State Single-Payer Rises From the Ashes
Hallelujah – there was actual healthcare movement in the Senate Wednesday and Thursday, some of it in a forward direction. Senators took a vote on a few of the 60+ amendments, despite Republican slow-down tactics to avoid actually legislating (that is what we pay them for, isn’t it?) The usual topics loomed large: barely-there public options, Medicare cuts and horse-trading women’s rights. But the happiest unexpected news was state single-payer rising from the ashes, courtesy of Bernie Sanders. That’s a good thing, because other key amendments wait in the wings to knee-cap cost-effective, quality coverage in multi-payer states.
First, the good news. Ben Nelson didn’t quite have the language right yet on his Stupak amendment clone to strip women of their reproductive rights, so we are spared that atrocity for the time being. Meanwhile, someone please send the man a dozen coat hangers. Better yet, McCain’s attempt to hobble Medicare’s financial viability failed. So the cuts, primarily to strip privatized Medicare waste, remain. Best, though, is Sanders’ amendment, SA 2837. It deals with a “State-Based American Health Security Program”, aka state single-payer. The 410-page amendment has everything you would expect in a state single-payer bill, including one plan covering health, mental, dental, vision, and long-term care. If that doesn’t fly, Sanders is also trying to include dental and vision coverage under general HR 3590 essential benefits.
All right, on to the bad news. There are a lot of time-waster Republican amendments, as expected. John Cornyn and Mike Crapo win the master prize, with 26 amendments in all (my eyes crossed halfway down the list.) My personal favorite: SA 2803, requiring members of Congress to be covered through Medicaid rather than the Federal Employee Health Benefits Program. That will be a fun debate to watch. Less fun is the Mary Landrieu/Blanche Lincoln/Olympia Snowe amendment to remove states’ ability to opt-out of a nationwide private plan. Why is this bad? Because insurers can set up in the state with the weakest regulatory standards – I’m imagining an insurer stampede heading for Texas – and force other states to accept their bottom-dweller plans, while allowing them no regulatory authority over these plans.
It gets worse though. The two combined really bad news items are the featherweight compromised public options (from watered-down opt-out to opt-in, trigger, or quasi-non-public) and the mob out to get the Independent Medicare Commissions. We’ve seen the writing on the wall for a public option, but I really didn’t like being right about the IMC lynch mob. Why are these two proposals such a big deal? Because they are the only ones that can effectively contain costs. With a neutered or non-existent public option, we’re down to the IMC, which is supposed to have Medicare cost-savings power independent of D.C. political deal-making. Now the IMC is barred from any cost-savings measures as long as the Medicare 5-year spending growth average is less than that of all health plans combined. That would be the opposite of a “never event”, otherwise known as an “always event”.
Yep, the country would go bankrupt and the IMC cost containment trigger STILL wouldn’t get pulled. Remember why triggers are such a bad idea? Let’s hope that Sanders’ state single-payer amendment passes so we can seek refuge in innovative and cost-containing states. Now that’s change I can believe in.
UPDATE: Take action to tell your senators you support Sanders' state single-payer amendment. Healthcare-NOW is sponsoring a petition here.
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