Single-payer health care in health care overhaul law?
by: MARK GRUENBERG
WASHINGTON (PAI) - Is single-payer government-run health care - a key
cause for 21 international unions and 500 other labor organizations
and a bugaboo for the health insurers and the Radical Right - in the
massive health care overhaul Congress approved on party-line votes and
President Barack Obama signed?
Its top senatorial proponent, Vermont Independent Bernie Sanders, says
the answer is "yes," even though the words "single payer" aren't
written down. And there are some conditions that must be met before
single-payer systems are up and running.
Interviews with Sanders, his staff and some experts in the health care
field disclose the law has a provision allowing states, under certain
conditions, to establish their own alternative state-run health care
systems, starting in 2017.
States would have to get federal waivers to establish their own
systems. But within broad guidelines, states could set up whatever
they want, including single-payer.
The state alternative systems must meet certain conditions, Sanders'
top health care legislative staffers say. One condition - that all
states must in 2014 establish health care "exchanges" to cover those
who otherwise are not covered - may make it harder to switch to
single-payer, the staffers admit.
After all, they point out, the states would in essence have to
establish one system that year, and then tear it down and replace it
with another, and that's heavy lifting for state legislators, the
Sanders staffers admit. Sanders is trying to build a coalition to
change the date for the alternative systems to 2014, too.
The key requirement states must meet, the staffers say, is that any
alternative health care system, including single-payer, "must do as
much or more" for health care users "as the existing program does,"
referring to the exchanges.
"The idea is that if a state puts together a health care plan - and it
could be any type of a plan, including single-payer - as long as they
could demonstrate that it would cover as many people, that the
coverage would be at least as good, and that it would be at least as
affordable, they'd get the waiver from operating the exchange,"
Sanders' top legislative aide told Press Associates Union News
"Then all the tax subsidies" for health care in the overhaul bill
"would go to single-payer instead - as long as individuals wouldn't
have to pay more," he added.
The prospect of being allowed to experiment pushed several states into
probing single-payer and other alternatives on their own, before the
2017 date, says Rachel Rosen DeGolia, executive director of
Cleveland-based Universal Health Care Action Now, a longtime advocate
of single-payer - including single-payer state by state.
Those states include California, Pennsylvania, Vermont and Connecticut:
In California, the California Nurses Association/National Nurses
Organizing Committee - now a large part of 155,000-member National
Nurses United - pushed two statewide single-payer bills through the
Democratic-run legislature since the start of the decade. Both were
vetoed by GOP Gov. Arnold Schwarzenegger.
Vermont extended its state-run health care system to cover 95% of
state residents during the administration of former Democratic Gov.
Howard Dean, a physician. Its legislature just approved a measure to
study both single-payer and the "public option."
The public option, which would have put the federal government in
competition with the health insurers for covering the uninsured, was
dropped from the health care overhaul at the insistence of a "swing"
lawmaker, Sen. Joseph Lieberman, Ind.-Conn. Otherwise, he would have
voted "no," killing the bill.
Ironically, Lieberman's Connecticut - which houses headquarters of
several large insurers - is considering alternatives, too. Faced with
threatened huge health insurance rate hikes last year, the
Democratic-run legislature passed and GOP Gov. M. Jodi Rell signed a
measure to extend the public option there, DeGolia says.
In Pennsylvania, a bipartisan coalition of 34 state senators signed
onto a bill to explore single-payer, and is putting pressure on the
state senate's health committee chairman to hold hearings. That
lawmaker is from Pittsburgh, headquarters of the Steelworkers. USW,
led by Canadian native Leo Gerard, whose nation got single-payer
province by province, is one of the most-outspoken backers of
Meanwhile, Ellen Shaffer, a former congressional staffer specializing
in health care who now co-heads the Center for Policy Analysis, warns
progressives not to sit on their hands this fall, lest the GOP win
back Congress - and undo prior progress.
"While we share the long-term goal of a universal 'Medicare for all'
system, too many on the left are ignoring the important improvements
to access and quality of care that the new law will achieve - and the
policy space that it creates to go further in the future," she writes
in a recent blog. "Women in particular have important reasons to stay
active, including the need to defend new laws that prohibit insurance
companies from discriminating against them," Shaffer adds.