What You Need To Know: A Summary For You Lazy Asses
- Those who cling to the tired refrain that this health insurance law is the first step towards something better need to explain to me exactly what is that “something better” and how this law gets us there. And it should be obvious that we’re not any closer to the public option now that this law has been passed.
- The ultimate goal for now is single-payer Medicare for All. Some have argued that we need to go even further to a British/VHA-style government-run health care system; I’m tentatively favorable to such a system and I think we should definitely consider it. But for now let’s stick with Medicare for All.
- We currently have 83 Medicare for All supporters in the U.S. House of Representatives and 6 in the U.S. Senate. (See below; I will also post a separate “whip count” for Medicare for All support in Congress in a future entry.) We have to get that up to 218 in the House and 51 in the Senate.
- We currently have a President who is indifferent to or even slightly hostile to Medicare for All. We need to nominate a pro-Medicare for All Democratic presidential candidate in 2016.
- To build public support for Medicare for All, we have to promote the idea of active, benevolent and competent government and talk up Medicare everywhere we go. See Anthony Weiner on how to do this effectively.
- Passing a Medicare Buy-In will serve as a legislative stepping stone to Medicare for All. Right now we’re at 81 in the House and 8-34 in the Senate, and a President who might sign it but won’t really push for it. We have to get that to 218 in the House, 51 in the Senate and a supporter in the White House.
- If you want to do something immediate to help, donate to Jennifer Brunner, a Medicare for All supporter who is running for Senate from Ohio and is in urgent need of help, as her primary is on May 4 2010 and her campaign has neared bankruptcy several times. If you still have money to burn, donate to Medicare for All supporter Marcy Winograd, who is running in a primary on June 8 2010 against incumbent Rep. Jane Harman in CA-36.
- APRIL 26 2010 UPDATE: Also important as legislative stepping-stones are efforts to pass single-payer on the state level. Right now I know of major efforts in two states. In Pennsylvania the state legislature is considering it and the most passionate and reliable single-payer supporter running for Governor is Joe Hoeffel, who is in desperate need of money. Please donate to him here. In California the state legislature has passed it twice but we need a pro-single-payer Governor to sign it, which we don’t have now and we may not have with Jerry Brown, the sole major Democratic contender. I’m looking for another candidate to support in the primary and general elections and I will update as I make progress.
One of the most tired refrains I have heard from the liberals who supported passing the health care/insurance law is that “this represents just the first step! It paves the way for better things in the future!” Well pardon me, but how? Those who claim that this law is the first step towards something better need to explain to me exactly what is that “something better”, how we’re gonna get there, and how having the new health insurance law makes a difference over not having it in getting there.
Some liberals have argued that with this new legislative “framework” in place, it’ll be easier to adopt a public option than to adopt a public option without the framework of guaranteed issue, individual mandate and subsidies. Policy-wise, that may be so, though I don’t see why we can’t have a public insurance program that is able to filter between legitimate cases of denial for preexisting conditions and those who just want to game the system by waiting until the last minute to sign up. But politically, it should be obvious that now that the insurance companies have their ice cream – the individual mandate – they’re not gonna want to eat their veggies – the public option. Passing the public option as part of a larger health insurance reform law was our best chance to get it through because we had the leverage of withholding the individual mandate then. Giving insurance companies their individual mandate and then saying, “okay time to pass the public option!” is like a parent giving a child their ice cream and then saying “okay time to eat your veggies!” Good luck with that and good luck with this.
In any case, as I explained in My Thoughts on Health Care, Part I, the ultimate goal for now should be to get to single-payer, Medicare for All. I have heard arguments that even Medicare for All may not be good enough in controlling costs and guaranteeing medical access, and that we may ultimately need to adopt a system of complete government provision of medical services – “socialized medicine” – similar to the hospitals in the United Kingdom’s NHS or in our own Veterans Health Administration. That may be so, and my pro-government ideological instincts are certainly favorable to socialized medicine, pending further study. I certainly think that we should consider such a system and not reflexively rule it out.
For now, though, let’s just establish that the bare minimum way to provide decent universal health care is either through Medicare for All or through a Swiss-style system of government-regulated non-profit health insurance organizations. (Obamacare, by the way, is neither of these.) Of these two options, I prefer Medicare for All because I trust the government to do a better job in controlling costs and guaranteeing access if it provides health insurance directly rather than devolving the role to private insurance companies. Also, because I think insurance companies for basic, non-cosmetic/frivolous services are a waste (but people should be allowed to choose to use them if they so desire, as long as they still pay into the public service – just as it is with public and private education).
Okay, now how do we get to Medicare for All? When asked about Medicare for All, most candidates who don’t simply wave it off will say something like, “Gee that’d be nice, but it’s too politically unrealistic and there’s no way we’re passing it now. Next.” Okay, tell me something I don’t know. Just saying it’s “unrealistic – yeah it sucks” is just stating the obvious and not telling me what they would do about it. So instead of just saying “it’s unrealistic”, let’s figure out how we can collectively make it from “unrealistic” to “realistic”.
It’s pretty simple, really. Any legislation has to pass both houses of Congress and then be signed by the President. Right now, in the U.S. House of Representatives there are 87 listed cosponsors of H.R. 676, the Medicare for All legislation, plus the sponsor Rep. John Conyers, which brings us to 88. But you have to subtract the non-voting delegates of Donna M. Christensen of the Virgin Islands and Eleanor Holmes Norton of the District of Columbia. That leaves us with 86. Then we have to subtract Reps. Neil Abercrombie, Eric Massa and Robert Wexler, who have all resigned, as well as Rep. John Murtha who died, which leaves us with 82. (And I may be missing a few others.) Rep. John Garamendi has expressed support for it, bringing us up to 83 supporters of Medicare for All in the House.
Trying to replace the departed Representatives with pro-single-payer candidates may be too much of a stretch. Abercrombie’s seat is being contested by centrist slime Ed Case (who is NOT for single-payer) and the more liberal Colleen Hanabusa, who doesn’t mention single-payer on her website but is reported to be supportive. She’s currently running behind both Case and Republican Charles Djou. The presumptive Democratic nominee for Massa’s seat is Matthew Zeller, a former Republican who is “fiscally conservative”. Wexler has since been replaced by Rep. Ted Deutch, whose campaign Issues page made no mention of single-payer. And the chosen Democratic candidate to succeed Murtha is Mark Critz, who does not appear to be running a promisingly liberal campaign.
In the U.S. Senate, the main spearcarrier for Medicare for All is Senator Bernie Sanders, who attempted to introduce a Medicare for All amendment in the Senate and had to withdraw it because the 700-page amendment was being read aloud. (I wouldn’t have withdrawn it.) He was joined only by Senators Sherrod Brown and Roland Burris (who is departing the Senate in 2011). Senator Al Franken had expressed support for it on his campaign website, and Senators Tom Harkin and Russ Feingold have also publically expressed support for it. That makes 6 Senators for single-payer Medicare for All.
So, the bottom line is to get more single-payer/Medicare for All advocates into Congress. I can’t think of all the ones that are running, but right now I know of two who can win but are in immediate need of help. The first is Jennifer Brunner, who is running for Senate from Ohio. Brunner’s campaign is the one in more urgent need of help, as her primary is on May 4 2010 and her campaign has neared bankruptcy several times. Donate to her here! The other is Marcy Winograd, who is running in a primary against incumbent Rep. Jane Harman in CA-36. The election is on June 8 2010 – donate to her here after you help elect Brunner on May 4!
I will post more about pro-Medicare for All (and good on other issues too) candidates in the near future.
Assuming we go from 82 in the House and 6 in the Senate to 218 in the House and 51 in the Senate, we then need a President who will push hard for it and sign it into law. That President is NOT President Barack Obama, who has expressed support for Medicare for All in the past but has disavowed it as “too disruptive” since he began running for President in 2007. A successful primary challenge to President Obama in 2012 would be very desirable and satisfying to me, but it’s highly unlikely to happen. So our next chance for a Medicare for All President is 2016. We HAVE TO nominate a pro-Medicare for All Democrat for President in 2016. We haven’t had a pro-Medicare for All Democratic nominee in a long time – probably not since Walter Mondale in 1984. So we gotta do it in 2016. I don’t know who it’ll be – bless Dennis Kucinich, but I don’t think another run by him will be productive – but we gotta focus on Medicare for All in the presidential campaign like we’ve never before.
Even if and when we get all our Congressional and Presidential ducks lined up in a row, we have to make sure public support is behind Medicare for All. After all, we saw how in the legislative fight over health care this past year, a bill that did the bare minimum to cover everyone and included all of the Republicans’ ideas in it was still slandered as some far-left socialist Armageddon.
So the time to start building support for Medicare for All is NOW. If and whenever health care comes up, bring up single-payer and Medicare for All. Make sure everyone knows what each term means and how Medicare does a great job at providing our senior citizens with health care right now. Also, mention other forms of public health care/health insurance such as Medicaid, Veterans Health Administration and Indian Health Service. The idea is to generate as much discussion and acceptance of the idea of public health insurance as possible and get people used to it. (Do people even know Medicare is government-run?)
A great example of how to frame this issue has been shown to us by Rep. Anthony Weiner. During this past year’s health care fight, every time he talked about the public option, he started by clearly stating that he was a supporter of single-payer Medicare for All (and making sure to distinguish that from the public option) and he always made sure to put in a good word for Medicare. Watch how he deftly handles it here:
On one occasion on Morning Joe, Weiner even turned the brief-but-important mention of Medicare for All into a full-blown discussion. This is good shit:
Take note, everyone, that this is EXACTLY how we should all be discussing Medicare for All in relation to the public option. Bring up the fact that our ideal is Medicare for All and that it could be a great system because we do have great government health insurance programs already in service. Get people to think about government in general and Medicare/government health insurance in particular in a positive light.
Until we have the votes and the President for Medicare for All, our “compromise” will be to have a Medicare Buy-In – or, a Medicare for All Who Want It and Will Pay For It. This is basically Medicare for only those who choose to pay for it and receive it, instead of Medicare for All where everyone has to pay for Medicare through taxes and everyone is entitled to receive it (just like everyone has to pay for their military, police, fire, public schools regardless of whether or not they use them). It’s slightly less ambitious than full Medicare for All but it’s still leaps and bounds ahead of both the status quo and what we’re getting out of Obamacare. Also, it would act as an important legislative stepping-stone between here and Medicare for All, and it would let people get used to the idea of non-retirees being in a government health insurance program – especially when they see their friends, neighbors, co-workers etc. being on Medicare and not only not dying a horrible, government bureaucrat-mandated death, but getting better health care than those on private insurance.
There is currently legislation providing for a Medicare Buy-In – H.R. 4789 – sponsored by Rep. Alan Grayson. Besides Grayson there are 80 cosponsors, making a total of 81 supporters. The Senate is a little harder to pin down since not many Senators have been asked about a Medicare Buy-In, though there was a limited Medicare Buy-In for those ages 55-64 years old offered as an idea in late 2009, and accepted by just about every Senate Democrat except Joe Lieberman. A larger Medicare Buy-In for all would likely be rejected by many rural Senators due their complaints about Medicare reimbursement rates (which may have been addressed to some degree in the recent health insurance reform law). On the Senate Finance Committee, a Medicare+5 public option, which is a slightly less ambitious form of a Medicare Buy-In, got 8 out of 23 votes; extrapolating that to the entire 100-vote Senate would mean at least the 8 votes and possibly up to roughly 34 votes. Of course, the Finance Committee is much more conservative than the Senate as a whole so the number could be more, but 8-34 votes serves as a good baseline.
Judging by his behavior during the past year, President Obama would be unlikely to help much with the Medicare Buy-In effort but he might be willing to at least sign it into law (and then take total credit for it as he’s running for reelection). His betrayal of the public option while having sex with the hospital lobbyists is discouraging, but if there’s enough left-wing, Democratic base public support out there for it, it might be impossible to ignore once it arrives on his desk, though he might finagle with Senators to make sure it never gets to that point. We should certainly work for a pro-Medicare Buy-In President in 2016.
The work is cut out for us. Get from 81 House votes and 8-34 Senate votes to 218 and 51 for a Medicare Buy-In. Get a President willing to support Medicare Buy-In, and pass it into law. From there, use Medicare Buy-In as a springboard to get us to Medicare for All. Get from 83 House votes and 6 Senate votes to 218 and 51, and get a President willing to sign Medicare for All into law. Talk up Medicare (and government programs in general) all the while and get the idea of a competent and benevolent government ingrained into the public psyche. This doesn’t sound too hard, does it?
APRIL 26 2010 UPDATE: There’s one other important legislative stepping-stone I forgot to mention: single-payer at the state level. Right now there are two states I can think of where major single-payer efforts are underway. The first is Pennsylvania, which is considering single-payer in the State Legislature and is currently having a competitive Democratic primary for governor. While three of the five Democratic candidates – frontrunner Dan Onorato, Chris Doherty and Joe Hoeffel – are unequivocally for single-payer, the most passionate and reliable supporter of single-payer out of those three is Montgomery County Commissioner Joe Hoeffel, who is running the most liberal campaign in the race. Joe Hoeffel would make an excellent progressive Governor of Pennsylvania and, as is all too often the case with liberal candidates, he’s in desperate need of money, so please donate to him here.
The other state is much closer to heart and home: California. The State Legislature here has twice passed single-payer and it has been twice vetoed by Governor Schwarzenegger. Unfortunately, his replacement probably won’t be much better; the sole major Democratic candidate, Attorney General Jerry Brown, was a supporter of single-payer in 1992 but is not so much anymore, and he could be old and cantankerous enough to even veto single-payer. I’m in the process of shopping around for an alternative to support in both the primary and general elections, and will update with new information as I go.