to be discerning but not offend them (while not going along with bullshit from the top either).

      It’s a fine line to walk but I think it’s the place to be. We don’t need Clinton but we need a bunch of her followers (and some Trump followers too) — so, respect!

      Which makes me not too comfortable with #NotMyResistance.
      #NoBamaNoClinton and
      though I’m sort of OK with #ClintonWatch and #ObamaWatch (if we’re just watching for honchos not supporters)

      and I loooovve
      because those Clinton supporters that DO want the same stuff we do will NOT be put off by that (even though Clinton would be) and in fact will love the idea! that will unite us!

      let’s focus on the real principles, like #NewDealRevival or #JobGuarantee or something, that can unite

      1. different clue

        You raise some good points. You may be correct. I still like my approach but that may be due to my bitterness as a Bitter Berner.

        I would suggest that different people try different approaches and compare notes from time to time to see which approach is making most gains. People with Twitter accounts could launch all kinds of #TwitterWords and see which ones achieve Darwinian success, perhaps even enough Darwinian success to feed back into Analog Meatspace with something to build a movement on.

        I wonder how far down the Honcho Ladder a ClintonWatch and an ObamaWatch should go and where they should stop. Obiously the higher and highest levels of Clinton Honchos and Obama Honchos pose the higher and highest levels of danger to any legitimate group they seek to infiltrate.
        So starting with the biggest fish and working downward to expose and exclude all the middle fish might be a good way to start. But remember, the candiru is a very little fish but it can cause a lot of very big pain. Perhaps the candirus should be identified by their behavior and excluded by profile, not by name at this level?

  7. funemployed

    I’m all for single payer, but I worry about CA being able to adequately finance it when the inevitable economic slump/recession/depression hits. I also worry about health care migrants increasing costs. Even though it does take a year to establish CA residency, if I had a chronic condition costing me 7K out of pocket a year, I’d be scheming to move there or set up a dummy address the day the law passed. Probably wouldn’t be huge numbers, but it wouldn’t take all that many to make a significant budgetary impact given the differences in health care costs between the expensive few and the inexpensive many.

    Still, better than nothing while we fight for federal single payer.

    1. dcblogger

      single payer would be cheaper than what California is doing now. Cut the insurance companies out of the equation and every thing become simpler and cheaper.

      1. Adamski

        The problem is it’s more difficult for the states to borrow than the federal government. And as far as I can tell California’s constitution requires a balanced budget, except for capital spending, since Schwarzenegger (if anyone knows otherwise please say so since the text is unreadable to me). When there’s a recession, CA would have to cut other spending to keep the single payer programme the same, and may cut it too.

        1. aab

          Or change or repeal Prop. 13. Or renegotiate with Nestle over what it pays to take and sell California water elsewhere. Or renegotiate with the Prison Guards Union.

          Why, if Jerry Brown and the legislative Democratic supermajority wanted to, it could do all sorts of things right now to increase state revenues flowing to the government to create the necessary surplus to protect health care during cyclical downturns.

          Every time I turn around, California asks me to approve a bond initiative. I don’t like that, and think they should cut that out and just get rid of the Reagan era restrictions on taxation like Prop. 13. But if they can float bonds to pay upper administrators in the UC system (I believe there was a notorious bond initiative that was sold to us as “helping the kids” that turned into “funding several new layers of Deans and their offices”), they can float bonds to fund health care, it seems to me.

          I’m sick of TINA. There’s always an alternative. If France can have universal health care, so can California. Being tied to the US system and its fiat doesn’t seem to me to be innately worse/more restrictive than being tied to the EU system and its fiat. Can anyone explain to me how that is incorrect?

          1. jrs

            A repeal of Prop 13 is never going to happen. So that is a fantasy budget. Because face it Prop 13 is popular. Not fair or just perhaps but popular.

            1. aab

              I offered several different ways to get more revenues — and that was off the top of my head. California’s neoliberal Democratic government leaves lots of revenue on the table because they won’t go after corporations. And it should be a no-brainer to amend Prop. 13 to eliminate coverage for corporate property, especially to fund health care.

              Do you have recent data on Prop. 13’s popularity? Because we have a growing housing crisis in this state. Other than corporations, I bet the actual number of California voters benefiting in a significant way from it is not a majority, and is shrinking. It’s a scam, and a decent pol ought to be able to run on getting rid of it — if they wanted to, and could fund their campaign statewide without establishment support. (That’s the downside of being a huge state.)

              1. JCC

                As a (small) property owner in both CA and NY I’m not so sure Prop 13 is bad at all for homeowners. A $175K home in CA costs around $1500.00 to $2000.00 a year in taxes. That same priced home in a rust belt upstate NY town would cost you anywhere from $8K to $14K per year in taxes.

                I would agree on eliminating Prop. 13 coverage for Corporate property, but you would have a hard time winning the elimination of Prop. 13 for homeowners, particularly those homeowners with a wider experience than just owning property in CA.

                1. Ivy

                  One favorable aspect of Prop 13 is that the taxes include bonded indebtedness. People have, at least theoretically, a vote in that. Time and again elected representatives forget who elected them and run off with whatever lobbyist or group that is willing to fund their lifestyles, to the detriment of the public. Prop 13 was in part a revolt against the runaway tendencies of anonymous folk in Sacramento. There were plenty of side-effects however the underlying angry populist message did not go unnoticed.

              2. Jack

                “California’s neoliberal Democratic government leaves lots of revenue on the table because they won’t go after corporations.” You hit the nail on the head and not just for California. The ongoing reductions in the corporation tax is an injustice. I had been thinking about this issue (expanding Medicare) myself and realized how easy it would be to expand Medicare just by increasing the corporate tax. Right now corporations only pay 11% of tax revenues. It used to be well over 30%. 55 million people are covered by Medicare at a cost of $12.5 k per person. Adding those 55 and over would add another 25 million to the rolls. You could easily cover that cost just by increasing the tax burden of corps by 2% of revenues. Drop the age down to 45 and you just about cover most people who are going to need any type of expensive coverage. California could easily reduce the avg Medicare cost by insuring everyone and streamlining its system like the VA (VA spends $7,200 per vet yearly). And never mind the fact that low corporate taxes are just another way of shielding the wealthy from taxation.

                1. Adamski

                  Hyman Minsky gave an interesting argument to abolish corp tax altogether which I’m open to. Under imperfect competition, which is always, corp tax would tend to get passed on in prices. There’s no inflation today but if we want back to full employment it becomes a factor. Plus corps move overseas etc. So shut them up permanently by abolishing it and taxing the dividends instead.

                  The stuff about Prop 13 etc on this thread is still misconceived I think because whatever you propose, it will be harder for CA to have countercyclical fiscal policy than the federal govt. Ask Detroit! And if you resort to repealing Prop 13 or using MMT I think you have proven my case…

    2. aab

      If you move there and have to reside for a year, then you’re bringing assets with you or working and contributing to the economy that creates the productivity that funds the health care system. Presumably, you will continue to contribute, and possibly benefit the economy more than your chronic condition costs it, especially if the universal health care system does a good job of helping you manage your chronic condition.

      Nothing costs more than dying in the current system. I strongly doubt lots of 80 year olds will migrate to California to die here, particularly given that their circumstance is better addressed (in terms of coverage) than almost any other health event. California loses a lot of productivity because of poor health care. There are costs throughout the economy on a daily basis due to people wasting time and money trying to get health care or manage their illnesses and conditions on their own. I’m sure it cost New York and New Jersey money when several train engineers with undiagnosed sleep apnea due to lack of health care access (note: they were employed, so presumably had “insurance”) separately fell asleep and crashed their trains, killing hundreds of people, IIRC, and causing millions of dollars of damage.

      Yes, health care migration will be something that needs to be addressed. But if this works, it could also put pressure on the currently red states to our east to implement it, because their citizens will be able to see first hand that it works, and some of those health care migrants will be valuable to those red states and they’ll want to retain them.

      And Prop 13 could be repealed or at least amended to no longer cover corporate property, if more tax money is needed. I realize that a national plan funded by fiat currency would be superior, but the ruling class shell game and shadow puppet show has prevented that from happening. California is a one party state. The Democrats can’t blame the Republicans for anything here. If we must use the Canadian approach to implementing universal health care state by state, it really has to start in California.

      1. Science Officer Smirnoff

        On Prop 13 (again). Prop 8 was competing against Prop 13 at the time of the latter’s enactment. It restricted Prop 13’s overbroad benefits to owner-occupied homes.

        I say overbroad since (forgive my quote of myself from last Oct 9th):

        Instead of goosing (real estate) asset inflation by the combination of California’s Proposition 13 “tax abatement” and capital gains tax exclusion on real estate sales (up to a limit) make it actual tax abatement by:

        1 giving back some of the capital gains at selling time due to property tax limitation during occupancy*

        2 so property inflation is moderated and education is better provided for (do think of California universities’ tuition hikes in recent years and school teaching salaries in general)

        When California made the decision on which pieces of tax “reform” in the Clinton-Republican Taxpayer Relief Act of 1997 to mimic or reject for the state income tax, it copied only cap gains cuts on real estate sales, the opposite of an anti-asset inflation regime.

        (A double whammy for youth getting hit on their tuition costs and starter homes, if any)

        3 Furthermore, limit Prop 13 benefits (so abated) to owner occupied-homes—as originally proposed in Prop 8 but piggishly fought by commercial interests to the triumph of Prop 13.

        * in the unlikely event there are none—the world must be ending

        P. S. Of course, hard to predict how much to give back—it’s like predicting oil prices as drillers react to price spikes or dives (etc.)

      2. Inquiring Mind

        80-year-olds are covered by Medicare…so let them come to CA! Seniors generally spend more than they earn, so they would boost the economy for the young.

    3. different clue

      I read somewhere that the Health Care System in France is at least partly funded by a special sales tax on everything that gets bought in France. That way every single thing-buying inhabitant of France is permitted to feel that they pay SOMEthing and therefor have an equal right to equal access to care. It appears crafted to live out one of the Laiicist All-Equal Republican virtues which France upholds.

      California could do the same and then have other taxes to make up the difference. But with a France-style health-care-dedicated sales tax, everyone in California would be paying SOMEthing . . . EVen the illegal aliens. That might reduce the pressure to say “no illegal aliens allowed coverage under Single Payer Canadafornia Care.

      1. JTMcPhee

        “Conservatives” just love them some consumption taxes. Wonderfully regressive! What a great idea! /s

        How ’bout a “consumption tax” just levied on “financial transactions?” Any recent “scholarship” on how much $$ that would “raise,” and knock-on social effects on “high-speed trading” and pump and dump and other 10-bigger features of FIRE?

    4. Dead Dog

      Yes, but if the government doesn’t simultaneously re-nationalize a good portion of the private hospitals and medical centres – putting the clinicians on a public servant, reasonable salary, footing, then the costs to the public will be unaffordable.

      And, this will be the rub (where will the money come from), and the insurance sector will cry foul too, making it almost impossible to implement.

      MMT, ie funding without borrowing or taxing, won’t fix it as the whole health sector would simply keep charging what they do. And for most clinicians, incl doctors, specialists, pharmacists, dentists etc. the 0.5m + salary is what they aim for and many succeed in getting – which IMHO is way out of whack with what the rest of us get.

      The final issue I will mention is that when your health care becomes free or at minor cost, we tend to consume more of it. So some sort of means tested copay seems reasonable.

      1. katiebird

        The final issue I will mention is that when your health care becomes free or at minor cost, we tend to consume more of it. So some sort of means tested copay seems reasonable.

        “Tend to consume more” …. If that’s true it might just be because we can afford to go when we are sick enough to need it.

        Your statement is very close to Obama’s Skin in the game Policy. My belief is that being sick is all the Skin in the game We should need to deserve care.

        1. Anon

          The way health care is provided needs to change with single payer, I believe. Recently, I went to an Urgent Care facility (because my PrimPhys. wasn’t available for two weeks) and was examined and treated by a Nurse Physician. Expand the Urgent Care model as a “first responder” for people, and costs/service and employment opportunities for sub-Physician technicians improves. (As does health outcomes, I would imagine.)

          Most folks don’t need specialized intervention. They need regular treatment for regular ailments.

          1. JEHR

            You can also think of single payer healthcare in terms of preventing illness through education re diet and exercise.

          2. Normal

            PAs are one of the biggest profit centers for a medical practice. Currently, They make an average of $100k vs $190k for a pcp, but they bill out at the same rate.

            The only way that PAs can be a solution is for reimbursements to reflect costs.

            And another major problem – the profit motive is causing practices to have more PAs and fewer MDs.

        2. Dead Dog

          for many, particularly those with children, a $2 or even $5 copay is hard to find in the budget, so some poorer citizens need to be able to access healthcare services, even dentists, without a copay.

          Skin the game – he said this in relation to controlling costs.

          When you are being funded and lobbied to keep the status quo rent seekers, that’s the sort of thing you would say.

          When a market is failing, a responsible govt will step in and provide the services direct and at lower cost, by taking the rentiers out of the system (and this includes the clinicians). How this can ever be achieved… getting more light on single payer is a good thing. But does the average punter even know what this term means?

          1. jrs

            Besides that you have to miss a day of work to go to the doctor since they never work weekends, so it’s using a vacation day, so you do it if you must, and for a yearly checkup if your disciplined, but it’s using a precious vacation day, if you even get them and they are few and far between in this country, and who wouldn’t rather go to the beach on their vacation day?

      2. Anon

        “California Single Payer” is only in the conceptual stage; no details. My guess is the initial legislative bill is a finger in the wind to get a sense of public support.

        As for seniors moving to Calif. to die, most probably have Medicare coverage and would likely stay in/around relatives. (Calif. is an expensive place to live, or die.)

        Your comments on Prop. 13 are accurate. Commercial property is regularly schemed on sale to avoid paying appropriate increases in property tax. Originally, the residential/commercial property property tax income was ~40/60. It is now ~60/40, with many commercial properties un-reassessed after multiple transfers.

        1. JTMcPhee

          The snotty Yuppies around here (Tampa Bay Area) who want the rest of us to build billion-dollar “world class” new stadiums for the carpetbaggers who own the Rays and other “sports franchises,” regularly refer to the ordinary non-sports-going people in area they live in but despise, as “just living in God’s waiting room.”

          The Rays owners, as I recall, got their billions in walking-around money by selling the complex code they developed for various kinds of derivative products (sic) to I think it was Bear Stearns or one of those. So a double-F–k-you to the mopes from these little sh!ts, who could pay to build their own stadium if they wanted it so bad.

          Something like 15% of the locals have any interest in going to games, anyway, or in MLB except for when their home teams (most of us are from Somewhere Else) are playing the Rays. So why do these t_rds think the rest of us, about a million and a half people in the area, are happy to pay over $1,000 per person, man, woman and child, to give these cretins a gift of a billion bucks? They already have a sweetheart deal on the Tropicana stadium.

          One more: Rays tickets were getting more expensive, parking is a ripoff, and don’t ask the price of a hot dog and a beer because if you have to ask, you can’t afford it. One of the Rays owners said “The new stadium is for the wealthy to go to and be seen. The poorer people can stay home and watch the gamed on TV.”

          1. Adam Eran

            Worth remembering in all the pro sports grifts: Professional sports in the U.S. have an exemption from anti-trust prosecution. That means they can charge monopoly rents, legally. In plain terms: they can threaten to leave and extort stadiums from wherever they are. Al Davis extorted both Anaheim and Oakland for the Raiders.

            …And 75% of W’s net worth comes from persuading the citizens of Anaheim to pony up for a Texas Rangers’ stadium.

            London apparently has more than a dozen soccer teams, but none are able to extort stadiums.

            –Facts all courtesy David Cay Johnston

      3. marym

        H.R. 676: provider fees are negotiated by the government, and for-profit private provider entities must convert to non-profit.

        As far as people using too much health care, that’s just a scare tactic – countries that provide universal health care spend less and produce better outcomes than the US. People can get preventive care and care before conditions become more serious. Greatly reduced administrative fees also reduce costs.

        Means testing turns a universal benefit into a welfare program much more at risk for politicians to attack.

        1. aab

          What she said.

          But also, I think some citizens “consuming more health care” is preferable to some oligarchs consuming more hookers and blow, as happens in our current system.

      4. different clue

        I am very well covered where I work. Thank you for pointing out that I have not consumed nearly as much low-cost-to-me health care as your theory instructs me to do. I think I will run right out and get a couple of kidney transplants for the natural fun of it. Better consume that low-cost-to-me health care while I still have it.

      5. leftover

        Public healthcare costs are already unaffordable…and getting more so every day. We don’t need to nationalize the healthcare system. It’s an attractive idea, but not necessary. Consider Canada.

        Take a look at Gerald Friedman’s 2013 funding proposals. (pdf) Particularly Figure 2 on page six. We can achieve universal healthcare, saving most Americans a great deal of money, through a publicly funded, privately delivered nonprofit healthcare system.The key is progressive, as opposed to regressive, taxation.

    5. Adam Eran

      Yet another argument for public banking. Currently, California sets aside a multi-billion-dollar “rainy day” fund for such emergencies. Everyone paying attention knows this fund is taken out of budgets for schools, the indigent, medicaid, etc… In other words, it’s a direct cost to social safety nets, and not much else.

      Why have such a thing if a state bank could offer the state a line of credit instead (secured by future tax collections)? North Dakota does that.

      In fact public banking has a long history in the U.S. FDR used Herbert Hoover’s Reconstruction Finance Corporation to fund the Tennessee Valley Authority and the first Bay Bridge (connecting San Francisco to the East Bay). California just rebuilt that bridge to improve its earthquake resistance. Who financed that? Goldman Sachs. (Eisenhower terminated the RFC)

      IMHO, until the public realm (and in the largest sense of that phrase, the environment) commands as many economic resources as the private profit of the likes of Goldman Sachs, we’ll continue to slide further into a dystopian oligarchy.

  8. Isolato

    Go get ’em. It was Jane Hamsher that re-engaged me w/the possibility of political struggle on this issue years ago.

    Lotta’ grifting in this sector (EpiPen, much?), and it isn’t going down to moral suasion, But just as Occupy is not given anywhere near enough credit for their transformation of our vocabulary, Bernie deserves some credit for putting the single-payer issue back out there…and, if DJT was the dealer he wishes to be…he could steal a march.

    If we cannot invest in the health and education of our children (instead of sticking them w/the bills) then we are an utter failure as a society.

  9. meeps

    I just monitored the Resistance Manual Wiki. Clicked on “Latest Revision” and Lambert’s ever so useful and appropriate edits are there. Well done, sir!

    Stay tuned for “Approved revisions…”

      1. JTMcPhee

        Not altogether gone, for those who go to the site and are willing to wander through links and footnotes, but yes, “liquidated” in any ordinary understanding. Is it worth continuing to insert and parse and modify the content?

        Here’s the text as of 15 minutes ago:

        Call your member of Congress by dialing tel:844-6-RESIST and tell them to vote against repealing Obamacare and to support positive legislation listed below.
        Find out when your Senators and US Representative are holding town halls and other Upcoming Events/Opportunities. Show up and tell them to protect the Affordable Care Act and to support positive legislation listed below.
        Get involved with People and Organizations that are working on health care.
        Technologists can join an organization or work on an open-source project to drive social progress. Tech Forward has a compilation of options.
        Call your state representatives and ask them to support the State-Level Resistance Agenda. See State and Local Pages for state-specific legislation.

  10. Toolate

    Great post.
    One question: what is more important, true access to healthcare or having health insurance?
    For example having Medicaid improves access but still falls way short in many respects of grating full access to good healthcare.

    1. aab

      That depends on the state. California’s Medicaid system is better than most of the country’s, I believe. It still has problems, don’t get me wrong. But a lot of that is too much bureaucracy and too few doctors, IIRC. Single payer should help with both, if properly designed. I’m not knowledgeable enough to know whether a CA system could jettison some of the really burdensome and unhelpful bureaucratic requirements of the ACA, but I think it would just require permission from the Trump administration, which seems like a no-brainer unless that sector captures him, as well. And there’s a lot of potential streamlining that could lead to improved access and care even without exemptions from ACA stuff.

      1. different clue

        California voted against Trump. All those ” popular vote majority for Clinton” happened in California. Trump would probably deNY permission to California to have Single Payer in order to get revenge for California voting for Clinton.

        That is not to say it should not be tried. Go ahead and try it. Make Trump deny permission in the full light of day.

        1. aab

          While that’s certainly possible, I don’t think that’s likely. That’s treating Trump as dumber and more vindictive than existing evidence suggests.

          The party pushing incredibly hard to avoid single payer is the Democratic Party. Trump refusing permission to set it up in California helps the corporate Democrats by giving them the Republican excuse they need. That doesn’t seem to be the game Trump is playing, although the neoliberal Republicans might want to.

          With a national majority pushing for universal health care that includes a growing segment of the Republican base, denying California permission could cost the Republicans crucial votes in other states (like Tennessee). I’m not saying they still might not do it. After all, Obama cheerfully killed, starved and robbed his own voters and expected to pay no penalty — which he, personally, has not paid, but his party sure has.

          While the CIA and other swamp creatures are trying to turn Trump into Obama (as a captured vassal), there are differences there beyond party and ideology that may be more salient. Trump entered office a billionaire. Whether or not he can turn the presidency into a business opportunity to expand his empire and increase his dynastic wealth, as long as he keeps his head, he can at least exit the job still a member of the ruling class, whose offspring and their offspring never have to worry about their material needs being met as long as we continue as a capitalist system. Obama entered the White House as a striver. He needed to please a whole lot of billionaires throughout his presidency in order to have the opportunity for the kind of self-enrichment after leaving office that Trump already had when he entered.

          That means that purely as a matter of very basic self-interest, Trump has different personal incentives and disincentives than Obama did. If the coup succeeds, that may not matter, depending on how tight the control is over him. But otherwise, it could end up mattering a lot.

          1. Carolinian

            Trump in the past has said he was for single payer and if a popular groundswell began to demand it he might very well go along. As some have said here he is currently catering to the GOP establishment because that’s the only place he can find allies. But during the campaign he invited Sanders supporters to join him in a crusade against the Swamp.

            A cynic might suggest that one of the goals of the “resistance” is to make sure the above doesn’t happen. The over the top Trump hate is designed to poison the debate and guaranty none on the left will ever find common cause with Trump against the current war mongering, single payer opposing establishment.

            At any rate Lambert is right that single payer is a great issue for the Dems even if one they seem very unlikely to ever embrace.

          2. B1whois

            I have to agree with different clue and aab about the possibility of trump denying permission for California to single-payer healthcare. I think he might broker it for something else like no “Sanctuary State”.

  11. Dave

    How about
    “California Health Coverage Based on a minimum of Ten Years of Filing State Income Taxes.”
    Yes, that covers illegals too, they are allowed to get a federal taxpayer i.d. even though they can’t legally get a social security number.

    Oh, you work for cash in California and never filed state income taxes? Tough luck, go on Medi-Cal, if you are legal.


    “I’M WITH HIM”

  12. mrtmbrnmn

    As long as we are fantasizing, fantasize this! The Trump is undeniably a world class salesman (mostly of himself) and an irresistible media magnet. He talks Everyman not Politispeak. If, at the risk of life and limb, he came out yuuuugely and loudly in favor of Single Payer (he did mention it favorably in the debates but it got disappeared amid the yowling about Mexican rapists) and relentlessly pushed it in the face of the gutless and bought-off (cheap) Dem$ and GOP$, he would be elected President-For-Life!!

  13. Adamski

    The only remaining reference on the wiki to single payer or Medicare for all is the line about HR 676

    1. marym

      The link in the post is to the “approved” revision. At the top of the page is a link to the “most recent revision” (currently Lambert’s).

      1. chicagogal

        Lambert’s revision was removed, so I kindly undid their deletion. Guess we’ll see how long it lasts.

          1. BillC

            And I’ve undone the deletion again.

            Anyone know why “talk” is blocked for newbies/the masses/who knows who? I’d like to ask Dancers1126 (the deleting editor) to at least explain why they will not hoist Single Payer to the same prominance as “save the [botched] ACA”.

            1. marym

              Last night I looked around 10:00 PM ET and it said “This is the approved and latest version.” It had what looked like a compromise version of Lambert’s change. His first 2 references to HR 676 changed to “support positive legislation listed below” (which is HR 676); and his California reference changed to “see State pages.”

              Now that’s still the approved version but it’s back to Lambert’s original on the “latest’ version.

              Maybe best to decide for or against the compromise version instead of going back and forth?

                1. marym

                  I never saw Lambert’s version on the “approved” page (link in Lambert’s post), only on the “latest” page (link at top of “approved” page). However, the “approved” page appears to have been updated with a modified reference to HR 676 and the Calif plan (compare Lambert’s before and after screen prints and current “approved” page). The “Recent Updates” list hasn’t been updated with this change.

            2. Stephen Gardner

              I think we all know the answer to your question and why the deleting editor (or editors — this will be a sustained effort of idea suppression) will never tell you why. The wiki is really an astroturf effort that is driven by PR firms that are out to protect the neoliberal economic order from anything vaguely resembling economic democracy. When people like Neera Tandon become involved in something it is because it is their job. Being an effective “thought leader” for the neoliberal economic order is potentially very lucrative. Lest anyone be fooled, in the tweedle dee and tweedle dum world of American politics the money is behind both parties. Trump “accidentally” broke the scheme and that is why he is being attacked by both Ds and Rs. Now I am not saying that Trump is a good president but I am saying that he accidentally stumbled into the presidency and he is not easily controllable by either of the two avatars of the money & war party.

              1. Adamski

                In fairness to the Resistance peeps, whoever they are, they’re not the Sanders campaign or Our Revolution or whatever. Sticking together means compromise, and the Clintonites can’t currently be frozen out. Promoting single payer is the job of the Sanderistas. Much as I would love the revolución to begin on that wiki. Ppl who want single payer should be helping Healthcare-Now! or Our Revolution and not praying for miracles…

                1. Foppe

                  How is this in any way a response to Stephen? And what’s with all the marching orders, and the ‘hip’ spellings/words?

                  1. Adamski

                    I always type ppl and space is limited. Yes I should have hit reply further up the thread. Not marching orders at all — pointing out the #resistance ppl (or people) won’t like marching orders themselves as not everyone is in favour of single payer (as much as I want them to be)

  14. Elizabeth

    Thanks Lambert for covering this so well! It’s odd – Rep. Lara’s bill for single payer is not getting a lot of press in the Bay Area. We are constantly reminded how wonderful Obamacare is and how it has worked so well in Calif. and how many more have coverage (even though many can’t afford to use it)! We hear that repealing this wonderful Republican plan would be a disaster – but the mention of single payer is never mentioned. I’m wondering even if Lara’s bill passed in the legislature, would Jerry Brown sign it? He’s a neoliberal through and through.

    Rose Ann DeMoro is a fighter – and I think the nurses’ union has a lot of clout here. I’m keeping my fingers crossed.

  15. Gman

    Call me cynical, but I suspect the reason more people, even in the USA where there always seems to have been an almost innate ideological zeal in opposing single provider healthcare by a significant number, are coming round to the idea as the feeling that day to day life is getting more precarious and insecure for more and more of the population and that Jack isn’t always likely to be as alright as they thought.

    Either way ‘competition’ rarely, if ever, belongs in general healthcare, you can afford it and it’s the right thing to do.

    1. Adamski

      Countries like Germany and Switzerland have competition in health insurance but it’s non-profit and has conditions attached that would never pass Congress. I think it’s all or nothing i.e. abolish insurance and the vested interest and donations and lobbyists for it in one go. Can you imagine the Dems rejecting single payer in favour of a really big fine for the individual mandate, or auto-enrolment in a policy, lots of govt intervention for cost control, banning the cancellation of policies by the insurer except for non-payment of premiums, premiums withheld from paycheques? Hahaha

  16. John

    Before they give us single payer they are going
    to try to give us this crap:

    Catastrophic insurance sold across state lines.
    High risk pools. And health savings accounts.

  17. May

    This is great Lambert-thank you!

    I’d just like to add that establishment Democrats also killed the right to health amendment in Massachusetts in 2006. The Massachusetts Health Care Campaign had used the ballot initiative process to try to get a constitutional amendment on the ballot in 2008. The campaign complied with all constitutional requirements but the Massachusetts legislature (controlled by Democrats) ignored their constitutional duty and killed the amendment in committee. The campaign sued the Legislature and the Supreme Judicial Court found that the Legislature had violated the constitution but that there was no remedy available.

    The proposed amendment read:
    “Upon ratification of this amendment and thereafter, it shall be the obligation and duty(1) of the
    Legislature and executive officials, on behalf of the Commonwealth, to enact and implement such
    laws, subject to approval by the voters at a statewide election(2), as will ensure that no Massachusetts
    resident lacks(3) comprehensive(4), affordable(5) and equitably financed(6) health insurance(7)
    coverage for all medically necessary(8) preventive, acute and chronic health care and mental health
    care services, prescription drugs and devices(9).”

    This constitutional amendment push was happening simultaneously with the passage of the 2006 health reforms that became the model for the ACA. So instead of a right to health, Massachusetts residents got a mandate to buy private insurance and the Democrats made that happen!

    Lambert, I’m also curious what you think about legislation in Vermont to create a universal primary care bill. As I understand it the thinking is to start with primary care which is relatively cheap but meaningful as it’s the kind of health care most people use, and then slowly expand the system. Do you think this model might be easier for states, particularly small states to implement than full-scale single payer implementation all at once?

    1. aletheia33

      i too would like lambert to weigh in on this plan.

      vermont does provide better plans under obamacare than most states: BCBS premium increases are kept somewhat under control.
      but vermont’s current healthcare plan is worse than what vermont had prior to obamacare.

  18. Jason Boxman

    You’re not stupid. I naively thought Democrats would end the war. We know how that turned out.

  19. Jason Boxman

    And it looks like StayWoke hasn’t posted to their Twitter since end of January. I wonder if they even actively monitor their wiki or if it’s just for dissemination of information.

  20. Matt

    Wow, mealy-mouthed is right. You don’t have a right to a living wage, but you do have a right to ask for one! Moreover, apparently there is no right to a job, pension, or housing either.

    1. William Branch

      Correct. No go eat some cake, peasant! Then get back to work (if we even want you to do that).

  21. Ep3

    But here is the problem. Trump could write a bill tomorrow proposing Medicare for all. But then the health insurance lobby will demand rules like the one Medicare has now; no negotiating for lower drug prices. Add in no negotiation for all other medical services and then Medicare for all is worthless. We end up paying far more for a service that doesn’t work and we have no other options. Then it goes broke, because the politicians rob the fund, like they are robbing social security. So then they privatize it because markets are good. And we are back to where we are now.
    So it’s great that everyone is wanting single payer Medicare for all. But it has to have some teeth to hold hospitals and doctors accountable.
    One last thing. I have no problem at all with rich doctors. They should make more than sports players.

    1. leftover

      Here’s the deal: In a publicly funded, privately delivered nonprofit healthcare system, as proposed in HR676, the role of private for-profit insurers is vastly reduced. Practically eliminated. The government assumes the role of payer for all “medically necessary” treatment. The power the insurance lobby currently enjoys to influence healthcare policy and healthcare delivery is virtually eliminated. Multiple for-profit payers would have virtually no standing to influence policy or practice.

      Pilfering of funds could be a problem. Protection from that could be legislated. But with the savings inherent in Single Payer funding as proposed, (pdf Table 7 page 5), legislators may not feel the need.

    1. William Branch

      The public isn’t seen as an asset, we are deplorable and expendable. Why invest in our health care? The public votes the way it does, because they don’t realize they are oppressed peasants, we in the US think we are millionaires.

      In Europe, y’all will be finding out, one Greece spot at a time, what deplorable and expandable people you really are. Then your health care will be crapified like ours. Germany and the royalists win.

      1. sunny129

        American Public is persistently ‘brainwashed’ by MSM ( 90% controlled by mere 6 mega Corps) re Canadian style single payer system! As an MD over 40 years, with family on both sides, per my observation, there is absolutely NO DIFFERENCE in the quality of medical services for Cancer and Cardiovascular diseases between USA and Canada! Of course, there is NO, PRONTO service for elective tests or surgeries! No difference for Emergency care services! I have closely observed their medical services to immediate family members!

        There may be a few exceptions with sad stories. But no one has suffered hardship or lost house or declared personal Bkcy, unlike in USA!

        One can have only 2 out of 3 -quality, Cheap(accessibility/affordability) and Pronto, but NOT all the 3!

        1. Adamski

          Japanese healthcare is high quality and via insurance but the govt has strict cost control through a fee schedule. Despite this the waiting times are almost instantaneous i.e. don’t even need an appointment to see a specialist

            1. Adamski

              If private insurance continues it must be made non-profit and mandatory. Bigger fine for the individual mandate, or automatic enrolment in a policy if the person fails to act. Premium has to be withheld from salary like a payroll tax. Everywhere else with private insurance does this. Subsidies between groups have to be bigger than under Obamacare too.

  22. sleepy

    Stereotypes never end–the Atlantic writer presumes “hillbilly dumb” when in fact the town hall took place in Murfreesboro TN, a city of over 100,000 in a fairly well-off suburban Nashville county of 300,000. Hardly small town Appalachia.

    1. Ivy

      For The Atlantic and their fellow travelers, the hinterlands begin at the Hudson, or maybe even Amsterdam Avenue. /s

  23. Abigail Caplovitz Field

    New York has passed single payer in the Assembly a few times, but it always gets stuck in the state senate. There’s a big push for it again this year. To get involved, join the campaign for NY Health.

    1. Adamski

      You have the right idea posting that link, no offence to Lambert for complaining about the wiki… :)

  24. JEHR

    It makes me very happy to see all the work that is being done to get single payer health care in the US. I hope it works out because it will give everyone more peace of mind and sense of security than almost anything else in life. Good luck. I am rooting for you!

  25. Kramer

    All this talk about single prayer is distressing I see what you are doing, pitting the high earners of the Healthcare industry against the rest of the corporate world. What’s next, are you going to turn blue collar republicans aagainst their CEO bosses? Can’t we just focus on non-SWM rights and language policing, those won’t cost any money.

  26. Anne

    One issue Trump has been pounding pretty hard on is the cost of prescription drugs; Cummings and Sanders have a bill on that issue that they want to get Trump’s support on, and I wonder – if they did, would that open the door a little more?

    Two things occur to me:

    1. If Medicare were available to me now – I’m 63 – I would retire in a heartbeat. But I can’t retire now and then have to go out on the market and get decent insurance I could afford. And, at 63, I’m reluctant to wing it until I’m Medicare-eligible. I think – I know – there are a lot of people like me, and if we could exit the job market, it might make room for more people to get in. So, jobs.

    2. On the other hand, you know one of the arguments against single-payer/Medicare-for-All is and always has been about the millions of people in the insurance industry who would lose their jobs. I don’t think there’s been enough effort to educate people to the reality that if we have a MFA plan that covers everyone, there’s going to be a pretty big need to staff way up to accommodate that – I think a lot of those needs can be covered by people who could slide right from the private sector into those areas.

    And, I don’t think private insurance goes away, either. People on Medicare have supplemental plans through private insurance companies – why would that end in a MFA scenario? So there would still be a need for jobs within the private insurance industry.

    Since Trump is the jobs guy, if he could be convinced that a MFA system would create more jobs – either from attrition of those of us would would be happy to get out of the workforce, or addition from increased staffing needs of a plan that covers all Americans – it might make it harder for Congressional Republicans to be successful in their efforts to completely fk up the system.

    If we could find a way to get the MFA advocates onto Fox & Friends, we might be able to grab Trump’s attention…

    There are some things I haven’t figured out. For example, if you were to do a gradual rollout by lowering the eligibility age from 65 to 55, you’d immediately push people with more medical needs out of the private market and into the public. Does this mean higher premiums for those in the MFA program? Should there then be inclusion of those, say, from birth to age 25, which would possibly balance out the claims pool and help keep universal premiums lower?

    Or do you just go – boom! – everyone into the pool, all at once?

    And what happens to the money that’s invested in the private insurance industry, either through individuals or mutual fund holdings or retirement accounts? Is it just balanced out by money transferring to another market sector? I’m sure there’s been some research/study/analysis on this, and would be happy to educate myself if anyone has any good sources.

    I think we are at a pivotal point that must be taken advantage of, especially with the GOP visibly struggling with how to keep their promises without making things worse (which they will, you know they will).

    1. marym

      HR 676 Expanded and Improved Medicare for All virtually eliminates the need for supplement policies, as mostly everything is covered. In some countries that have universal healthcare private insurers still cover things outside the universal plan like cosmetic surgery or private rooms. The bill also has provisions for 2 years of salary continuation, and job training and placement priority for private insurance sector workers.

  27. Lawyercat

    It is probably no coincidence that the rural, Christian voice for universal healthcare comes from Tennessee. Tennessee had a comprehensive Medicaid program that approximated a public option (literally one way to qualify was to show that private insurance companions rejected you because of your chronic illness), I think, and achieved maybe the largest coverage of any state Medicaid. Of course, that was dismantled by a Democrat who received significant health industry campaign funds.

    I take this to show that consolidating Medicare for all in one state, like california, would quickly make it viable everywhere else, maybe like marijuana legalization.

  28. leftover

    When HR676 The Expanded and Improved Medicare For All Act was reintroduced in The House on January 24 it had 51 original cosponsors which, if memory serves, is the largest number of originals in its 14 year history in The House. It currently has 59 cosponsors…another record. The Act is currently in Committee…again. This time, however, one of the three Committees set to review the bill is the influential Ways and Means Committee. Please consider contacting the members of that Committee (here), especially the Republicans, and demand they petition for a CBO score based on Gerald Friedman’s funding proposals (pdf). No universal healthcare proposal has received a CBO/JCT score since 1993. It’s time Single Payer/HR676 financing get an agency analysis sincere advocates can employ. Literally trillions of dollars can be saved within ten years. And the estimated surplus can be used to reduce The Deficit™.

    Also…send them this Fix It link. It’s new, so it’s less likely to be dismissed out of hand. And it’s framed from a conservative economic perspective.

    1. Left in Wisconsin

      Well, I think that is interesting about the large number of co-sponsors. I would be a bit skeptical of many. My recollection is that Conyers, with assent from my “liberal” Sen. Baldwin, introduced single payer every session except for when Obama was in office, when it would have really been meaningful. Always good to keep the conversation going, of course, but I wonder if this is simply theater. OK, I don’t wonder.

      1. leftover

        The political opportunism of Conyers is clearly evident. I suppose that might be said about many of the cosponsors. But I hope that doesn’t discourage anyone from contacting members of the Ways and Means Committee, (or Energy and Commerce and the Natural Resources Subcommittee on Indian, Insular and Alaska Native Affairs for that matter), and insisting on a CBO/JCT score for Friedman’s funding proposals. (I mistakenly implied HR676 had not been before Ways and Means previously. It’s been before that Committee before.)

        The Committees considering the bill are simply not doing their job without a CBO score. Due diligence demands it. As it would on any bill that proposes such broad scale changes to a system that so deeply impacts our national economy.

        Congressional politicians may or may not be sincere advocates. But a CBO/JCT score is a necessary tool to reinforce and build support within the electorate, especially among Republicans. And is equally necessary to defeat the traditional “yes…but” argument against Single Payer that has been employed by Congressional Democrats and Party corporatists for decades.

      2. Adamski

        Could Conyers have had another motive such as to get team Obama to give him amendments to Obamacare in exchange for shutting up about single payer in the interim?

        1. leftover

          I think Conyers’ primary motivation is to make points with his constituents, particularly organized labor.

  29. jerry

    single-payer under Trump = nail in the coffin of democratic party as we know it.

    Unfortunately it does seem like one of those issues where it’s going to have to go state by state, given the complexity and state rules about it.

  30. Anne Scheetz

    Thanks, Lambert; but immigrants regardless of the documents they do or do not have are not disposable. Under HR 676, the Expanded and Improved Medicare for All Act sponsored by John Conyers of MI, all residents of the US will be covered under the same plan. That’s what we struggle for. Anne Scheetz, Chicago

    1. Adamski

      Yes, but there is a duty on the department to come up with a mechanism to recover costs from the home countries of foreigners. Mexico will pay…!

  31. B1whois

    It would seem that having publicly-financed Health Care in the state of California would be seen as an advantage by businesses looking to locate facilities with lots of employees. Has anyone looked at this angle? Lambert? Yves? Outis?

  32. casino implosion

    “A word about “the Christian case”: In the steam-powered era of blogging, 2003-2006, I, and many many other “progressive” bloggers, did a good deal of mocking and shaming of Christianity and Christians; that was one aspect of snark. And the Pharisees of the Bush administration richly deserved it! But deserved or not, the bottom line is that the mocking and shaming — a precursor, or even an earlier brand, of today’s “callout culture” — simply didn’t work politically.”

    Self-awareness, self-criticism and humility on display! The beginnings of common sense!

    We’re all in this against Leviathan, from the leatheriest Montana rancher to the gnarliest backwoods Vermont hippie. And with a little historical insight, one discovers that the Christian Right was at the forefront of the good fight in the 1970s, back when most of the so called “left” was still obsessed with dead categories and bygone battles.

  33. aletheia33

    lambert’s changes are now on the “newer revision” page.

    whoever is monitoring this is certainly getting a strong message from NC! yay for NCers keeping up the fight!

    could we get someone with a big twitter following in “our” media to tweet this out?
    i’ve put up lambert’s post on the kossacks for sanders subreddit, with the following comment:

    >The majority of Americans want single payer, not Obamacare. Let’s make Expanded Medicare for All (H.R. 676) a priority for #theresistance, instead of just fighting to keep crappy Obamacare.

    We can follow through on Jesse Bohon’s viral call–what she said: “So we are effectively punishing our sickest people. And I want to know why not, instead of fix what’s wrong with Obamacare, make companies like Aetna that pulled out and lied to their consumers about why they pulled out, and said they pulled out because Obamacare was too expensive, but they really pulled out because of a merger. Why don’t we expand Medicaid and have everybody have insurance?”

    Single payer may be the single most popular element of Bernie’s program. He’s forced the mainstream media to occasionally mention it. Both Sanders and Trump voters want it. National Nurses United is supporting a new bill to do it in California. We can make it happen nationwide if we speak out for it loudly and relentlessly!

    At the end of this Naked Capitalism article you will find a link to the “how you can resist” section of the wiki for “obamacare/ACA” in the “resistance manual”–and a copy of text that we can add to the suggested resistance actions to focus them on singer payer instead of Obamacare. If you find the text is not there, and you add it yourself, you send a persistent message to #theresistance that the people want single payer, not Obamacare. Have fun!

    How about some other ideas we can come up with for this fight. Anyone?<

  34. B1whois

    Woild a single-payer plan in California make it more attractive to businesses to relocate their employees there, since assumably they wouldn’t have to pay for their care anymore? And if they don’t pay for their employees care now, would they see benefit from having healthier employees?
    Perhaps this is a place to look for some of how to pay for it as well, from the companies who were paying for their employee’s health insurance, mostly state county and City organizations I believe.

  35. Gaylord

    Regulation of the corporate unhealthy lifestyle promotion industries is needed. But that won’t fly because sustaining and increasing profits are the highest priority of all corporations, which means the health care system (however that is configured) will continue to have an uphill battle. Society should begin to grapple with the prevalent sickness of mind.

  36. Tim

    If I may, Clinton’s first act as president was “don’t ask, don’t tell” which was heralded as a great accomplishment for LGBT rights when it was implemented. Many years later, “don’t ask don’t tell” was terrible policy, why are we still punishing LGBT and not treating them as equals in the open?

    I bring that up because the parallels are similar here. Time and the initial accomplishment has a way of moving the goal post.

    Obamacare, did at least make health insurance everybody’s problem and was heralded as a great move forward, but here we are years later and the goal post has moved, it is far more acknowledged/accepted by republicans that health care is a right, since obamacare was passed, which was really the biggest hurdle, now it just has to be done properly, which all people that are able to see or hear the facts of our care relative to costs vs the rest of the modern would realize it is indeed single payer.

    So I have to say I should be more optimistic about this than I have been. I don’t think the oligarchy will win this battle in the long term.

    1. sunny129

      OLIGARCHY always wins in America. B/c as ex-prez Carter said ‘ there is NO functioning Democracy in America’ nor a representative democracy. Gerry-mandering of the districts has defeated proper representation!

      Besides per SCOTUS, a Corporation is a citizen and the money is free speech!

      Until the powers of the vested interested parties( Medical-industrial complex incl Big PHARMA) are nipped in bud, there will be no kind of affordable health care in USA! that means meaningful campaign contribution reform to which neither parties are NOT seriously interested!

      Will the #Resistance stand up to these forces including against Corporate Democrats like Clintons and Obama-surrogates?

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