Should universal care advocates bite their tongues on single-payer?

By Mike Alberti for Remapping Debate

It was not so long ago that a universal, single-payer health insurance program administered and financed by the federal government looked like a viable policy option. Barack Obama supported a single-payer system on the campaign trail in 2008, and, in the early stages of the subsequent battle over health care reform, both a single-payer framework and a “public option” that would compete with private health insurance were solidly backed by many Democrats and a significant portion of the general population.

But by the final stages of the debate, amidst united Republican opposition, single-payer had largely been excluded as an option by the Administration. What became known as the Patient Protection and Affordable Care Act (ACA) did not include even a public option. And for the last year, as Republicans attempt to repeal the ACA and hobble it by underfunding, Democrats and health care advocates have rallied behind it. For many, the fact that the ACA represents far less than they had originally wanted has been put aside, with the legislation recast as a victory to be defended.

There is still a vocal group of advocates, however, who believe that the ACA does not go far enough in providing guaranteed access to quality, affordable health care. And indeed, at both the state and national level, there has been a resurgence of interest in moving the United States past the Affordable Care Act and into a single-payer system. Single-payer bills have been introduced at the federal level and in several states; this year, Vermont became the first state to pass a framework bill that could introduce a single-payer system in the next several years.

But these single-payer proponents are finding it hard to recruit those organizations who favor increased access and affordability, but who feel that support for single-payer could make the ACA more vulnerable, and that support for the ACA is obligatory because the legislation constitutes the only “realistic” policy choice. According to advocates who continue to press for a single-payer system, however, the acquiescence of those sympathetic to pro-access arguments has had a significant impact on narrowing the debate over how the health care system in the U.S. should work — and on moving the center of gravity of that debate further to the right.

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  1. jacksmith on June 24, 2011 at 4:34 am


    ( )

    ( Gov. Peter Shumlin: Real Healthcare reform — )

    ( Health Care Budget Deficit Calculator — )

    ( Briefing: Dean Baker on Boosting the Economy by Saving Healthcare )


    As you all know. Had congress passed a single-payer or government-run robust Public Option CHOICE! available to everyone on day one, our economy and jobs would have taken off like a rocket. And still will. Single-payer would be best. But a government-run robust Public Option CHOICE! that can lead to a single-payer system is the least you can accept. It’s not about competing with for-profit healthcare and for-profit health insurance. It’s about replacing it with Universal Healthcare Assurance. Everyone knows this now.

    The message from the midterm elections was clear. The American people want real healthcare reform. They want that individual mandate requiring them to buy private health insurance abolished. And they want a government-run robust public option CHOICE! available to everyone on day one. And they want it now.

    They want Drug re-importation, and abolishment, or strong restrictions on patents for biologic and prescription drugs. And government controlled and negotiated drug and medical cost. They want back control of their healthcare system from the Medical Industrial Complex. And they want it NOW!


    For profit health insurance is extremely unethical, and morally repugnant. It’s as morally repugnant as slavery was. And few if any decent Americans are going to allow them-self to be compelled to support such an unethical and immoral crime against humanity.

    This is a matter of National and Global security. There can be NO MORE EXCUSES.

    Further, we want that corrupt, undemocratic filibuster abolished. Whats the point of an election if one corrupt member of congress can block the will of the people, and any legislation the majority wants. And do it in secret. Give me a break people.

    Also, unemployment healthcare benefits are critically needed. But they should be provided through the Medicare program at cost, less the 65% government premium subsidy provided now to private for profit health insurance.

    Congress should stop wasting hundreds of millions of dollars of taxpayer money on private for profit health insurance subsidies. Subsidies that cost the taxpayer 10x as much or more than Medicare does. Private for profit health insurance plans cost more. But provide dangerous and poorer quality patient care.



    This is what the American people are shouting at you. Both parties have just enough power now to do what the American people want. GET! IT! DONE! NOW!

    If congress does not abolish the individual mandate. And establish a government-run public option CHOICE! before the end of 2011. EVERY! member of congress up for reelection in 2012 will face strong progressive pro public option, and anti-individual mandate replacement candidates.

    Strong progressive pro “PUBLIC OPTION” CHOICE! and anti-individual mandate volunteer candidates should begin now. And start the process of replacing any and all members of congress that obstruct, or fail to add a government-run robust PUBLIC OPTION CHOICE! before the end of 2011.

    We need two or three very strong progressive volunteer candidates for every member of congress that will be up for reelection in 2012. You should be fully prepared to politically EVISCERATE EVERY INCUMBENT that fails or obstructs “THE PUBLIC OPTION”. And you should be willing to step aside and support the strongest pro “PUBLIC OPTION” candidate if the need arises.

    ASSUME CONGRESS WILL FAIL and SELLOUT again. So start preparing now to CUT THEIR POLITICAL THROATS. You can always step aside if they succeed. But only if they succeed. We didn’t have much time to prepare before these past midterm elections. So the American people had to use a political shotgun approach. But by 2012 you will have a scalpel.

    Congress could have pass a robust government-run public option during it’s lame duck session. They knew what the American people wanted. They already had several bills on record. And the house had already passed a public option. Departing members could have left with a truly great accomplishment. And the rest of you could have solidified your job before the 2012 elections.

    President Obama, you promised the American people a strong public option available to everyone. And the American people overwhelmingly supported you for it. Maybe it just wasn’t possible before. But it is now.

    Knock heads. Threaten people. Or do whatever you have to. We will support you. But get us that robust public option CHOICE! available to everyone on day one before the end of 2011. Or We The People Of The United States will make the past midterm election look like a cake walk in 2012. And it will include you.

    We still have a healthcare crisis in America. With hundreds of thousands dieing needlessly every year in America. And a for profit medical industrial complex that threatens the security and health of the entire world. They have already attacked the world with H1N1 killing thousands, and injuring millions. And more attacks are planned for profit, and to feed their greed.

    Spread the word people.

    Progressives, prepare the American peoples scalpels. It’s time to remove some politically diseased tissues.

    God Bless You my fellow human beings. I’m proud to be one of you. You did good.

    See you on the battle field.


    jacksmith – WorkingClass :-)

  2. Joel Weddington MD on June 24, 2011 at 1:32 pm

    In our quest for single payer “Medicare for all,” or even for positive change via the ACA, we continue to overlook a major cost driver – doctors. Doctors, unlike insurers, are protected by professional autonomy and our fragmented healthcare system. Last month a colleague boasted he made $3M in 2010. An orthopedist in San Mateo made $1M in profits just from dispensing meds in his office. A podiatrist I know makes a 7-figure income. Insurers are guilty, and are easy targets. Yet, they don’t operate in a vacuum. We will have to confront doctors before true change can occur, and it’s way beyond just a few bad apples. Where is the activism to do this?

    • Chris Hagel on June 27, 2011 at 11:00 am

      Hi Joel, this discussion needs to be had too.
      Have you signed this petition?

      I feel that these doctors should have applied their academic talents in the business area or such (that doesn’t hurt people)
      where the primary objective is money; because MDs are truly, first, about truly curing people of their injuries or aliments.
      (Not masking the symptoms with pharmaceutical drugs or primarily money making medical devices and surgical interventions either!)
      If they got through medical school, they can surely apply themselves in this area and make big bucks.
      This is where their heads are really at, big bucks, not humanity, so they should just do it.

      Health insurance company CEO yachts and mansions, health insurance company CEO million dollar bonuses and golden parachutes. MDs with primarily $$$ in their sights. Billions of our health care dollars are funneled off into this annually.
      Meanwhile people are walking around worried about ailments that need attention. I observed A senior citizen (or Medicaid person) last week who couldn’t afford the $25 copay. Fortunately the receptionist said he can pay little by little. These are the human rights violations and indignities that our fellow citizens are subjected to every day.

      I think Physicians for a National Health Program (PNHP) has put this issue you speak of into a better context.
      Are you a member?

      • Joel Weddington MD on July 8, 2011 at 12:47 pm

        Thanks for asking. My comment represents individual opinion, and does not represent any organization. I am pro-single payer, and actively promoting it as the ultimate solution to our crisis. To answer your question, I am a member of PNHP and other allied organizations. Let’s increase our numbers and make our voice stronger!

  3. Vashti Winterburg on June 24, 2011 at 2:49 pm

    I personally think that the best way to “save” Medicare and Medicaid is to go to single payer so that everyone is essentially on Medicare.
    Someone needs to remind AARP that Medicare is a single payer system and if it’s good enough for old folks, it’s good enough for all of us.

  4. MaryMcClure on June 29, 2011 at 2:23 pm

    Healthcare is our primary concern and the single payer system is the way to go. Too much money is being pocketed and by physicians, the medical equipment industry, pharmaceutical companies and insurers. But the overall problem is we live in an overpriced economy. The reason our dollar loses value faster than other currencies is because we set our prices higher and give our dollar less value. And this makes it harder for the everyday person to make ends meet.