I must admit I haven't tried to unravel the details of Bernie's single payer plan but why, on earth, would he propose to allow a national plan to be administered by states? Does he not grasp what is happening with Obamacare in the South and Midwest and other places and why?
Single payer, in the health care world, means facing hospitals, doctors, and insurers with a single source of funding and payment by a national program, much like Medicare, so as to hold the line on spending. Even with that huge leverage, Congress manages to weaken the significant parts of the program and to give doctors and the drug companies a great deal of leeway to charge pretty much what they want.
Why shouldn't we use a national plan to end this domination by physician groups, pharmaceutical companies, and so forth? If the VA or the DOD can negotiate drug prices, why can't a national single payer plan do the same?
Why would any sane reformer propose to let Medicare be administered by each state separately, letting Mississippi, Texas, South Carolina, etc. make sure that the distinctions of class and skin color are not erased as crucial political cleavage in state politics? Bernie is changing this but it such an obvious political gaffe that it makes me wonder who is advising him to follow such an uncharted path?
When Carole and I first moved to North Carolina, in 1972, Jim Hunt was finishing out a term as a moderate governor, while at the same time a popular Democrat, Nick Galifinakis, was running for the Senate. Galiffinakis led in the early returns led until the East Carolina voters, racist, and fundamentalists, rolled in and Jesse Helms went to Washington.
I suspect Bernie has Canada in mind, but Canada is not the United States, with its history of slavery, a brutal Civil War, the disenfranchising of newly-freed blacks by Southern racists, for 100 years after the war's end.
When Texas elected officials, Republicans all, won't accept federal funds to expand Medicaid to help poor white and black citizens to receive health care, to deny a future of health security for all, we know that the South's long goodbye is still not finished.
Governor Maro Cuomo always referred to universal health care as National Health Insurance in the two or three occasions I met with him and outlined a plan for New York. That's what "single payer" should mean.
That's also how we should think about a national "single payer" health care system: a National Health Insurance plan, just as Medicare and Social Security are national programs.
When Wilbur Mills, Chairman of Ways and Means and from Arkansas, was a power in the early seventies in Washington, he proposed, with Nixon, the broad outlines of a national health insurance plan, with benefits nationally defined, and private insurance companies designated as "carriers."
It still is a good idea. If Nixon, Mills, and other conservatives had such a radical idea in 1974 or so, why can't we return to those ideals? And just in case we decide to do this, the key political leaders should stay clear of strippers from Baltimore.