Why Single Payer Must Remain on the Table
ACA For 2016, Single Payer for the Future. Why the Democrats Need Single Payer on the Table to Ensure a Progressive Platform
Despite improvements to the ACA (ObamaCare) being a smart focus for Democrats, Single Payer must remain on the table and in the Democratic party platform.
The ACA is a matter of progress, strategy, and practicality; single payer universal healthcare is a matter of morality and ethics.
Below we explain why the 2016 Democratic platform must include language about single payer to unite the party, and why that doesn’t have to be “the end of ObamaCare”.
TIP: Credit where credit is due, Hillary’s website says, “Hillary has never given up on the fight for universal coverage—and she won’t stop now. Building on the Affordable Care Act to expand coverage for millions of Americans.” Very good. Let’s see wording like that in the platform.
FACT: States can use a Sec. 1332. Waiver for State innovation to create a state-based single payer system. States that haven’t expanded Medicaid can also create state-based programs. Learn more about state-based alternatives allowed for under the ACA.
Single Payer, Excluded From 2016 Democratic Party Platform After June 25th Drafting Meeting
Single payer (or Universal Healthcare, or Medicare-for-All, etc) was not included in the Democratic National Party platform.
The platform, after tense debate between Bernie and Hillary committee nominees, entered its final draft phase on June 25th at a Drafting Meeting hearing testimony from 114 witnesses from across the country to advance progressive democratic values. The final draft ended up including many important concessions that helped to bridge the gap between to both Bernie and Hillary supporters (including breaking up too-big-to-fail banks and enacting a modern-day Glass-Steagall Act).
The platform did not however include key issues, including single payer universal healthcare.
Why Single Payer Universal Healthcare Should be Included in the Platform, and Why it Wasn’t
The number one reason we got ACA support instead of single payer support in the platform is that Hillary is running on ACA and Bernie is running on single payer. It is a matter of politics here, politics held fast by the majority of nominees at the drafting committee despite hearing testimony and counter-points, and this does no favor to the people or the party.
The second main reason over the disagreement is that Bernie’s single payer plan has caught some flak for being too spend-y and too generous. Is it a good ideal? You bet! Is it practical given the hard-won ACA? Maybe not. Meanwhile Hillary has moved from pushing for Single Payer-ish “Hillary Care” to simply supporting the ACA and working out the kinks. Is this overly practical? Probably a little.
To come together for a 2016 candidate we must have compromise between “improve ACA, we can’t get single payer” and “expand single payer and eliminate all private plans and cost sharing”. That compromise must include strong wording about the goal being universal single payer healthcare. It can be “focusing on the ACA” by promoting smart state-based single payer solutions allowed for in Section 1332, expanding Medicaid, and making sure cost curbing provisions work. Or it can be a more immediate push for single payer that Sanders is hoping for, but it shouldn’t be a quiet dismissal of the idea of having universal healthcare in America.
Pure politics aside, below is a list of reasons why the ACA should be included and perhaps why it wasn’t, and some other key points in the single payer / ACA discussion:
- Logically, one would have to imagine that, in order to get the ACA concessions were made to insurers. Democrats can’t renege on the deals that were struck or they lose face. In this respect it is reasonable not have a platform that suggests we fully dismantle the ACA for single payer. From this perspective vocal support for the state-based section 1332 alternatives and Sec. 1115 Medicaid alternatives work well.
- Medicaid and Medicare are already single-payer-like systems. These are parts of the ACA, thus expanding these systems isn’t explicitly outside of the ACA.
- The ACA includes important funding mechanisms that help fund not only the ACA, but help fund Medicare and Medicaid as well. Single payer would eliminate this income stream and we would need to replace it with other funding mechanisms.
- The ACA gets a lot right, but high deductible plans are very literally killing Americans keeping them from getting the very preventive care that the ACA seeks to ensure. With rates rising every year it is unreasonable to assume this is an acceptable long term solution. Wait times might ration care under a single payer system, but deductibles are a more cumbersome system of rationing that is leaving a bad taste in people’s mouths.
- Despite deals struck and risks associated with a poorly implemented single payer, the long-term goal must be at least a Medicare-like system with 100% coverage, if not a full universal coverage public single payer option (so a compromise version that includes private plans sold on-top a public plan could be a good next step, but no step should ever be a final step).
- Despite the importance of the ACA, it is wrong to think that supporting single payer and universal coverage is somehow an affront to the ACA. It isn’t and it is insulting to frame it this way. The point of the ACA is to get close to 100% coverage, to keep healthcare spending down, to ensure affordable coverage, to expand healthcare access, and to ensure a safety net to all Americans making under 100% of the poverty level. Single payer accomplishes all of this with minimum mutilation to the bulk of the ACA or its values.
- A lite form of single payer would only replace the coverage provisions and taxes regarding premiums. We could keep the rest of the ACA and even still call it ACA (or ObamaCare). Repeal is not necessary to fight for coverage as a tax instead of coverage as a tax subsidy and tax penalty.
- Single payer won’t result in “people loosing coverage”. The only ones who would “lose” coverage are those with gold plated health plans, and this would only be true if there was no supplemental option.
- In its simplest form, literally all we do is replace individual and employer mandates and subsidies with a universal catastrophic plan and then let insurers sell supplemental coverage. This is a compromise between Bernie and the Clinton supported ACA.
- Millions are dropped each year due to non-payment. It will never be possible to get 100% coverage with the ACA and this has been long known by the CBO and the designers of the bill. In MA where the ACA was a pilot program they currently have coverage rates in the high 90%’s (96.3% in 2013 for example). This is way better than pre-ACA, but it should NOT be an end-game.
What Should the 2016 Democratic Platform Say About HealthCare?
To set the right example for the world and to reign in abuses by the private market in regards to our healthcare system and to ensure cronyism doesn’t run amok with one of the world’s biggest for-profit industries, we must continue to reform healthcare. It is immoral to strive for anything less than universal healthcare, but as noted, it is also somewhat impractical to ask those who fought for the ACA to simply push for complete single payer out of the gate.
Thus, the language used in 2016 Democratic Platform should be something like:
We will continue to improve the ACA, help states expand Medicaid to ALL Americans below the 138% poverty level, drive down healthcare costs, prevent fraud, waste, and abuse, and to work toward universal coverage and a single payer system, expanding on public options, including those found in the ACA under Sec. 1332 and Sec. 1115.
You can see the 2012 Democratic Platform here, the 2016 platform is not released yet and there is still time to update the wording to reflect a long-term goal of expanding the ACA into a single payer universal healthcare system.
Remember, we don’t need to “get rid of ObamaCare” to implement single payer, but if we don’t support universal healthcare and single payer we may find ourselves losing ObamaCare by alienating those who are willing to turn away from the party for the hope of say “GREEN-er” pastures and less sensible, but perhaps more hopeful, healthcare reform plans.