Vermont is the first state who may actually have single payer health insurance become a reality. The Vermont House has passed a single payer bill which might actually get through the Vermont Senate, too.
"This bill takes our state one step closer to a system that ensures that all Vermonters have access to the care they deserve and contains costs," House Speaker Shap Smith said shortly after the House passed the bill 92-49.
The measure now goes to the Senate, where it is expected to pass, but with some possible changes.
Gov. Peter Shumlin, who made single-payer health care a centerpiece of his gubernatorial campaign last year, also praised the legislation. He said it would make Vermont "the first state in the country to make the first substantive step to deliver a health care system where health care will be a right and not a privilege, where health care will follow the individual, not be a requirement of the employer, and where we'll have an affordable system that contains costs."
Under the proposed plan, Vermont would create a state-run insurance exchange which would then be converted to the single-payer model in 2013. Despite Republican efforts to exempt some businesses who self-insure their health benefits, the Democrats remained united and passed it without those exemptions.
This is how it will happen. One state at a time. Watch Vermont to see how it's done.
Both sides have now laid out strategy roadmaps for the upcoming repeal battle in the Senate. Or not. Right now it feels like a fist-shaking session with a big pissing contest for the finale.
It will go something like this: Senate Democrats will force Republicans to debate and take votes on provisions like closing the doughnut hole, ending exclusions for pre-existing conditions, barring exclusion of children with pre-existing conditions and allowing young adults to remain on their parents' policies until age 26.
It will continue what is already a contentious, annoying, academic debate, and one that's not likely to be settled in the Congress, anyway. The downside risk to Democrats will be giving Republicans more time to turn people against it. The downside risk to Republicans is reinforcing the perception they don't really want to 'replace' the law with anything else. Ultimately the Supreme Court will have the final say on the individual mandate. If it is nullified, the entire law could be tossed, since no provision was built in to preserve all other provisions if one provision is found to be unconstitutional.
It's still about the pre-existing conditions. Republicans don't want people with pre-existing conditions to have access to health care unless they can pay for it themselves. Democrats understand that health care is one of the fundamental obligations of a government to its people.
The Affordable Care Act doesn't make the government much larger as a share of GDP. Rather, it commits the government to guaranteeing something close to universal health care, even if the relevant transactions occur between individuals and private insurance companies. The reason the GOP talks about "repeal and replace" is that they don't think they can persuade Americans to undo that underlying commitment. If they did, they'd just go for repeal.
Meanwhile, Vermont marches toward single-payer healthcare for residents there. California passed single payer twice and was twice vetoed. The last time they tried to pass it through the legislature, it failed, but they aren't giving up. It will rise again, particularly in light of Gov. Brown's proposed cuts to Medicaid and MediCal coverage.
I believe the only way to move the country toward a national single payer system is via the states, similar to how Canada's came into being. But before that happens, this nation has to embrace the idea that sick people shouldn't be excluded from access to the health care system, which is what this debate should be about, rather than pissing contests over every damn provision in the Affordable Care Act.
Bonus: Joan McCarter at Daily Kos breaks down a recent poll showing zero support for repeal of the whole thing.
When they actually asked about those certain parts, "8% are opposed to everything and 11% are opposed to the individual mandate. And that's about it. Not a single other provision was opposed by more than 1% of the respondents. Not even higher taxes! Hell, a full 14% were supposedly in favor of repeal but couldn't name even a single provision they disliked."
This makes the piece-by-piece strategy the Senate Dems are devising very smart.
Any projection which goes out 27 years is so incredibly reliant on the embedded assumptions about growth, employment and lifespans that it amounts to a fiction. It is, at best, a guess.
Increase growth by just a little bit and the entire "problem" goes away. Get rid of the taxation cap so the rich are not capped in what they pay and the entire problem goes away. Assume higher employment, and the entire problem goes away. Assume a reduction in inequality, and the problem goes away.
The US has a number of problems which are at or near crisis, such as employment, inequality and healthcare costs, to name just a few. Social Security is not one of them. It isn't even close, and politicians and billionaires like Pete Peterson who are trying to gin up a crisis should be ashamed of themselves.
If they want the US budget more in order they should look at health care, where single payer could cut costs by at least a third, and at the military, where real spending has doubled since the end of the Clinton administration.
Or they should work on increasing employment and increasing wages for ordinary people. That's a crisis.
Instead of dealing with real problems, instead of tackling the medical industry or the military-industrial complex, instead of fixing the job situation, they want to steal money from old people.
1) Social Security, at current rates, is not expected to run short of money before 2037.
2)The simplest way to "fix" Social Security, if you're worried about a "problem" 27 years in the future, is simply to remove the contribution limit. End of problem. Period. Social Security is not in crisis.
3) The reason politicians want to "fix" Social Security is to increase the SS surplus, so they can use it for other things.
4) Medicare has more serious issues. However the simplest way to fix healthcare in the US is to move single payer, which would reduce healthcare per person by one-third. It has worked for every other country in the history of the world that has done it. It will work for the US. Since we've admitted now that everyone deserves health care, and since it's cheaper, and better, why not use the next round of healthcare to fix Medicare by fixing health care?
The unspoken entitlement is the US military. The US spends about half the entire world's military budget. There is, actually, no one in the world who can invade or seriously threaten the US in any fashion. (Is Canada going to invade? Mexico?) You can easily slash the military budget in half and still be so far ahead of any possible combination of enemies that it isn't even close.
The fact that many of them joined the Tea Party after losing their jobs raises questions of whether the movement can survive an improvement in the economy, with people trading protest signs for paychecks.
This wasn't necessary. A real, properly put together stimulus bill would have got them back to work. For example, a program to make every building in America be at least energy neutral and preferably creating energy, would have kept them usefully employed.
The bottom line in America today is that while everyone who isn't paid not to know, knows how to fix what's wrong with America (for example, instead of Health Care Reform, pass single payer), nothing that really fixes anything fundamental will be allowed to occur.
America is controlled by what economists call rent-seeking behaviour. Virtually everyone important has a revenue stream, and they don't want anyone to take that revenue stream away. So pharma and insurance companies, who would have been damaged badly by single payer (they would have lost hundreds of billions) made sure that a plan to provide everyone with better health care for a third less than current costs was never even considered.
The most important game in America today is the contest for control of government, so that government can directly or indirectly give you money. Health care "reform" in which the government decided to force Americans to buy private health insurance or be fined is merely the latest (and most blatant) example. Virtually every industry, from finance to telecom to agriculture is involved in this game. It is in all their interests to make sure the game continues, but they do fight amongst each other for the spoils.
This game will continue until the US can no longer afford it. Indeed, even now, some industries are taking it on the chin, loosing out to their better connected cousins. For example, the current downturn has seen the prison-industrial complex taking losing out. They get most of their money from State governments, and the States simply cannot afford to keep locking up so many people at so much cost.
This is the downward spiral of a great power in senescence. It ends in collapse, reformation or revolution, when it becomes clear that the rents of the Ancien Regime can no longer be afforded, and too many of those who were bought off are thrown off their dole.
The Tea Partiers, however misguided they may be in many respects, have been thrown off the dole. Whatever they are called, they will not be going away.
Smart move. Bloggers are outside the Beltway cocktail circuit. We're informed, we can get to the heart of the issue quickly and we're not afraid to be confrontational at times, which makes for good television.
So I come back to where's my gig? I think I'm as likely a choice as Erick Erickson and in many ways, a better business choice. I'm educated, articulate, snarky, and unafraid to defend my political stances, all traits you need and want in a television commentator. Moreover, I'm committed to facts and context and I'm capable of having a discussion with someone with whom I disagree without pulling facts from my posterior region, insulting them or wishing them harm or death, something you'll NEVER see from Erickson (did you even read his blog before hiring him?).
But most importantly, I've been on the right correct side of issues far more often than Erickson. Hell, I've been correct more often than ALL of your conservative commentators put together. Go ahead. Line up my posts next to Erickson's and let's see who really reports facts and who just catapults the propaganda.
"Erick's a perfect fit for John King, USA, because not only is he an agenda-setter whose words are closely watched in Washington, but as a person who still lives in small-town America, Erick is in touch with the very people John hopes to reach," said Sam Feist, CNN political director and vice president of Washington-based programming. "With Erick's exceptional knowledge of politics, as well as his role as a conservative opinion leader, he will add an important voice to CNN's ideologically diverse group of political contributors." [CNN's Political Ticker, 3/16/10]
Well, actually, if that's the kind of audience you're seeking, maybe I'm not the right person for the job.
However, if you ever get serious about actually wanting a fact-based and ideologically diverse group of contributors--rather than the lip-service you pay it now, you can always reach me through this site.
I was on a conference call with Nancy Pelosi Tuesday afternoon, and she was clear: There's not a snowball's chance in hell that the House will vote to pass the Senate health-care bill in its present form.
"Don’t even think of asking us to vote for the Senate bill unless the other bill has passed both houses that will amend it through reconciliation," she said. But she promised several times during the call: "We will get this done."
What the House apparently will vote for is a repeal of the antitrust legislation that exempted the health insurance and malpractice insurers for the past 65 years. She said it will happen next week.
And in case you haven't figured it out yet, the new Democratic mantra is "Jobs, jobs, jobs." Pelosi wove the theme throughout the call.
She talked about job lock ("If you want to leave your job and become a writer or an entrepreneur without worrying about your health insurance, you can do that.")
"Every issue for us has been about jobs. The recovery, the budget, health, education, climate and energy bills – all about the economic well-being of America’s families," she said.
"Healthcare is central because the current system is so unsustainable. It’s not back-burnered," she said. She noted the difference it make "in the economic security of America’s families.
"We have to get this done, we are so very, very close.
She said some senators are calling her, urging her to take the opportunity to put in single payer and the public option. "I have to wonder, is there a market for these things?" she said, noting she didn't think the Senate had the votes for either.
She ended the call with an exhortation.
"It’s a heavy lift," she said. "The other side has endless money, total determination that change will not happen." She said the insurance industries have the "same philosophical backing as the same people who tried to keep Medicare from happening."
"It’s a pretty exciting time. You can’t be discouraged, we have to keep fighting for the American people and our democracy, she said.
"It’s not only about their health, it’s about economic security. We are determined to get that done. If I sound calm, it’s because we will not be deterred from this, we will get it done."
Just got off another blogger conference call, this time with Howard Dean, former CIGNA exec Wendell Potter, and Mike Lux.
Dean announced the results of a DFA poll that is "really quite stunning," he said. (You can read the results here.) The Senate cloture vote is scheduled for 7:30 p.m. on Christmas Eve, he said.
Democracy for America's "No Option, No Mandate" campaign to contact Harry Reid clocked 7000 calls in four hours, too, he said.
Dr. Dean opened the call by saying "this bill has always been a giveaway to the insurance industry, but we were willing to compromise" to get the public option.
He recapped all the compromises we made: "We wanted single payer, but that was taken off the table early on. That was a mistake. We had to get to the place where we had health insurance for all Americans." But now, he said, there's no public option, and no Medicare option.
"You're forced to pay money to an insurance company or get fined $750 by your government, while 27% of your money goes to CEOs who are flying around in these private jets," he said.
He talked about the compromises made for pre-existing conditions, the most disturbing one the ability to charge you 300% more, merely for being older. "It's guaranteed issue, but if you’re making $65,000 a year for a family of four and you’re paying $20,000 for insurance, how is that reform?"
He said the real bad stuff in the Senate bill was
"hidden in the weeds, so you can’t find it."
Dr. Dean brushed aside the "Get a bill, any bill" mentality in Washington. "Any legislation passed will have a huge impact on American healthcare. If they can’t fix it, it shouldn’t pass."
Wendell Potter, former CIGNA executive and reform activist, said the insurance industry got "every single thing they wanted" in the Senate bill.
"There's no individual mandate, no public option. There's also three words, 'benefit design flexibility' in Senate bill – that means the freedom to design plans that will pass more and more of us into ranks of the underinsured - and charge up to 22% of income if someone gets sick," he said.
In Massachusetts, they have a 2 to 1 premium ratio, "and they're already having trouble finding affordable, adequate insurance. The industry wants to shift even more costs to individuals and families, having the government pay them half a trillion dollars. The Senate bill meets every one of their requirements," Potter said.
"They will continue to shift the cost burden to consumers and get around not using preexisting conditions by charging for certain factors like high cholesterol."
Dr. Dean pointed out the House bill "is the compromise, we didn’t think it was right to take the option of an employer-based system away if people liked it."
In Vermont, he said, you can't be charged more than double the lowest premium.
Dean listed some more of the insurance company wish list the Senate was so eager to fill. "Getting rid of the anti-trust provision. This contributes to the predatory effect of the insurance companies – they're essentially unregulated. We need to get the provision in, get them regulated.
Wendell Potter talked about something you often hear pushed from the Republican side: "Just let us sell across state lines and let the market decide." As he points out, insurers would go to the states with least regulation.
Paul Hogarth from Daily Kos asked them to address criticism that if the bill is killed, "there's no reform and we’re worse off, the momentum is gone."
"I don’t know that we’ll be worse off," Dr. Dean said. "We ought to strip down this bill and get rid of the mandate. It should have been done by reconciliation."
I think Marcy Wheeler makes the single most compelling argument here about the precedent of a private health insurance mandate:
And for those who promise we’ll go back and fix this later, once we achieve universal health care, understand what will have happened in the meantime. The idea, of course, is to establish some means to get people single payer coverage (before Lieberman, this would have been through a public option or Medicare buy-in) and, over time, expand it.
In fact, this bill will move toward single payer, too–though not the kind we want. For the large number of people who live in a place where there is limited competition, this bill will require them to get health care through the oligopoly or monopoly provider. It’ll work great for the provider: they will be able to dictate rates. But the Senate bill allows these blossoming single payer providers to keep up to 25% of the benefit in profits and marketing costs, and pass little of that benefit onto citizens. If we make private corporations our single payer, how are we going to convince them to cede control when we ask them to let the government be the single payer?
The reason this matters, though, is the power it gives the health care corporations. We can’t ditch Halliburton or Blackwater because they have become the sole primary contractor providing precisely the services they do. And so, like it or not, we’re dependent on them. And if we were to try to exercise oversight over them, we’d ultimately face the reality that we have no leverage over them, so we’d have to accept whatever they chose to provide. This bill gives the health care industry the leverage we’ve already given Halliburton and Blackwater.
It’s the 9.8% tithe that bothers me the most. But for those who think we can fix it, consider this, too. If the Senate bill passes, in its current form, it will mean that the health care industry was able to dictate–through their Senators Joe Lieberman and Ben Nelson–what they wanted the US Congress to do. They will have succeeded in dictating the precise terms of legislation.
Now, that’s not the first time that has happened. It certainly happened on telecom immunity. It certainly has happened, repeatedly, on Defense contracting (see also Randy Cunningham). But none of these egregious instances of corporations dictating legislation included a tithe–the requirement that citizens pay corporations to provide their service, rather than allowing the government to contract the service.
This is a fundamentally different relationship we’re talking about–one that gives corporations vast new powers. And the fact that–with one temper tantrum from Joe Lieberman–the corporations were able to dictate the terms of this new relationship deeply troubles me.
When this passes, it will become clear that Congress is no longer the sovereign of this nation. Rather, the corporations dictating the laws will be.
I understand the temptation to offer 30 million people health care. What I don’t understand is the nonchalance with which we’re about to fundamentally shift the relationships of governance in doing so.
We’ve seen our Constitution and means of government under attack in the last 8 years. This does so in a different–but every bit as significant way. We don’t mandate tithing corporations in this country–at least not yet. And it troubles me that so many Democrats are rushing to do so, without considering the logical consequences.
Nate Silver picks up an interesting point: Much of the opposition to healthcare reform comes from the left - about 25%. We need to keep pushing on the final bill, because if there's one thing politicians understand and fear, it's bad poll numbers:
Ipsos/McClatchy put out a health care poll two weeks ago. The topline results were nothing special: 34 percent favored "the health care reform proposals presently being discussed", versus 46 percent opposed, and 20 percent undecided. The negative-12 net score is roughly in line with the average of other polls, although the Ipsos poll shows a higher number of undecideds than most others.
Ipsos, however, did something that no other pollster has done. They asked the people who opposed the bill why they opposed it: because they are opposed to health care reform and thought the bill went too far? Or because they support health care reform but thought the bill didn't go far enough?
It turns out that a significant minority of about 25 percent of the people who opposed the plan -- or about 12 of the overall sample -- did so from the left; they thought the plan didn't go far enough.
1) Social Security, at current rates, is not expected to run short of money before 2037.
