Bernie Sanders' Bill Gets America Zero Percent Closer to Single Payer

[brooklynite]

Jonathan Chait:

The sight of 15 Senate Democrats, including many of the party’s likely presidential contenders, co-sponsoring Bernie Sanders’s single-payer health-care bill may look like a momentous step. “What that means,” writes Jake Tapper, “is that with the notable exception of former Vice President Joe Biden, every top tier(ish) 2020 Democrat is now on board with a policy proposal that Clinton said less than two years ago would ‘never, ever come to pass.’”

But this image of progress only holds true if you imagine the process as a series of continuous steps. In reality, single payer has always been, and remains, a political dilemma that nobody has been able to resolve, and there is no evidence the resolution has grown any easier. What looks like a large step forward is actually a party edging closer to a cliff it has no intention of going over.

The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.

Pointing out the immense political obstacles to single-payer is NOT the same as being against it.

[leftstreet]

1. "by accident" my ass

The US for profit healthcare system has FOUGHT and bribed and deceived for decades against the will of politicians, grassroots activists, and everyday citizens

Healthcare is a right. It WILL happen, and it will be no accident

[onit2day]

33. Don't know what you're talking about.

Medicare operates at a 3% overhead compared to private who operate at (by rule of the ACA) at least 20% and as much as 50%. This profiteering must end. We got closer to single payer with the ACA and if the Medicaid expansion had remained mandatory for all states we would almost be there now. Single payer would lower HC cost for all Americans because everyone would be covered by the same ins payer. Those employer plans will now be covered by your Medicare taxes which you already pay only you won't be paying into employer plans. If taxes go up it will still be in your favor because you will pay less overall by saving on the costs of employer plans only Medicare will cover everything including dental, vision and hearing.. All the paper work saved by having one company covering all payments. Single payer is the only way to keep corporations from profiteering on you health care. The program is already in place and merely needs to be expanded and taxes raised and ins costs now being payed would be eliminated. Should have been done years ago and will be as successful as SS...and as well liked. No my friend, we are almost there on single payer because it's what the people want.

[leftstreet]

35. This makes no sense

I just said single payer hasn't prevailed because for-profiteers fought against it

That means I agree with you

But maybe you meant to respond to someone else

[ollie10]

43. Are you saying medicare covers dental, vision and hearing?

Check it out.

I am on Medicare, and the coverage for dental, vision....is so poor that I opt to use my wife's employer-provided insurance for that, and Medicare for everything else.

[still_one]

66. Unless you have some kind of advantage plan, dental is not covered, and vision for glasses is not

covered, though vision for checking the health of one's eyes is covered, such as glaucoma, etc.

Part A is what most people have being paying for in their taxes, and is covered when one turns 65. Part B requires an additional premium which most people sign up for, and it is usually deducted from their social security. In addition, a supplemental plan is also necessary to cover expenses Medicare does not fully cover. A prescription plan may also result in an additional premium, and as far as I am aware dental is not covered by Medicare, so a separate dental insurance policy is necessary

[WyattKansas]

91. Bernie did mention dental and vision on tv last night.

So yes, Bernie is very aware of it and the importance of it. I think it is more important for health care in general to move to the Medicare for all model and get rid of the Extortion Wealth Care Racket that all of America is crippled with instead of health care. Once you do that, then there will be funding available for needs that have been neglected in favor of our vulture capitalism medical system.

And here is the most important point for the Democratic Party to understand... Unless you start mentioning it and start demanding it as a right in this country, then you will never receive any help or even consideration for it. After all, war profiteers and the wealthy elite understand the importance of demanding what they claim to first need and now just want.

[NurseJackie]

2. "Pointing out the immense political obstacles to single-payer is NOT the same as being against it."

Pointing out the immense political obstacles to single-payer is NOT the same as being against it.

I agree with you.

[Voltaire2]

7. It must be troubling to have so many Democrats

across the party standing up and supporting this.

[Eliot Rosewater]

55. What troubles me is the traitor, nazi racist in the WH

[NurseJackie]

63. What a weird thing to say. Why should that be troubling?

Nancy Pelosi is right about this, however. Fix and strengthen the ACA. Single-payer gets closer to reality with an ACA that functions well and delivers what's promised.

[kstewart33]

31. Single payer isn't the answer. Not yet.

Less than 10% of the population struggle for health care coverage. The remaining 90% have health care coverage and do not want anyone messing with their healthcare coverage. That's the insurmountable barrier.

UNLESS, legislation effectively curbs the power of insurance companies to raise premiums and do all of the other reprehensible things they have been allowed to do, to boost their profits.

And UNLESS the government can guarantee good healthcare for all without raising taxes sky-high.

Want to get even more Republicans elected to Congress? Raise taxes big-time.

The Dems and Sanders haven't figured any of this out yet.

So for now, the best option is to improve the ACA, make the changes that strengthen the ACA market which would reduce healthcare costs and eliminate these huge premium increases.

So far, no solutions have been developed to break down these barriers.

So for now, I'll pass on the 'Medicare for all' press conferences.

[jamesatemple]

53. Kindly explain this to me:

You state "Want to get even more Republicans elected to Congress? Raise taxes big-time." Yet if my taxes were to be raised by an additional $500.00/month (to my limited income, that's "big-time&quot which would allow me to drop my $600.00/month health insurance premium, I'd jump on it in a heart beat. I could save $1,200.00 per year.

Now when folks, like yourself, raise the issue of "big tax increases, why do they/you never mention the savings from getting out from under those massive health insurance premiums? Surely you are aware of these facts; there must be something that I don't understand. Thanks for your reply.

[Moostache]

65. I join you in wondering the same...why are all "tax increases" still dirty words???

I want to know how corporations would feel about legislation that REDUCED their contributions to employee health plans by INCREASING the corporate tax rate to include a non-profit based employer contribution for health care?

I look at it this way...all hypothetical numbers, just using round numbers to make the math easy...comparisons are meant to be relative, not absolute!!

Say my family health plan costs $3,000 a month and my employer and I split that 80:20 where my monthly contribution is $600 a month and my employer is picking up the other $2,400. That $3,000 a month policy has to cover the 20-50% overhead for the for-profit insurance providers...so as much as $1,500 a month from that premium is covering the costs of the INSURER, NOT the cost of the insurance or the cost of the medical care provided by it.

So...
$3,000 total
$2,400 employer cost
$600 employee cost

$1,500 insurance company cut (profits)
$1,500 available for healthcare costs

Versus...
$3,000 total
$60 insurance company cut (administrative expenses)
$2,940 available for healthcare costs

Let's be realistic (ie. OVERLY generous to the corporations and OVERLY harsh on the individuals)

Instead of paying $2,400 as an employer contribution, let's give them ALL of the overhead and profit reductions...cut their contributions from $2,400 to $900 a month; but call it a "corporate health care tax" - and leave the employee contribution at the same $600 but now call it a "healthcare tax".

***FULL DISCLOSURE...I have no idea how the tax ramifications of the employer contribution being deductible affects this...but a reduction of the total outlay from $2,400 per month to $900 a month covers a lot of tax deduction potential either way...

As a business owner, if I was asked to cover 2-3% of operational expenses (Medicare for all) or 20-50% of operational expense (private insurance), EVEN IF MY TAX RATES APPEAR TO GO UP, it is a no-brain decision!!!

The conversion from the existing system, which literally NO ONE BUT THE INSURANCE COMPANIES REALLY LOVE, is converting the employer contributions without allowing them to become some kind of boost to the bottom line beyond the amount the company's are currently financing for the insurance companies. If the employer contribution is currently financing 100% of the insurance company profits, then the law needs to recognize this and REDUCE that outlay by eliminating the grift...the skimming of profits off of human misery, misfortune and woe.

This is not an intractable problem, just a very complicated and serious one. It should be debated IN PUBLIC and OPEN HEARINGS robustly and honestly and ideologues that start prevaricating and muddying the waters for financial purpose should be tried as profiteers and treated like those who would cheat the government in war time...harshly and with public shame.

This is not an easy nut to crack...far better men than I have tried and failed for over a 100 years...but getting better should never be seen as an unreachable Nirvana. Where we are is unacceptable, just be moving to something slightly better is hard to do does not mean we should ever stop trying to take that next step!!!

[kstewart33]

71. Remember George HW Bush's infamous statement?

"Read my lips. No new taxes." Bush made that promise in his renomination acceptance speech at the Republican convention in 1992. He broke his promise. Republicans were furious. It cost him his re-election.

Cutting taxes has been at the top of the Republican agenda for at least 40 years. People understand tax increases. More taxes mean that it comes right out of the paycheck. Very simple.

Promising that premiums will decline with a tax increase is a very, very difficult case to make. Because many people won't believe it. Congress has disappointed them all - Dem and Republican - so many times.

Putting a promise that many people won't even understand against a mantra that's reigned supreme for decades - "Don't raise may taxes!" - seems rational to think it won't be an easy sell.

[The Velveteen Ocelot]

3. Jonathan Chait is a washed-up neoliberal dick.

Of course the bill won't pass as things are now. The point of the bill is to get the issue on the table and get people to think about it seriously. It's a foot in the door.

[GaryCnf]

4. What a puzzle . . .

What's a Bernie hater like Chait to do with every the Democratic Party favorite standing right by his side?

Conyers et al. in the House, Sanders et al. in the Senate = the COURAGE to stand for SOMETHING = victory in 2018

[left-of-center2012]

34. "a Bernie hater like Chait"

Maybe he thinks being a Bernie hater will get him support from certain folks.

I long ago tired of the daily attacks on Bernie.

P.S.
I voted for Hillary.

[Voltaire2]

5. Yes let's rain on the parade.

We wouldn't want our party to look unified strong and determined to make life better for all of us.

[brooklynite]

14. Better still, lets not threaten to Primary every otherwise reliable Democrat who doesn't sign on

[Voltaire2]

19. so we are in agreement: we should all get on board and stop fighting over this issue.

Great.

[Expecting Rain]

39. Have a parade when we have a well-vetted plan that passes.

This day isn't parade worthy.

Although some hot air balloons might....

[tecelote]

40. +1

How can you not be behind this 100%?!

Is it a litmus test for Democrats. Damn right it is. A plan to help all Americans. To bring America up to the minimum standards of so many other countries.

It's the right thing to do. It's beyond the right time to do it.

[Demsrule86]

72. This is not a parade but a funeral march for the many who depend on the ACA.

[Voltaire2]

93. tp 3: somehow supporting medicare for all will kill the ACA instead.

OK please explain. Are the Democrats who support medicare for all are now going to vote to repeal the ACA the next time it comes up or a vote?

[stevenleser]

6. More specifically regarding the already insured is that those 155 million must get equal or better

health coverage and care than they currently get or they will vote legislators into office that will repeal it.

So they have to get moved onto Medicare or whatever other system, and it better be equal or better than what they have now.

And we need details, not "This is going to be great because it will cover stuff!!!!!"

[ismnotwasm]

13. Medicare would have to be modified

Right now there is only one chronic disease covered by Medicare to 80% and that's chronic renal failure. Moving chronic diseases from Medicaid to Medicare is also something that needs to be considered. It seems to me, a public option is the first reasonable step.

[stevenleser]

28. Yes, and if you dare point that out to the wrong people, You're the devil!

And you are a double devil if you point out that closing holes like that will be very expensive, potentially prohibitively so.

[ismnotwasm]

30. i get really bothered

By people thinking a "medicare expansion" is somehow simple--a matter of easy transference and taxation. Right now reimbursements for hospitals are "bundled" i.e. If you go in for a hip replacement, the costs of complications are not necessarily covered. What the government considers preventable, pressure sores and UTIs, some pneumonias are not covered at all. Our current system isn't providing adequate reimbursement for caregivers. Plus there are NOT ENOUGH care givers, not enough doctors, not enough,nurses, not enough anybody for Medicare for all. It would be a giant clusterfuck.

[Demsrule86]

73. They don't want to change...and that is why Hillarycare went south...find a plan like a public

option that insures those who need it...it will be less costly and can be increased as needed...and it has chance of passing...single payer does not.

[Quixote1818]

8. It's a battle that will take years to win but it's worth having

It's gaining momentum and one of these days we will control all three branches of Gov and get it through. But if Sanders hadn't been pushing it there would be zero percent chance even in the future. These battles are extremely difficult but changing public opinion and getting enough political capitol to get something like this through can take years.

[Demsrule86]

50. Do you think the majority of insured who get it at work will support single payer?

They sure didn't support Hillarycare...and I do not believe they will support single payer now...a public option and an improved ACA are what we should focus on...we could also drop the Medicare age to 55.

[Demsrule86]

74. We need to protect what we have now...while we wage this 'war' which we may not win.

[Demit]

9. The value in this is showing that the Democratic Party stands FOR something.

[Voltaire2]

17. no shit.

This is a calculated strategy to change the narrative for the 2018 midterm. We should all get on board. Is it a risk? Absolutely. Is it worth taking this risk? Yes indeed. Control of Congress is at stake.

[Demsrule86]

75. I don't think single payer will work. I am for universal coverage however.

[JI7]

10. So what happens if this passed and a pres signed it ?

Who would work out the details of funding ?

[brooklynite]

16. It doesn't work that way...

...the funding would have to be agreed to and incorporated into the legislation.

[Voltaire2]

18. the funding is detailed in the bill.

[Demsrule86]

49. What president will sign it? And only a super majority can pass it.

[yodermon]

11. Right. So, CAMPAIGN ON SINGLE PAYER, LAND ON THE PUBLIC OPTION.

Yes i'm shouting because some Democrats are politically tone deaf.

[Demsrule86]

47. Yes they are ...single payer won't work anyway, but we won't ever get it in the first place.

[Demsrule86]

77. or be demonized and lose big and lose the ACA and a public option.

[HarmonyRockets]

12. I never listen to that hack Chait.

[Hassin Bin Sober]

15. Throwing up your hands saying it's never ever going to happen means you might as well be against it

[Voltaire2]

20. may the FUD be with you.

You would think that when moderate party leaders like Shaheen get on board, people here would step back and reconsider their position.

[Gothmog]

21. K&R

[jalan48]

22. No we can't! Got that America?

[bullwinkle428]

23. "Man, we are NEVER going to see the abolition of Jim Crow, so what's

even the point of trying to take a stand against it?"

[tiredtoo]

26. ouch

You are cutting close to the bone here bullwinkle428. Use caution.

[Arazi]

24. Lol, of course Chait is against it

No we can't! No we can't! No we can't!

[Autumn]

25. We know. Single payer will never ever happen. It's the Republican mantra.

That sucks for those people, because it's going to happen.

[Demsrule86]

46. Give me a plausible scenario how Sen. Sander's bill becomes law.

[Autumn]

58. Same as the ACA, we work on it until we get it.

[Demsrule86]

60. That is not how we got the ACA...tell me right now how this bill becomes law.

You can't because it won't...it's a dream not a plan.

[Autumn]

61. Are you telling me that our Dems didn't work on the ACA until Obama signed it into law?

It didn't just drop out of the sky onto Obamas desk March 23, 2010 out of the blue. It was a long time coming and a lot of people worked their asses off on it.

[Demsrule86]

68. We had the Congress and the presidency...did we 'work' on it during the Bush years other

than the House bill presented every year? No...it was process which we can't emulate because we are out of power...but we could save the ACA...and the ACA passed by the skin of its teeth...we could make o changes because it would have lost in the House...this single payer is foolish and risks the ACA which is reality not a dream. It will save people's lives.

[Autumn]

69. We must only discuss/ attempt important things when we have Congress and the presidency. Right.

[Demsrule86]

70. Well introducing this bill when it has no chance of passing reminds me of the 50 times the GOP

introduced bill to repeal the ACA...what is the point? We would be better served to save the ACA.

[Autumn]

90. I can see why you would think that.

[HarmonyRockets]

27. This is Chait, by the way:

[Gore1FL]

29. We can't get movement on climate change or fair taxes either.

We might as well not try--or even better, adopt GOP policies....

[RandiFan1290]

32. Same naysayers told us to STFU about marriage equality

They must enjoy being on the wrong side of history.

[ms liberty]

48. This. n/t

[R B Garr]

67. This isn't really an equitable comparison because single payer costs literally

billions and is a huge economic shift. Marriage equality is about bigotry and Constitutional equality.

[Demsrule86]

78. I never said that...civil rights are not part of politics...but consider those on the left left

that rail against identity politics which is the same thing.

[mentalslavery]

36. Chait is a concern troll

another centrist trying to get us to "tone it down". This is an excellent opening salvo....and puts the administration in an awkward position. Feel the bern.....

[LarryNM]

37. And the Real Reason for a decade of Democratic Loses eom

[mentalslavery]

38. and a little context to boot

Hillary is talking about her loss....bernie is talking about single payer

[Demsrule86]

42. Which will never happen...and Sen. Sanders has certainly made some comments

about his primary loss.

[Demsrule86]

45. The gerrymander and the fact...that we passed a health care plan in 09

( I am not sorry), but finally people like it and now we go for something they won't like for a variety of reasons...makes no sense.

[Demsrule86]

41. So true...I do not believe single payer is possible...in a bill like Sen. Sanders is

hawking...keep the aca, add a public option and lower the medicare age to 55...these could happen...single payer never. This would care for those who can't get work place insurance and in time workplace insurance will be less and less...keep expanded Medicare,it truly is a life saver.

[Sienna86]

44. We must try, and keep trying

Simply because it's the right thing to do.

[Not Ruth]

51. Bernie persisted

[mentalslavery]

56. nevertheless....bernie persisted nt

[Demsrule86]

79. To what end? It won't become law...would that he would persist in saving the only health care we

and may ever have in the foreseeable future...the ACA.

[Not Ruth]

82. Many important things take time, civil rights for example

People these days want immediate gratification, sorry to say, the world often does not work that way.

[Demsrule86]

84. So people who need insurance now are unimportant?

[ck4829]

52. All I want to know is what protects us from the liars who say we have the "greatest healthcare

system in the world" (Especially when they are referring to healthcare before the ACA).

Whatever gives us protection from them and fights back against their vision for the healthcare (or lack of it) for the American people is what we desperately need more of.

[Dustlawyer]

54. Just getting more people talking about it helps to add legitimacy

And support. The majority of the American people understand that they could be un-employed tomorrow, pre-existing conditions could be re-instituted, anything could happen.

We are tired of the uncertainty, high costs of prescriptions, and watching foamy, friends, and other loved ones being denied treatment or filing bankruptcy.

Bringing this up builds the expectation and feeling of inevitability we will eventually get single payer.

It is a complicated and difficult process, but one that makes financial sense to all. Sure taxes go up, but the cost savings to employers and employees more than make up for it.

Lastly, No one has to die because they are poor or cannot afford the insane expense of treatment!

[mentalslavery]

57. Yeeeeppp...control the narrative...while we are talkin single payer

we are not talkin tax reform...

[QC]

59. Chait's still around? n/t

[aikoaiko]

62. Pointing out the immense political obstacles is fuckin easy.

Persisting nevertheless is leadership.

[Voltaire2]

64. indeed.

[Demsrule86]

80. No it is not...when you have a plan that needs to be saved and instead you go all out on a plan

that can't pass, it is just foolishness. Save the ACA.

[aikoaiko]

83. Maybe this option is worrisome enough to motivate Republicans to save ACA.

We'll see.

[Demsrule86]

88. It isn't. They want nothing and can use this to get rid of all health care.

[Bettie]

76. Ah yes, another

post about how "it will never happen" so no one should try or even talk about it beyond saying "No We Can't".

[Demsrule86]

81. I would bet, and I will save this post that a year from now...single payer will not be

enacted...and I sincerely hope the ACA is still here...it is all we have or may ever have.

[Bettie]

86. Right now, with a fully Republican congress

it will go nowhere, but that doesn't mean we should never try, doesn't mean we should just shrug and say "meh, we don't need to try for anything better than what the right wing is willing to concede"...which, by the way, is less than nothing.

Even if it doesn't happen, the effort is worthwhile.

[Donkees]

85. 'Zero is everything; everything is zero. This is Zen mathematics'

[alarimer]

87. It's about health care as a RIGHT.

Why is nobody here talking about that and what that implies? Yes, this bill will not pass. BUT it gets the conversation going and framing health care as a RIGHT goes a long way towards changing the narrative. But some people are so fucking fixated on attacking Bernie Sanders that they cannot see that the right thing to do is to make health care a RIGHT. The pundit class like Chait have no fucking clue at all what is is actually like not to have health care. Or not to be able to afford the costs associated with health insurance, even the small copays associated with most insurance. I swear liberal pundits are the worst people on the planet, after Trumpians. Affluent, out-of-touch idiots. The Democrats would be better off ignoring "writers" like Chait.

Does he know about the disparities in outcomes for hospitals that serve primarily the poor? They don't get transplants. They don't get other lifesaving or life-improving treatments. They DIE sooner than others. DO YOU EVEN FUCKING CARE, Jonathan Chait??? Obviously not.

Centrists like Jonathan Chait don't seem to give a shit about anything that would actually make a difference. Just another version of "Fuck you, I've got mine." I mean, I also know plenty of liberals like that, but they don't have newspaper columns.

Look, whether Medicare for all is what we end up with is anybody's guess. Right now the point is changing the conversation and that includes talking about real disparities in care that currently exist, even with the ACA and expansion of Medicaid. People die sooner than they need to. We spend more as a percentage of GDP than we need to. Outcomes are worse across the board when you compare the US with countries like Canada, which has a Medicare for all type system. They live longer and the disparities between the bottom and the top are not as great.

Edited because the real target of my ire should have been Jonathan Chait.

[CousinIT]

89. Is that the point of their pushing this now? I don't think it is.

We all know it will never pass right now. Lining up support, plans and generating public awareness for elections/fights ahead though is a good idea. Voters will remember the Trump admin trying to gut their health insurance. And they will remember Democrats supporting what so many other countries do: have a single payer system that reduces costs and provides care for virtually everyone.

The writer presents a false premise. The false premise that Sanders and other Democrats supporting Medicare for All or a single payer system expect to get that passed right now. Then the writer grouses because the false premise he put forth is unfulfillable by Sanders' bill.

Of COURSE it is. Duh.

[Calista241]

92. The problem with this approach is that Republicans are going to dictate the negatives

Bernie's plan doesn't talk about funding. In the next week or so, Trump and others are going to start talking about an 80-100% tax increase to fund this plan.

That is going to stick with everyone that stood up there on that stage. So all the middle classers in the 28% tax bracket, are now going to be in the 56% tax bracket after this bill goes into effect. We'll be fighting that label for decades.