Johnathan Chait in New York Magazine has penned a scathing critique of Bernie Sander's health proposal. So has Ezra Klein . Every liberal or progressive should read it. Chait argues that Bernie's proposal is a reform too far, with a serious design flaw. Chait is right; Bernie's proposal is not just too ambitious; weirdly he envisions a Medicare for All system with the states administering it. While Bernie has rushed to change this feature of his plan, it is instructive at least to me how hasty, and opportunistic his support for single payer is. And what about Vermont itself turning its back on single-payer?
Obama led us toward health care reform–Obamacare–and today almost 20 million more people have health insurance. That's very good news, despite what critics say, and this shift is the primary reason the GOP is beside itself with plans to finally end Obamacare. Not because Obamacare is terrible but because Obamacare isn't terrible.
Obamacare advances the cause for more social justice in health provision, and the GOP sees this more equality and social justice as a dire threat to a party based on endlessly playing the racial and class card, while singing the hymn of small government and low taxes.
Why is it that no state in the South has embraced Obamacare and its incredibly generous expansion of Medicaid? This despite that many conservative states, like Arizona, have expanded Medicaid with federal dollars? The race and inequality card is played constantly in the South and that won't change anytime soon with state discretion to adopt Obamacare, even if the financial deal would dearly benefit the states, the hospitals in the states, and the economic stimulus of federally financed spending..
From 1988 to 1992 I served as deputy commissioner of health for policy and planning and resource development, serving under Dr. David Axelrod, Commissioner of Health. Ron Rouse served as the deputy director for policy, planning and resource development. While Governor Cuomo finally rejected our proposal for state-based Universal New York Health Care (UNY-Care), he did authorize a New York State Child Health plan, and this plan became the model for the national child health insurance program. That's huge progress for the United States.
But we need to ask ourselves, why did Governor Cuomo turn away from what he termed "national health insurance?" All of us who worked for the Governor and Dr. Axelrod have our views about this but mine is that someone got to the governor and explained that Governor Mario Cuomo embracing an ambitious health reform plan would play into the hands of the GOP and their gospel of lower taxes and small and weak government, hapless before the economic power of the health care industry and organized medicine.
What's truly weird about the gospel of small government is that it is actually the gospel of weak and hapless government forced to dance to the tune of big corporations and the power of organized medicine.
In our divided Republic progressives do what we can and it is usually not enough but then we must try again. That's what Obama has done and this is extraordinarily important.
Yet Hillary is right: Obama's accomplishments are where we must start and we also must stop treating Obamacare as if it is pale beer. Obamacare is progress, huge progress. But it's simply not enough and the reason why lies with the refusal of many states, all the Southern states as well as other states that have become 'Southernized,' to accept essentially free money to provide needed medical care. Why would any state refuse to expand Medicaid funded almost entirely by the federal government and leave so many poor blacks and white children and adults stranded, if not for reasons of racial animus?
Hillary suggests that we might allow the public option for opting into Medicare, and that could be a major step. (The public option, first proposed by Jacob Hacker, would allow anyone faced with choosing insurance offered under Obamacare could instead opt to be enrolled in Medicare. That was soundly defeated by a health insurance lobby that cannot abide by using government to make things simple and lower in costs while also breaking up the predatory pricing so many goods and services?
Universal health care requires national leadership and that level of regional and state participation that does not seek to sabotage universal health's egalitarian philosophy. States participate in environmental regulations that require states to enforce federal policies; we saw some of that in Arizona in my work as a local mayor in Bisbee, AZ, and where state environmental leadership working under the leadership of federal policy, in our case NAFTA, was outstanding.
We all need to think more clearly about the South's resistance to Medicaid's almost free expansion is so universal. What else can it be but yet another instance of the 'Southern Strategy' to divide the nation along race and class lines and to thwart policy to advance our nation's health together.
Shifting the funding to Washington with strong incentives for state participation offers hope, but we need more.We need a national policy for pharmaceuticals that does not give Big Pharma an endless sweetheart deal. If the VA negotiates drug prices with the pharmaceutical industry, and if the DOD does the same, we need to finish the job for all Americans. The pharmaceutical industry has for far too long held the United States hostage to an elaborate price-fixing scheme. We need to stop this, once and for all.
Also see the article, "What Liberals Get Wrong About Single Payer...explaining how the lack of negotiating power of hospitals and other providers results in far higher prices for medical devices, and much, much else..Single payer bundles together hospitals and other health care providers to give them market power.