How would single-payer pass Congress?

[liberalpragmatist]

I just have a question for the single-payer-only crowd: how do you plan on getting single-payer through Congress, when even a limited public option can barely pass?

I'm not trying to be facetious - I would like single-payer as much as any of you, but so many are saying kill these bills so we can get single-payer. Where do you plan on getting the votes? Or do you think the president is just that powerful that if he were to endorse single-payer it would suddenly get 60 votes in the Senate (or at least 50 with reconciliation)?

[DrDan]

1. outbid the insurance companies

need to buy the votes - the vote goes to the highest bidder

[el_bryanto]

2. Good question

One answer is that you are guaranteed to have to compromise in the political process. If you shoot for what you want and everything you want, well you will have to water it down to get to the end. But if you start at a weak position (like the Public Option), well it's that much easier for the political process to water it down to effectively nothing.

That doesn't really answer your question, I suppose, but it is a rational for the Obama administration and others to have fought for Single payer instead of what they eventually brought to the table.

Bryant

[liberalpragmatist]

4. That's a fair point

Personally, I'm supportive of this legislation, as I think it does a lot of good things and makes a lot of progress, although doubtless this is going to be a multistep process.

That being said, I do wonder what would happen if a president were to propose single-payer, and campaign on it. It is possible, as you said, that the political pressure of being on the left flank would make a potential compromise much sounder and bolder.

The counterargument is that single-payer has such little support in Congress (Bernie Sanders estimates it has only 10 votes in the Senate) that Congress doesn't even take the argument seriously, and the bargaining position is essentially worthless.

[mike_c]

3. the last time I checked, HR 676 had more than 80 cosponsors....

I'm not sure how many it has now, but that's significant support. Note too that the DEMOCRATIC PARTY leadership in the House is the primary force blocking consideration of HR 676-- why do you think they fear it so much that they keep it hidden from the light of day?

I'd like to hear congress debate REAL health care reform. Simple, straightforward, Medicare for everyone. Everything covered. No exceptions, no complicated formulae, no thousand pages of fine print. Maybe it would pass, maybe it wouldn't but the people could read it and understand it in ten minutes, and hiding from the will of the people behind obfuscation and corporate smoke screens would be impossible. We would know exactly what we wanted, and we would know exactly what our political leadership chose to do about it. Congress is terrified of that. That tells me that real single payer reform DOES have a chance, because congress would have no where to hide.

[Cessna Invesco Palin]

8. That's the House. We're talking about the Senate. n/t

[mike_c]

9. the OP doesn't say anything about the Senate....

It says Congress, which-- again, the last time I checked-- was made up of two houses with the tradition of initiating most legislation in the House of Representatives before it is passed to the Senate for debate and ratification. Of course, the senate initiates legislation too, but usually in parallel with the house. Anyway, I'm sure you get the point-- we can't have ANY meaningful discussion about legislative agendas if we restrict the discussion to the Senate.

[Cessna Invesco Palin]

26. Well, yes it does say something about it, actually.

Specifically:

Or do you think the president is just that powerful that if he were to endorse single-payer it would suddenly get 60 votes in the Senate (or at least 50 with reconciliation)?

[mike_c]

27. oh for pete's sake....

Well, it's pretty clear now why progress on health care reform in America seems impossible. Mike C. interpreted "Congress" to mean both houses! :spank:

Seriously. Is this really germane? Should we just ignore the one bill that actually exists, with considerable support, because it originates in the House where most actual legislation originates?

[Egnever]

41. Absolutely not but first 80 people is not considerable support

in a house with 435 members. As I said this bill would never ever pass, thank god. A large portion of why is because its 14 pages or whatever it is. It leaves so many open questions that it probably couldnt even be enforced if it were passed.

The cost of this thing would be astronomical as well, it talks about building facilities and one lump sum payments to said facilities its just rediculous on so many levels I am just astounded there is any support for it at all.

Its gonna fund itself with bonds LOL

[mike_c]

44. that's 80 COSPONSORS, not simply 80 supporters....

It would seem that lots of reps take a different view. On the other hand, maybe those 80 are the bill's only backers. We'll never know if it's not debated and voted on, will we?

[Egnever]

10. thats fairly simplistic thinking

I understand that you would like for it to be ten pages long and at the reading level of a 5th grader but I don't see how that could happen. Just the rules governing payments alone would take that many pages you can just say single payer for all and be done with it. There are tons of details that have to be nailed down, and that takes pages of legislation.

Also you need something like 218 votes to pass a bill. We have 257 Dem's currently. 80 votes leaves us 138 short. Not even half way there. You know we couldn't get a single vote for single payer from the pukes as their agenda is to block anything that might help Obama get re-elected. The chances of single payer passing are slim and none. And thats just in the house where we have a stronger majority. Forget about the Senate where our majority is much more fragile.

Also i know its the fashion here to say single payer is the way to go but I think thats also simplistic thinking. Most of the top rated system for health care are not single payer and the top rated health care system france most certainly isn't and is a whole lot closer to what is being proposed than most people on this site want to admit.

[mike_c]

12. reality check....

HR 676 is, in fact, 14 pages long. You really should read it-- your comments make clear that you have not. It really is simple and staightforward. The best parts are in the first couple of pages after the table of contents (which occupies two of the 14 pages):

http://johnconyers.com/hr676text

TITLE I—Eligibility and Benefits


SEC. 101. Eligibility and registration.

(a) In general.—All individuals residing in the United States (including any territory of the United States) are covered under the USNHI Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual’s social security number shall not be used for purposes of registration under this section.

(b) Registration.—Individuals and families shall receive a United States National Health Insurance Card in the mail, after filling out a United States National Health Insurance application form at a health care provider. Such application form shall be no more than 2 pages long.

(c) Presumption.—Individuals who present themselves for covered services from a participating provider shall be presumed to be eligible for benefits under this Act, but shall complete an application for benefits in order to receive a United States National Health Insurance Card and have payment made for such benefits.

SEC. 102. Benefits and portability.

(a) In general.—The health insurance benefits under this Act cover all medically necessary services, including at least the following:

(1) Primary care and prevention.

(2) Inpatient care.

(3) Outpatient care.

(4) Emergency care.

(5) Prescription drugs.

(6) Durable medical equipment.

(7) Long term care.

(8) Mental health services.

(9) The full scope of dental services (other than cosmetic dentistry).

(10) Substance abuse treatment services.

(11) Chiropractic services.

(12) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).

(13) Hearing services, including coverage of hearing aids.

(b) Portability.—Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.

(c) No cost-sharing.—No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits.

SEC. 103. Qualification of participating providers.

(a) Requirement To be public or non-profit.—

(1) In general.—No institution may be a participating provider unless it is a public or not-for-profit institution.

(2) Conversion of investor-owned providers.—Investor-owned providers of care opting to participate shall be required to convert to not-for-profit status.

(3) Compensation for conversion.—The owners of such investor-owned providers shall be compensated for the actual appraised value of converted facilities used in the delivery of care.

(4) Funding.—There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3).

(5) Requirements.—The conversion to a not-for-profit health care system shall take place over a 15-year period, through the sale of U.S. Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits, but may be made only for costs associated with the conversion of real property and equipment.

(b) Quality standards.—

(1) In general.—Health care delivery facilities must meet regional and State quality and licensing guidelines as a condition of participation under such program, including guidelines regarding safe staffing and quality of care.

(2) Licensure requirements.—Participating clinicians must be licensed in their State of practice and meet the quality standards for their area of care. No clinician whose license is under suspension or who is under disciplinary action in any State may be a participating provider.

(c) Participation of health maintenance organizations.—

(1) In general.—Non-profit health maintenance organizations that actually deliver care in their own facilities and employ clinicians on a salaried basis may participate in the program and receive global budgets or capitation payments as specified in section 202.

(2) Exclusion of certain health maintenance organizations.—Other health maintenance organizations, including those which principally contract to pay for services delivered by non-employees, shall be classified as insurance plans. Such organizations shall not be participating providers, and are subject to the regulations promulgated by reason of section 104(a) (relating to prohibition against duplicating coverage).

(d) Freedom of choice.—Patients shall have free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.

SEC. 104. Prohibition against duplicating coverage.

(a) In general.—It is unlawful for a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act.

(b) Construction.—Nothing in this Act shall be construed as prohibiting the sale of health insurance coverage for any additional benefits not covered by this Act, such as for cosmetic surgery or other services and items that are not medically necessary.

more@link

on edit-- as for the complexity of establishing and operating a single-payer system, that's not really congress's concern, is it? The congress's job is to establish the law and describe its scope. Creating the administrative structure to accomplish that is the Executive's job.

[Egnever]

14. Thats not single payer

thats government paying insurance providers.

[mike_c]

17. I'm sorry, but you're not correct....

HR 676 calls for government to pay MEDICAL CARE PROVIDERS, not insurance companies. It expressly provides that insurance providers who want to participate must convert to non-profit status.

I'm not sure what you mean by "insurance providers." Do you mean medical insurance companies? There is nothing in HR 676 that allows public payment to "insurance providers" except as non-profit entities participating in single-payer universal health care for all Americans.

Again, I urge you to READ THE BILL before you make statements about it. It won't take more than a minute or so to read the part I've posted, and no more than two or three minutes to visit the link and scan the whole bill. Really. What's so difficult about that?

[Egnever]

21. I am not sure how you can claim that when by your own words

You say insurance companies must convert to non profit to participate. What are they participating in? If the government is paying the end providers.

[mike_c]

23. why won't you just READ THE BILL YOURSELF and answer your questions...?

I'm not in a pissing match with you about who said what. If you want to argue about what I said or didn't say, lets not and say we did, OK?

Here is the relevant passage from HR 676 (in Sec 103, quoted in the post up thread):

(2) Exclusion of certain health maintenance organizations.—Other health maintenance organizations, including those which principally contract to pay for services delivered by non-employees, shall be classified as insurance plans. Such organizations shall not be participating providers, and are subject to the regulations promulgated by reason of section 104(a) (relating to prohibition against duplicating coverage).

That seems pretty clear, don't you think?

Why not just read the bill before raising objections?

[Egnever]

38. OK I read it, and theres no way in hell that mess would pass

It completely destroys our medical system as it is today. it sets salary caps for doctors which aint gonna happen untill we start providing payment for doctors education and even though it provides for "training" it would be years before that would have any effect whatsoever.

There are so many holes in this bill you could drive a state through it.

This bill is a joke and the fact that 80 congress people support it scares the hell out of me.

[mike_c]

40. well then, we'll just have to agree to disagree....

eom

[slipslidingaway]

47. It is modeled on the Canadian system and yes it would radically alter...

our current system that has left 46 million without insurance, another 40 million underinsured and millions in bankruptcy due to medical costs.

From my vantage point we need a radical change, no sense building on a shaky foundation.

:)

[Egnever]

58. The canadian system was practicaly already in place

When they made it into law, we are talking apples and oranges here. This bill would wreak havok on our economy long before it started having its desired effect.

[Chisox08]

5. The Democrats in the Senate started off with a weak Public Option

If they started off with single-payer and fought like hell to get it. Followed that up by accepting a strong public option that is open to everybody. After a few years when the people see that the public option is better than getting ripped off by the insurance companies, revise it and make it single payer. Too bad we have a bunch of bought and paid for Senators who is completely out of touch with the people who elected them.

[kenfrequed]

34. Yup!

I have been saying this for what feels like six months now.

They forgot the part about politics that is negotiation and that it is stupid to start negotiating with far less than you need.

[Laelth]

6. It probably can't pass in the Federal Congress right now.

And that's why it's CRUCIAL that we not pass the turd of a law Obama is pushing (unless it contains the Kucinich Amendment, in which case it might be worth it).

California will pass single-payer on its own in 2011. All they need is a Democratic Governor. The legislature has already passed the bill. Schwarzenegger vetoed it. Once California has single-payer, most (if not all) states will follow suit.

It's likely that if we pass a new law now, the new law will preempt single-payer, i.e. the Federal law will preempt state law and prevent states from enacting a single-payer system.

THIS is what the health insurance companies fear. THIS is what brought them to the bargaining table. THIS is why they are not fighting Obama's tepid reforms, and THIS is why it is extremely important that we do not pass any health insurance reform bill this year.

Let's not settle for a bail-out of the health insurance industry. Let's insist on the eradication of it. In all likelihood, California will lead the way in 2011 ... if we can just give them time.

:dem:

-Laelth

[mike_c]

7. hear, hear!

I wish I could rec your response!

[Egnever]

11. What makes you think single payer is so great?

just the words single payer dont make it so.

most of the top rated health care systems in the world are not single payer systems. The top rated system in the world in France most certainly is not single payer.

[bluethruandthru]

13. +100

[bluethruandthru]

15. A big part of the problem is many, many people have no

idea what single payer really is and what it would do. The MS media has never really talked about it. The right has been allowed to control the message that it's socialized medicine and would be the end of the world as we know it.

Only people who really make an effort to learn about it understand what it is and what it will and won't do.

If Americans really understood it...they'd be storming Washington to demand that it be enacted.

[slipslidingaway]

22. You begin with educating the people, instead what has happened is time...

has been used to exaggerate and lie to the people about HC systems in other nations.

Republicans fighting a system that the Dems took off the table...it has only generated resistance to a government health care system.

Maybe that was the intention.

:(

[bluethruandthru]

42. You're absolutely right.

Too bad we couldn't have had a civilized, honest discussion in this country about the situation we're all in and how to fix it. Just too much to ask.

[slipslidingaway]

45. It was too risky - for the insurance companies :((( n/t

[FBaggins]

16. I think that the assumption all along has been...

...that a chance that substantial would be almost impossible to implement in one bite. The President's expectations (when he was running for Senate) was that it would take 10-15 years to transition.

I don't think that there's anything CLOSE to enough support to get single-payer through in one step. Yesterday wasn't as big a hit as Republicans obviously hope... but I sincerely believe that if we tried this, 2010 would be the real deal.

[Nikki Stone1]

18. First, we staple Rahm Emmanuel to the roof of the Foggy Bottom Metro Station and leave him there

Then we tell Michelle Bachmann and the other RW crazies that we've spotted the anti Christ in the Mojave Desert. We send them out with holy water, Bibles, and wooden stakes to wander in the desert for 40 weeks.

Then we run through a 1 page bill that extends Medicare for everyone and a 9-page addendum that describes how we pay for it.

Then, we have lunch.

[jemsan]

19. Pass Campaign Finance Reform!!

[Nikki Stone1]

32. Woohoo!

:D

[JeffR]

20. !

:rofl:

Funny. Also brilliant.

[Nikki Stone1]

30. Too bad you're not doing DUZYs anymore.

:(

[jgraz]

33. Unfortunately, the problem is not Rahm. It's the guy who hired him.

The Hope and Change President(tm) didn't even try to lead on Single Payer.

[Nikki Stone1]

35. Sigh

:sigh:

[juno jones]

37. F'n brilliant. +1! ^^^^^

[Kurovski]

59. DUzy!

Yes, you've just been nominated. That's all it takes for the new rules.

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=6893143

[optimator]

24. "Yes We Can"

ring a bell?

[Kansas Wyatt]

25. You need to pass another law first...

All past and present Members of Congress and all employees of the Federal Government shall not have Health Insurance & Prescription Coverage that EXCEEDS the Health Insurance & Prescription Coverage of any Citizen with below poverty level income in any year.

[mmonk]

28. Easy. Fight against those against it in Congress.

Expose them. Threaten them with no support at election time. Run progressive challengers. Carry through on any threats not to back them. Democracy isn't a spectator sport.

[jtrockville]

29. Start by scoring it, and tout the score on every talk show.

[jgraz]

31. Medicare for All is simple, easy to understand and impossible to argue against

It's not that it *won't* pass Congress, it's that it *might* pass -- which is why both parties will do anything they can to kill it before any serious debate can begin.

[Libertas1776]

36. +100

[Cessna Invesco Palin]

48. Impossible to argue against? Hardly.

Higher taxes: that's the argument against.

[jgraz]

51. Let me clarify: It's impossible for any honest broker to argue against it

And the liars can be quickly exposed. For example, you can easily show how Single Payer will lower out-of-pocket expenses for almost everyone in the country.

[Cessna Invesco Palin]

52. I'm not sure how you reckon a single payer system would lower taxes.

It would certainly lower per capita health care costs, but that's not the same thing as lowering taxes. The insurance costs of most people who are not currently on medicare or medicaid are borne by employers and individuals themselves, and all of that would then need to be paid by the government. When I lived in the UK my taxes to cover the NHS were certainly much higher than what I currently pay in the US to cover medicare and medicaid.

For the record, I'm an advocate of a single payer system, but let's be honest here.

[jgraz]

55. It would lower individual cost for healthcare. That's all you have to say.

If you cut someone's health insurance premium while giving them better coverage, they won't care that they're paying that premium to the federal government. Sure, the Pukes will try to paint that as a "tax increase", but that's not really honest now, is it?

For myself, I'd prefer a system completely funded by a progressive tax, but that's not the Single Payer proposals that are being discussed. And even if we did go that route, it would still lower expenses for the vast majority of taxpayers.

[Cessna Invesco Palin]

56. I was responding to the original assertion that it is impossible to argue against.

It is possible to argue against it. The arguments might not make much sense, but it's not impossible.

[jgraz]

57. Well, it's not like they would say it would kill your grandparents.

Oh wait...

[librechik]

39. Swallow it whole and poop it out in little bits--but only if it's tagged to Medicare Rates.

oohh--that Single Payer is the SCARIEST THING EVER!!!

[Odin2005]

43. We need to get rid of the Blue Dogs in the primaries.

But the purists would rather whine and moan and declare that we little people are powerless.

[slipslidingaway]

46. Blue dogs do not set policy - that is set from the top, even Waxman who had supported...

SP said he is now following the President's plan of building on the employer sponsored HC system.

Following the leader!

Video...
http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=385&topic_id=336207&mesg_id=336207

No reason to hide behind the Blue Dogs or Republicans - the Democratic Leadership took a not for profit, SP system off the table.

[Nikki Stone1]

49. No surprise there.

:(

[slipslidingaway]

50. You must mean Waxman, but I'm tired of people blaming the Blue Dogs and

Republicans for the policy that was presented by the leader.

And then Waxman goes on Democracy Now and says SP would require hugh tax increases and pretends he does not know what is spelled out in HR 676, the bill he had been a cosponsor of in the past.

He forgot about the employer contribution!

http://journals.democraticunderground.com/slipslidingaway/74

[MadBadger]

53. Good chance if you get ride of the Blue Dogs in the primaries, you'll lose the seat come General.

[Common Sense Party]

54. Obama scraps all the crap half-assed bills being discussed now. He focuses

100% on the economy and jobs. When everything turns around and people are glad to be back at work, he will have a shitload of political capital mojo and then single payer will pass with flying colors.

He's focusing on the wrong priority now, and that's why we're getting watered-down garbage.

[Geek_Girl]

60. It won't! We don't have progressives holding office we have Neocons disguised as DEMS

The best we are or ever were going to get was a major windfall to Insurance Companies, increased premiums and government subsidies to corporations. All this song and dance about the public option was a dog and pony show!

We all have been had!