Getting to Single Payer



Here are a few thoughts on health care, which is definitely not my area of expertise.  As you’ve probably read, Senator Sanders and some Democrats have proposed a single-payer health plan.  (John Conyers, an African American Congressman, has been proposing this for years. Now that a white guy did it, it apparently matters.)  Wikipedia explains that single-payer is “healthcare system in which the state, financed by taxes, covers basic healthcare costs for all residents regardless of income, occupation, or health status.”  I’m not a big Bernie Sanders fan, for reasons that I believe I have made clear in other posts, but, because I am a grown-up, I’m happy to support good policy and to work with even someone I really don’t like if it will lead to good results.

There’s an awful lot I liked about President Obama, but one of his true Achilles Heels was his belief that if he would just propose to Republicans the policy they’d said they wanted, why, then, those nice, reasonable, honorable Republicans would surely join with him in a bipartisan spirit and do what was best for America.  And one of the first times we really saw how bad he was at negotiating with Republicans was early in his first administration, during the battle over health care.  The plan that President Obama proposed was not the one most Democrats wanted; the bill he finally signed — the Affordable Care Act, which the Republicans derisively called “Obamacare” — was essentially an older Republican plan.  Wikipedia tells us that, ” The concept goes back to at least 1989, when the conservative  Heritage Foundation proposed an individual mandate as an alternative to single-payer health care.  It was championed for a time by conservative economists and Republican senators as a market-based approach to healthcare reform on the basis of individual responsibility and avoidance of free rider problems.”

Yet, in spite of that, and in spite of numerous procedural and substantive concessions, Republicans opposed the bill and spent years voting to repeal it.  As we now know, the ACA did insure many Americans who had been unable to obtain insurance and it did other good things, as well.  For example, it stopped insurance companies from refusing to provide care for pre-existing conditions and allowed young people to remain on their parents’ insurance for a longer time.   It was, in my Overton Window world, a decent first step.

Yet, many of us, especially those of us who negotiate deals for a living, believed that President Obama would have done better if he’d started off with a plan far to the left of the ACA and then negotiated downwards.  That’s pretty much Negotiating 101; you ask for more than you expect to get so that you can make some concessions and meet your opponent somewhere close to the middle.

Now, in light Donald Trump’s failure to repeal the ACA, Senator Sanders and some Democrats have proposed a single payer system.  The major criticism of their plan is that no one has explained how to pay for it.  Which, on the one hand, is funny because we never seem to worry about how we’ll pay for lots of completely unnecessary things like wars of empire, or tax cuts for billionaires, or cleaning up the climate disasters that Exxon creates, or paying Trump properties for golf cart rentals for our Secret Service agents who have to follow him around as he violates the Emoluments Clause.  But a necessity such as health care, well, that we need to figure out how to pay for way ahead of time.  It’s especially ironic coming from the “run government like you run your family” crowd because when I got breast cancer, my theory was that I was going to get the best care available and figure out how to pay for it if I lived.  Most families don’t figure out ahead of time how to pay for a major medical crisis; they get the needed care, if they can, and then figure out the finances.  As Elizabeth Warren learned, often, that means they declare bankruptcy.   Which is likely still better for their creditors than if they’d died.  Besides, we could pay for health care if we charged billionaires a few percentage points more in taxes, if we quit fighting insane wars, if we defunded ICE and taxed carbon for all the externalities it imposes.

But, on the other hand, someone needs to figure this out.  (And, yes, one of Senator Sanders’ Achilles Heels is proposing big social programs and just waiving his hands and saying “Here, a revolution occurs.”)  Because the reality is that, in today’s political climate, social programs need to have a revenue stream, even if wars and caviar tax cuts don’t.  And, single payer programs have been proposed and gone down to defeat in a number of states due to the inability to figure out how to pay for them, absent a tax hike.  People who support single payer need to figure out how to make this stop happening.

All of that said, I’m glad that single payer is now on the table.  I’m glad that Senator Sanders and some Democrats have proposed it.  Maybe now we can have a discussion.  Do we want health care?  Do we want it more than keeping every person who ever sold a joint locked up in a for-profit prison?  Do we want it more than we want yet another battleship?  Do we want it more than we want to let billionaires leave everything to their children, tax free?  Do we want it more than we want to subsidize the Waltons so they can get rich while refusing to pay their employees a living wage?  And even if we don’t wind up with pure single payer,  I’d rather have that be the starting point for our discussion than, well, “Let’s let the insurance companies screw everyone for fun and profit,” which was exactly the plan Republicans put forward last month.  One of my first wins as a new lawyer was convincing my boss that we’d do better if the negotiations took place based on a document we’d (OK, I’d) already drafted and that’s still my basic operating assumption.

What I don’t know about health care policy would fill libraries, but I do understand negotiating and I do know that it makes no sense at all for the richest country in the history of the world to leave its people sick and dying due to an archaic for-profit health-care-delivery system.  If we can use single payer as a starting point and then move the Overton Window to the left, well, I’ll gladly work with almost anyone to get there.

Picture found here.


4 responses to “Getting to Single Payer

  1. I have been advocating for a single-payer healthcare system for a least a decade now and I have to say your definition of what it is is lacking. The system we have today is one where a doctor’s office, clinic or hospital have a myriad of providers they have to bill – or whatever insurance companies they accept payment from. A single-payer system would reduce the number of insurance companies they have to bill to just one. Hence the name single-payer. Due to the astronomical cost of healthcare, (I have a spreadsheet that lays it all out if you would like to go into more detail), no individual state would be able to afford to implement a single-payer system because there just are not enough rich people to pay for it. Instead it should be implemented nation wide and be fully funded by our Government, just like our military expenses are paid. You see, states are currency users while our Government is a currency issuer. Every time our Government pays its bills it is creating new dollars. Every time our Government taxes it is destroying those dollars. If you think about how much our Government spends you would realize that it would bankrupt us all if we truly paid everything with taxes. Even back in 1946, Chairman of the Federal Reserve of NY made the statement that taxes for revenue are obsolete. The US Government uses fiat currency (free floating, not pegged to gold or anything else) and has the sole authority to issue the US dollars. The only constraint our Government has in spending is real resources – not dollars. How can a Government that spends dollars into existence ever run out of dollars to spend? That would be like a scorekeeper running out of points to award in a game. Not going to happen. Again, the only constraint to Government spending is real resources. As long as there are real resources to spend dollars on there is no danger of inflation. Japan is a great example of this as they have been pouring money into their private sector for decades now trying to generate inflation and have failed to do so. In my opinion the only thing that is preventing us from having a healthcare system that serves everyone is the lack of will to make it happen. We sorely need to find a way to turn that around. If you are interested in learning more here is a link to introduce you to MMT:

    • A well-thought-out comment here, but it conflates to uses of the word “inflation.” Currency inflation, creating money out of nothing, funds the bulk of governmental operations because the tax increase would result in open rebellion. One of the possible impacts of this economic distortion is price inflation, but it’s neither the only one, nor is there is direct correlation. Friedman does an excellent job of explaining how currency inflation invariably screws everyone but the most wealthy among us, as do others.

      The notion that tax collection removes money from the system is novel to me, and strikes me as quite inaccurate. However, I’m an avid reader and always welcome new information. Is there a source for that assertion which I could add to my library?

  2. Yes, our taxes would rise, probably a lot, if we went to single payer. But we wouldn’t have insurance premiums anymore (I get a wage cut every January to cover the premium increases), and taxpayers wouldn’t be on the hook for the health care of people who have no insurance.

  3. I love your blog… read it every day. Both of the previous comments are right on. And Bernie spelled out the NET SAVINGS that the middle class would reap because the new taxes would be less than the insurance premiums. You, know, like details and numbers and everything… no free ponies here.
    p.s. I have been a self-identified Democratic Socialist for decades now, so I was pretty pumped when Bernie joined the race and I volunteered for his campaign here in Arkansas. Most of my co-volunteers were women… just saying. Peace!

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