GOP Attack on Obamacare Won’t Slow Calls for Democrats to Back Single-Payer

Jerri-Lynn here: This Real News Network interview with Carol Paris, President of Physicians for a National Health Program, provides a brief overview of the implications of Thursday’s House vote to repeal Obamacare for the prospects for a single-payer alternative, such as Medicare-for-all.  Note that this is by no means either the last nor a particularly comprehensive look at the subject.  I’m nonetheless posting this short interview to provide readers with a chance to discuss the health care reform issue more thoroughly.

Aaron Maté: It’s The Real News, I’m Aaron Mate. The Republican controlled House of Representatives has voted to repeal and replace key parts of the Affordable Care Act known as Obamacare.

Speaker 1: The ayes are 217, the nays are 213. The bill is passed and without objection the motion to reconsider is laid upon the table.

Aaron Maté: The American Healthcare Act cuts hundreds of billions of dollars in healthcare spending by repealing taxes on high income earners and the healthcare industry. It phases out Medicaid expansion and allows states to make even deeper cuts. It also undoes the protection of people with preexisting conditions. Several provisions target women’s health including defunding Planned Parenthood and making essential benefits like maternity coverage optional. After the vote House Minority Leader Nancy Pelosi said Republicans will pay a political price.

Nancy Pelosi: The Republicans have the majority, they won the vote but the American people now have to judge them by how they have acted. Not by how we’ve characterized what they stand for, now they are on record. As I said, this vote will be tattooed to them as I also said they will glow in the dark.

Aaron Maté: The vote comes weeks after House Republicans failed to pass their first attempt. It now goes to the Senate where it faces an uphill battle. Joining me is Dr. Carol Paris, President of Physicians for a national health program. Dr. Paris, welcome.

Carol Paris: Thank you for having me, Aaron.

Aaron Maté: When Republicans failed to pass their first go at this, Trumpcare 1.0, the Congressional Budget Office estimate was that 24 million people would lose their health insurance. Now this time, perhaps intentionally, the CBO was not given a chance to score this one so we don’t know how many people exactly will be affected. It appears that Trumpcare 2.0 is even more draconian because now it drops the requirement that insurers cover people regardless of their medical history. It also takes away the requirement that insurers offer essential health benefits. Tell us what the impact would be if this manages to become law?

Carol Paris: Well you’re right, the CBO has not scored it and so we can only guesstimate that it will be at least 24 million people who will be kicked off of their health insurance. The more interesting thing that happened when the bill failed to pass last time is that H.R. 676, the expanded and improved Medicare for all bill, gained 24 co-sponsors including my Congressman, Jim Cooper, who is a blue dog Democrat who has never co-sponsored H.R. 676 in the past. There are some unintended consequences of this move and I’m expecting to see possibly our first Republican co-sponsors now that the House has passed this onto the Senate.

Aaron Maté: As this current one goes through the Senate there is uncertainty about its fate. Certainly Senators from states that stand to cut Medicaid as this one entails will face pressure to keep it. Talk to us about one of the key provisions which is taking away the requirement that insurers cover preexisting conditions and replacing that with this concept of high risk pools.

Carol Paris: Well, high risk pools was something that the ACA I think tried to avoid by mandating that everyone have health insurance which would have brought and was intended to bring young, healthy people into the risk pool hence making premiums more affordable for people who would otherwise be uninsurable and unaffordable because of their preexisting conditions. What they’ve now done is create these high risk pools which may sound good in some theory but in fact are thoroughly inadequately funded. Essentially, they are creating a situation where older, sicker Americans will simply not be able to afford healthcare. Younger Americans may be able to purchase a health insurance plan but that doesn’t mean they aren’t going to find out when they actually try to use it what the limitations of it are especially if they eliminate the essential health benefits.

Aaron Maté:Yeah. The numbers on this are, eight billion dollars in this current bill would go towards high risk pools. That’s enough to cover maybe a few hundred thousand people. Conservative estimates say that you need at least 25 billion dollars more so at least three times that amount to cover high risk enrollees. Let’s talk about Democrat’s response. After the vote Democrats in the House broke out into a chant of na-na-na-na, hey-hey, goodbye, a message to Republicans that this vote is going to hurt them politically. What do you think of how Democrats have handled the healthcare debate?

Nancy Pelosi who we heard from before, when she was asked today if Democrats are going to make single payer an issue in 2018 with the mid-terms she said definitely not. What’s your assessment of how Democrats have been handling the healthcare issue?

Carol Paris: I don’t have any hope that the Democrats are going to suddenly have a change of heart. After all, they had a majority in the House and the Senate and a president in 2010 and single payer didn’t get a seat at the table. All that says to me is that the American people are clearly in the majority and a growing majority of people who are beginning to understand and truly want a Medicare for all single payer solution. We’re not going to get Republicans or Democrats to get on board with it until we have a vocal and sustained movement of Americans who make it toxic for both Democrats and Republicans not to get on board.

We’ve seen that in the Civil Rights Movement as well, this is not surprising. I’m not looking to the Democratic Party to do the work of movement building for single payer, that’s the job of activists and I’m one of them. Trust me, I am going to do that job. I’m disappointed that the Democrats are not championing single payer but I’m not expecting them to. I’m just letting them … I’m putting them on notice that we’re working to make this toxic for them not to get on board, Democrats and Republicans alike.

Aaron Maté: Are you worried though that because this measure is so draconian it moves the goalpost from pushing through a single payer universal healthcare program to simply defending those who stand to lose their health insurance, the millions of people who stand to lose their health insurance under the repeal of the Affordable Care Act?

Carol Paris: There are many people who are defending the Affordable Care Act, the indivisible movement and our revolution, and that’s fine if that’s what they want to do. My experience when I’ve gone to town halls that are sponsored by local indivisible groups is that the minute someone stands up and asks the member of Congress to give them what they really want which is a single payer Medicare for all play the town hall erupts in cheers and applause. You know, my own feeling about this has evolved over time. I had been saying that I can walk and chew gum at the same time, I can defend the ACA from going backwards and continue to support single payer Medicare for all going forward but my feeling on that is changing.

The ACA is a flawed piece of legislation and I don’t want anyone to lose their insurance. I’m glad that there are people who are working to keep the Senate from passing this piece of legislation but there are others of us who are simply saying neither of these pieces of legislation is the solution. If we don’t keep talking about what the real solution is then we’re just going to keep talking and not getting there. Like I said before, we gained 24 co-sponsors the last time the Republicans tried to pass this legislation. I predict that while the Democrats and the Republican legislators may not know what to do with this the American people are going to respond and they are going to respond with a lot of anger and frustration. They’re going to realize that they’re standing to lose a great deal.

Aaron Maté: Dr. Carol Paris, President of Physicians for a national health program. Thanks so much.

Carol Paris: You’re welcome.

Aaron Maté: Thank you for joining us on the Real News.

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  1. Disturbed Voter

    I would like to prevent people from losing medical care, I really don’t care what happens to the rentiers of the medical industrial complex. If single-payer is simply a better way for the rentiers to extract from society … then I don’t see that as a revolution, but a bait-and-switch, just like the ACA itself was.

    1. Pat

      Why would single payer be a better means of extraction? We have decades of evidence in almost every other major country in the world that singlepayer provides more and better healthcare for far less money than our market rigged system mostly by either divorcing rentiers from the system or regulating their access. That isn’t to say there won’t be fraud or constant attempts to game the system, there will, but without the foxes running the hen house it is much harder to extract money for nothing.

    2. Katharine

      What on earth makes you think single-payer would be “simply a better way for the rentiers to extract from society”? Seriously, please point out something in the available information, either the text of H.R. 676 or something in the PNHP information that would lead to that expectation.

    3. Mel

      You say “If single-payer is …”. Please change that.
      If single-payer, as implemented, turned out to be “simply a better way for the rentiers to extract from society ..” then you’d be right to be dismayed.
      Single-payer systems that work in the rest of the world are managed by bureaucracies that aim to provide health care for the people at a cost that the respective nations can manage.
      Anything different you would have to file under mis-government.

      1. polecat

        Yes, This … !!
        It’s All about the ‘aim’ … and WHO(??) welds it !

        And with a totally disfunctional federal government, how does single-payer work properly, and smoothly … without being highjacked by a venal, corrupt CONgress ??

        1. craazyboy

          Like Medicare and SS are an “entitlement” – and therefore the Congress doesn’t get to vote on funding it every year.

      2. Disturbed Voter

        Fine, if you are a Swedish citizen living in Sweden. But they have other problems. Socialism never works, and importing massive numbers of poor refugees is also … not working. Not only will Sweden not have a social net soon, they might not even have a Sweden.

        The US decided that its “peculiar advantage” as the maker of the primary currency (now challenged by China), which gave it a very profitable financial scam for decades, should be spent on things other than health care. A lot of it is spent on other social net programs, but that may all be coming to an end soon.

        1. reslez

          “Socialism never works” — and then he changes the subject to immigrants. It doesn’t appear that you’re debating in good faith.

        2. James Kroeger

          It’s difficult to grasp why you willfully ignore Britain’s National Health Service—pure socialized medicine many would say—which has provided Brits with health outcomes equal to or better than America’s private HC system at less than half the cost, to the great satisfaction of most of the people who use it.

          And no, it’s not perfect, for it is underfunded, due to the constant efforts of the conservatives in England who constantly try to minimize its cost.

          The lesson for America? There is no reason to fear that putting the government in charge of the HC industry will result in a money pit of waste. Quite the opposite, in fact.

          1. Synoia

            The UK also did not have a parasitic University system, which changed thanks to Tony Blair.

            Containing costs includes not burdening new graduates with any loans.

            If one need the money form the budget, I know of a certain 5 sided building where much is available.

    4. James Kroeger

      What single-payer ‘extracts’ is savings from America’s current ungodly mess of a health care system.

      1. Disturbed Voter

        Depends on how it is written. After the efforts of the 2010 Congress .. I have no faith in the beneficence of the D party, they are clearly the same as the R party, as far as health care is concerned. The US leadership has clearly become European in thought, deeply malignant.

        So perhaps with ACA you will have to pay $1000 per month for Bronze, but with Single-Payer … your income taxes will go up, but more than the $1000 per month you were paying thru ACA, to get even more inferior care than you are currently getting thru ACA.

        Rentiers of the World Unite! You have only your peasantry to lose!

        1. marym

          Here’s how it’s written:

          The bill referenced in the interview (30 pages, plain language) – Link

          Brief summary of the bill – Link

          On-line FAQ – Link

        2. reslez

          Pulling fake numbers out of your butt isn’t a valid way to support your argument. The US pays three times as much for health care per capita than the UK, and fails on every single measure of health compared to other developed nations.

          We pay more. We get less. Our system is the worst that could be devised. It exists solely to enrich parasites in the insurance industry. If you’re one of the fortunate few who gets good care I’m happy for you, but even you pay 2x-3x more than you should. Meanwhile other people are dying because they can’t afford care. Go take a look at GoFundMe if you want a thousand pitiful examples.

          1. Tim

            There is a chicken and egg argument though. Our parasitic health care is parasitic not just because of the payment system, which is expensive. If we don’t assess what the cost of service differentiators are with other countryies and fix those first, we will be stuck with a government plan that will result in expenses that make the US budget look really bad which is bad PR.

            In a perfect world cost of actual healthcare provided (doctors, hospitals, prescriptions, etc. need to be dealt with first), then medical for all, then MMT to close the loop.

    5. James Kroeger

      I think you need to understand that the economic role private insurance companies play in our health care system is equivalent to that of The Mafia in the industries they dominate.

      Thanks to clever PR, most people believe that those who run HC insurance companies are ‘experts’ in their field who have a special knowledge of the HC industry that no group of government bureaucrats in Washington could ever hope to match.

      The actual truth is that the insurance companies who administer this nation’s HC industry are not experts in the field of HC services. They simply hire the experts that are needed to make their HC services operation work.

      Insurance people are finance people. Their only function in their companies is to figure out what to do with all of those $$ they receive in premiums that aren’t needed to pay claims and operational costs. That, and figuring out how much to pay off members of Congress to keep the whole scam going.

      They are no different from a bank in this respect. Their daily challenge, “How can I invest this money in a way that will make us insurance people even richer than we already are?”

      They are simply middle-men who get themselves involved in the provision of a service that people are desperate to have and they walk away with a big cut of the proceeds just because they can (and because they have bought themselves the political support they need to keep it going).

      We don’t need these Mafia-like middle-men in the middle of our HC services industry, milking us for every cent we’ve got, when government officials can hire experts just as easily as the Insurers can.

      The big difference between government-provided HC and HC provided by insurance companies is that you don’t have that parasitic element involved, gobbling up profits off of other people’s desperation.

      Simply eliminating that is going to reduce overall HC costs immediately. Add to that efficiencies of scale, the elimination of duplicated paperwork, the un-needed billing operation, etc. and you’ve got THE answer to [most of] America’s HC [cost] crisis.

      (Big Pharma’s monopoly power is another matter altogether.)

      For-profit insurance companies are NOT essential to the provision of quality HC services to the American people. They are, in economic terms, a pure waste. They are economic leeches who need to be excised from the HC industry and publicly shamed. (If Justice means anything to ya…)

      Maybe it would be a good idea for all of us who have been calling for single-payer to start casually—and constantly—referring to the Insurance companies as The Mafia, since it aptly describes their utterly un-needed and parasitic role in our HC industry.

      I mean just start calling them The Mafia at any excuse. A term (metaphor, actually) which describes their role in HC perfectly, a deprecation that fully intends to insult its target.

      It is the ONLY way we will ever be able to get members of Congress to be afraid of being identified with them. Harsh emotional attacks are just what’s needed.

      1. Disturbed Voter

        Since Pharaoh, it has been Mafia all the way down, just Egyptian originally, rather than Italian. The Elite have every reason to take care of their own families, and no reason to take care of yours. Every non-Elite American could be replaced in a year, with much cheaper and more compliant people from China and India.

        So no, “Mafia” is prejudicial toward Italians. Society has always been criminogenic, ordinary crime is prohibited not because it is bad, but because it competes against the dominant institutions of society. And I am not an anarchist, but a empirical realist. See things as they actually are, and stop having a cow.

        1. James Kroeger

          Ok, so for those who would see an anti-Italian bias in the metaphor Mafia, we’ll use “The Mob”, instead.
          (head shaking)

          1. Disturbed Vote

            Originating as a pejorative in the US, originally referring to the lose alliance of Jewish, Irish and Italian who crossed ethnic lines to make criminal syndicates. As a person of Jewish, Irish and Italian extraction, I am still triggered. Try Triad or Tong for example, since I am not Chinese. Of course as the Irish found out, the alliance with them was temporary on St Valentine’s Day … when the Italians hired the Jews to massacre them.

            Criminality is only trivially ethnic.

            1. sd

              What’s your point? Your only objective appears to be to demoralize people and disrupt the sangha that is NC.

              1. Disturbed Voter

                The Sangha in China was only permitted when it served the interests of the Emperor. This was terminated in the latter stages of the Tang Dynasty. The first goal on the path to enlightenment is to realize one isn’t enlightened already. Once that happens, then guarded optimism is merited.

    6. Scott Dunn

      There is one point that seems to be missing debates on single payer health care. If everybody pays in the form of taxes and there is one payer to go to for reimbursement for expenses, that makes it rather hard for the rentier class to escape the burdens they created in the first place.

      The game we’ve been playing for decades now is “who gets to shift the burden to someone else”. Single payer health care, with a tax on all forms of income, especially income derived from capital, makes that game nearly impossible to play. This should be the most appealing attribute of a single payer system, but few are talking about it.

      1. craazyboy

        It goes well beyond that. The rich wouldn’t have the segment of healthcare where our space age technology and drug making and free market organ donorship may actually work. Or your platoon of Docs will make you die trying.

        And if you’re rich and don’t like waiting in line, you can always offer cash to get priority scheduling.

        The rest of us will have to wait for Jason Bourne to conquer the orbiting space city that has the good hospital with the Nano-Tech Resurrection Machines. So what if it makes your hair turn orange?

  2. flora

    Obama and the Dems passing AHCA instead of single payer, or Medicare for All, revived the fortunes of the GOP in the 2010 midterms. The GOP House passing repeal/replace legislation will revive the Dem fortunes in the 2018 midterm. Call me skeptical, but I think that’s exactly the intent. Health care insurance has become part of the D.C. kabuki. Dems signing on to single payer at a time there’s no chance it will be voted on is more kabuki. If the current Dem estab regain power there’s no change single payer will pass, imo. “never, ever, ever…”

    1. oh

      Right! Anyone (Congress critter wise) can co sponser a bill when they know fully well it’s going nowhere! Another con on the gullible public.

  3. Marley's dad

    One of the first steps necessary for serious consideration of single payer must be getting rid of Nancy Pelousy.

  4. Cynthia

    If single-payer or Medicare-for -All has no chance of passage, which seems to be the case, then why can’t we just let individuals join a pool of large government employees or let them participate in a state-sponsored medicaid program, regardless of their income, age or health? Average costs per enrollee, including administrative and benefits, are well known and often underwritten by insurance companies. An HMO or “cadillac” plan could be offered to those who are well or have preexisting conditions, which would allow these individuals to purchase health insurance and pay premiums into a large pool, such as is done by postal workers and other government agency employees, many of whom have preexisting conditions and enjoy insurance through their employment. People can receive wellness checkups or costly procedures that are currently given to those who are employed by school systems, state parks, and federal agencies like the VA, to name a few, without fear of going bankrupt. Is this too simple an approach? Or, are insurance companies holding legislators hostage to their profits? Keep in mind, we only need to insure about 30 million Americans, which is less than 10% of the entire US population. Many of these people are young and healthy and would join large pools that insure all age groups, including some with prior illnesses.

    1. marym

      The suggested remedies seem broadly similar to the Obamacare approach – , expanded access to our existing patchwork of systems, incentives for healthier people to participate, and some risk mitigation features. All these current systems are under stress or inadequate – rising out-of-pocket costs, insurance companies abandoning some markets, privatization and its problems, narrow networks, Medicaid estate clawback, etc). Also, a system where benefits are so unevenly distributed through a maze of different types of coverage is, as we are seeing, very vulnerable to attack.

      Maybe I’m misunderstanding the statement that “we only need to insure about 30 million Americans,” but if it means only those without any insurance at all, I disagree. With all the issues listed above, it’s not the case that people who already have insurance have reliable access to affordable, adequate care.

      Countries that provide universal healthcare do so without relying on private, for-profit insurance.

    2. roardrider

      let them participate in a state-sponsored medicaid program

      Bah! Have you, or anyone of these disphit pundits who extoll the Medicaid expansion aspect of Obummercare, actually been on Medicaid? I was. Good luck finding doctors, let alone ones with good credentials that accepts patients in that program.

  5. Pinhead

    Medicare for all is not necessarily the ideal solution. Several European countries, among them Netherlands, Germany and Switzerland, have health insurance for all but do not have single payer systems. A combination of for-profit and not-for-profit insurers, strongly regulated in all cases, compete with each other and prevent bloated administration (as in France and, to some extent, with Medicare in America). Cutting administrative costs and central purchaing of drugs will do more than outlawing profits to bring America’s health care bill down to the OECD average while still insuring everyone. Small co-payments – $10 for visiting a family doctor, $20 for a specialist – can reduce wasted medical resources considerably. Sane end-of-life practice could cut hospital costs by one third.

    1. DH

      Time for an FCC investigation for using a four-letter word. “Sane” is no longer allowed in public discourse or legislative practices. That word has joined George Carlin’s “Seven Words You Can Never Say on Television”.

  6. roardrider

    strongly regulated in all cases

    And that is why such systems will fail in the regulation-phobic (unless its of the anti-consumer, anti-labor, pro-rent extraction variety) United Mistakes of America. Even if regulation was passes, it will, like most regulations that big business doesn’t like, poorly enforced, if at all.

  7. Synoia

    The more interesting thing that happened when the bill failed to pass last time is that H.R. 676, the expanded and improved Medicare for all bill, gained 24 co-sponsors including my Congressman, Jim Cooper, who is a blue dog Democrat who has never co-sponsored H.R. 676 in the past.

    Easy to do when you are in the minority. Covering his ass? I believe so.

  8. DH

    As Donald Trump so ably pointed out: “Of course the Australians have better healthcare than we do –everybody does. ObamaCare is dead! But our healthcare will soon be great.” Twitter 3:13 PM – 5 May 2017

    It would be nice if Congress actually held some hearings to explore why everybody else has better healthcare as illustrated in this graphic.

    It would be interesting to explore what some of these other countries are doing, since they are not all doing the same thing to come up with similar results (typically longer average lifespans with costs that are about 1/3 to 2/3 of US per capita healthcare costs). Getting some actual data and testimony for alternative approaches could actually allow for real debate instead of just hitting ideologies back and forth over a legislative net. We could actually get a really good healthcare system at lower cost out of that process. Unfortunately, I think we will just be subjected to more propaganda instead.

  9. craazyboy

    “Nancy Pelosi: The Republicans have the majority, they won the vote but the American people now have to judge them by how they have acted. Not by how we’ve characterized what they stand for, now they are on record. As I said, this vote will be tattooed to them as I also said they will glow in the dark.”

    Sayeth Nancy, day-glo orange Real News construction cone, formerly blocking the Highway To Healthcare.

    She can’t even keep her BS straight from one month to the next. “NancyCare” was the “Stairway To “ObamaCare”.

    Next, the bi-partisan_exec_branch [DOD and IRS approved – Pragmatic Citizen Responsibility Plan – to be financed by the states!]

    Push it down to state level – because competition! Translation: Insurance companies pulling out of OCare, ramp down state Medicaid, Health networks consolidating, all leading to waiting lines at the emergency room for those of us preferring NOT to compete with employer paid healthcare plans!

    How long? Take the 18% of GDP we pay now and try and find that money at state level – now spending 5-6% for everything else and needing real tax money to spend. Then comes the Fed income tax cuts for mostly the .01% – because they saved us all that money! Also too, innovation and yobs!

    Toss our “security” in the pile too – and a Wall to keep us “together”, tweeting, and bonding our troubles away. And grandchildren – no end in sight for those. Even at a 70% success rate! Or imports.

    Ugh. These are dangerous Stephen King clowns, indeed. Bad for our health.

    1. jrs

      yea but the people do this every 2 to 4 years, judge the Rs or Ds how they have acted, and all it ever gets us is being a sh*tty ping pong being hurled from one RACKET to another.

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