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The Health 202: Single-payer pushes the health-care debate decidedly leftward

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with Paulina Firozi


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Today's Prognosis is by Elise Viebeck and David Weigel. Paige will be back tomorrow.

For months, public debate over the future of the U.S. health-care system has been focused on one theme: the inability of Washington Republicans to repeal-and-replace Obamacare, a vow they made incessantly on the campaign trail.

That narrative may not predominate much longer, as single-payer legislation today takes (left) stage. Single-payer, in which the government would pay for almost all medical bills, 
“'is where the country has got to go,'” Sanders said in an interview at his Senate office. “Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All.”

It would be a dramatic departure from the system we have now, in which many Americans get their insurance through their workplaces, Dave reports. "The bill would revolutionize America’s health-care system, replacing it with a public system that would be paid for by higher taxes. Everything from emergency surgery to prescription drugs, from mental health to eye care, would be covered, with no co-payments. Americans under 18 would immediately obtain “universal Medicare cards,” while Americans not currently eligible for Medicare would be phased into the program over four years. Employer-provided health care would be replaced, with the employers paying higher taxes but no longer on the hook for insurance."

Single-payer -- with its high costs, which likely mean high taxes -- won't go anywhere in the Republican Congress. The support it is generating is significant, however, in showing how the Democratic Party has lurched leftward since Donald Trump's election, and telling of where Democrats will head as the party prepares for 2020.  "After months of behind-the-scenes meetings and a public pressure campaign, the bill is already backed by most of the senators seen as likely 2020 Democratic candidates — if not by most senators facing tough reelection battles in 2018," writes Dave.

Among the co-sponsors who are also possible presidential contenders are Democratic Sens. Elizabeth Warren (Mass.), Kamala Harris (Calif.), Corey Booker (N.J.) and Kirsten Gillibrand (N.Y.). Al Franken (Minn.) is expected to throw his weight behind the plan today.

Some version of single-payer has been steadily gaining congressional support for months -- a measure by Rep. John Conyers (D-Mich.) has the backing of most House Democrats and at least 15 Democratic senators have signed on to Sanders's plan.

Part of that is because surveys show the public is increasingly friendly to the idea. A Gallup survey from November shows that 43 percent of Americans are open to the idea, which is 10 points higher than last year. A full 56 percent of Democrats -- and even 36 percent of independents -- prefer a government-run system, compared to just 8 percent of Republicans.

But the issue holds danger for Democrats now that they are considering the legislative realities and not just pie-in-the-sky visions (similar to the problem, ironically, for Republicans who pushed elimination of Obamacare until it became a real possibility), writes the New York Times's Margot Sanger-Katz: " Leaders of liberal states saw support for the idea erode as they confronted those political realities. In Vermont, the framework of a single-payer system passed the state legislature in 2011, only to be abandoned after experts estimated the system would require the state to double its tax revenue." Sanger-Katz quotes Obama Centers for Medicare and Medicaid head Andy Slavitt, who "worries that the quick shift among his peers on single-payer could backfire. 'That could be the Democrats’ version of the thing that they promised to do for seven years and couldn’t do.'" 

Democratic heavyweights like House Minority Leader Nancy Pelosi (D-Calif.) understand the inherent dangers of moving too far to the left on health care. Neither she nor Senate Minority Leader Chuck Schumer (D-N.Y.) have signed on to Bernie's plan.

In an interview Tuesday,  Pelosi said support for a Medicare-for-All proposal won't become a "litmus test" for the party.

“I think to support the idea that it captures is that we want to have as many people as possible, everybody, covered and I think that’s something that we all embrace,” Pelosi said. She wants Democrats to consider a variety of options, but said she doesn't think much will succeed until Republicans stop attacking the Affordable Care Act.

"Most of the party’s congressional leaders and vulnerable Senate incumbents are steering clear" of endorsing the legislation, however, writes Politico's Elana Schor. "Wisconsin Sen. Tammy Baldwin on Tuesday became the single-payer bill’s first supporter from the class of Senate Democrats up for reelection next year in states Trump carried. But other politically imperiled incumbent Democrats have said no to Sanders ... Sen. Claire McCaskill [D-Mo.] said in a brief interview that lawmakers have more work to do to keep health care costs in check 'before we would think about expanding that [Medicare] system for everyone.'"

Sen. Patty Murray (Wash.), the ranking Democrat on the Senate Health, Education, Labor and Pensions Committee that is weighing a bipartisan compromise to stabilize the ACA, also wouldn't commit: “'There’s a lot of Democratic ideas out there, and I haven’t had the chance to look at all of them,' Murray said, adding that she remains 'very focused' on the committee’s work," Elana writes.

Writing in the Milwaukee Journal Sentinel, Baldwin argued the bill would “simplify a complicated system ... and reduce administrative costs for businesses.”

“This reform will help us achieve universal coverage for everyone,” Baldwin wrote. She called the plan “one of many paths we can take to expand coverage and lower health care costs.”

The Republican Party of Wisconsin quickly issued a statement blasting Baldwin for embracing a “radical $32 trillion health-care takeover.” 

Democrats who embrace single-payer are likely to see increasing attacks of this kind. Bernie answered them today in a Times's op-ed entitled "Why we need Medicare for all:" "The reason that our health care system is so outrageously expensive is that it is not designed to provide quality care to all in a cost-effective way, but to provide huge profits to the medical-industrial complex," Sanders wrote. "Needless to say, there will be huge opposition to this legislation from the powerful special interests that profit from the current wasteful system. The insurance companies, the drug companies and Wall Street will undoubtedly devote a lot of money to lobbying, campaign contributions and television ads to defeat this proposal. But they are on the wrong side of history."

Sanders acknowledged his plan would be expensive. But he said Americans would benefit from an end to the endless wrangling they currently do with insurance companies.

 "The size of the tax increase, he said, would be determined in a separate bill," he told Dave. “'I think the American people are sick and tired of filling out forms,' Sanders said. 'Your income went up — you can’t get this. Your income went down — you can’t get that. You’ve got to argue with insurance companies about what you thought you were getting. Doctors are spending an enormous amount of time arguing with insurers.'"

It's still a longshot that a measure like single-payer can make it through Congress -- or past any president, Republican or Democrat. But there's no question it's changing the terms of the debate.

Here's some reaction from the debate on social media. From HuffPost's Sam Stein: 

RNC chairwoman Ronna McDaniel: 

MSNBC's Joy Reid: 

Emma Sandoe, a former spokeswoman at the Department of Health and Human Services under Obama and a self-described Medicaid lover:



AHH: The number of uninsured Americans dropped to another all-time low in 2016. According to data the U.S. Census Bureau released on Tuesday, the number of Americans without insurance fell to 8.8 percent, or 28.1 million. In 2015, that number was 9.1 percent, or 29 million.

It's the third year in a row that the Census Bureau has reported a decrease in the number of Americans without health insurance. 

Here are a few key highlights from the report:

  • Just more than two-thirds of Americans got their insurance through private plans last year.

  • 55.7 percent of people got insurance through their employer.

  • Uninsured rates dropped for nearly all age groups under 65. The greatest drop was for working-age adults, 19-64.

Why is this important now? Lawmakers are in hearings this week as they work toward a bipartisan negotiation to stabilize insurance markets under the ACA. And there’s a time crunch. Insurers have until the end of September to sign contracts to participate in Obamacare marketplaces for next year. Sen.Lamar Alexander (R-Tenn.), chairman of the Senate HELP committee, has said he wants to have an agreement before next week. 

The numbers also comes as the Trump administration decides how much support to give the Obamacare law it derides. Late last month, the administration announced it would slash federal funding for outreach that helps people sign up for the exchanges.

OOF: The Centers for Disease Control and Prevention wants its employees to cut all communications with reporters, according to an Axios report. An email obtained by the publication revealed that a CDC spokesman ordered employees to cease communications with reporters, “even for a simple data-related question.”

"Effective immediately and until further notice, any and all correspondence with any member of the news media, regardless of the nature of the inquiry, must be cleared through CDC's Atlanta Communications Office. This correspondence includes everything from formal interview requests to the most basic of data requests,” wrote Jeffrey Lancashire in an Aug. 31 email, according to the report.

Now that Hurricane Irma has passed and the electricity is out, an assisted living facility worries for its residents' lives. (Video: Whitney Shefte, Whitney Leaming, Jorge Ribas/The Washington Post, Photo: Michael Williamson/The Washington Post)

OUCH: Residents of an assisted care facility in Cape Coral, Fla. were forced to shelter in place as Irma visited the state. About 20 elderly patients stayed at the facility during the storm, even when it lost power for three days. Our colleague Patricia Sullivan details the conditions for the patients as they waited for the lights to come back on. The indoor temperature spiked to the mid-80s by Wednesday morning, while humidity slicked the floors.

“People here are fragile,” said Dan Nelson, the facility’s chief operating officer. “This is not just about comfort, it’s about safety. We have magnet door locks that don’t work, fire suppression equipment whose batteries have run out, assisted bed lifts that don’t work. And the temperatures today and tomorrow are headed back to the mid-90s.”

Sullivan writes: “The situation at Cape Coral Shores was emblematic of the wider problem of massive power outages in Florida, which stretched from coast to coast and from the Keys to the Panhandle and into neighboring states. As of Tuesday, more than half of Florida’s residents were still without electricity as a result of the hurricane’s impact; the elderly and the very young are put most at risk from such outages, as September temperatures in Florida soar into the 90s. Officials have said it could take weeks to restore power in some places.’  


-- Time is running out for Republicans to revamp Obamacare. Today, a group of Republican senators will introduce what’s ostensibly their last chance to make major changes to the ACA this year as the budget instructions allowing them to do so without Democratic support expire on Sept. 30. 

Sens. Lindsey O. Graham (R-S.C.), Bill Cassidy (R-La.),Dean Heller (R-Nev.), and Ron Johnson (R-Wis.) will introduce their proposal at a news conference this morning. It will call for distributing federal funding to states to give them flexibility to create their own health plans.

The bill has gained some support ever since Senate Republicans dramatically failed to pass a more limited repeal-and-replace bill in July. Politico reported that President Trump pushed for progress over the August recess. Sen. John McCain (R-Ariz.) has also said he could support the measure.

Sen. Ted Cruz (R-Tex.) struck an optimistic tone, telling Politico that he thinks "we are much closer to getting this done than many outside observers believe. I think we've got 45-46 votes in the Senate." 

But others have expressed skepticism that the legislation has legs at all.

Sen. Rand Paul (R-Ky.) said Monday that he would oppose Graham-Cassidy (Paul voted against limited repeal, too), saying that he believed it ultimately continue to fund Obamacare. “I don’t think it’s going anywhere,” he told reporters, according to The Hill. “I haven’t heard anybody talking about it.” The Hill also noted that Sen. Orrin G. Hatch (R-Utah) said simply “no” when asked if he thought the bill would get a vote on the Senate floor.

Sen. Jeff Flake (R-Ariz.) told Politico he's not sure it will happen. "I don't see it," he said. "I don't see voting on doing it one more time." 

Meanwhile, Senate Majority Leader Mitch McConnell (R-Ky.) has made it clear that he would not bring Graham-Cassidy to the floor without the votes.

Vox’s Dylan Scott breaks down this last-gasp attempt: “On its face, this new legislation would encounter many of the same problems that earlier Republican health care bills did: Medicaid cuts and coverage losses. No other plan could get 50 Republican votes. Is this really the one that will?”

Cassidy shared his ideal timeline with Bloomberg’s Steven Dennis earlier this month. It basically leaves no room for error:

-- At least one bipartisan agreement has been brokered this week. Sens. Hatch and Ron Wyden (D-Ore.), chairman and ranking member of the Senate Finance Committee, announced Tuesday that the panel has agreed to a five-year extension of the Children’s Health Insurance Program.

The program, which provides medical insurance for about 9 million low-income children, was set to expire at the end of September.

"Not only does this proposal provide uninterrupted funding for CHIP, but it also provides certainty and increased flexibility for states to administer the program," said Hatch, who co-authored the program in 1997 with then-Sen. Edward M. Kennedy (D-Mass.).

The agreement would include a gradual phaseout of federal matching funds, according to the New York Times. The federal share would continue with the 23 percent increase for the matching rate in 2018 and 2019, as it is under Obamacare, then would drop to 11.5 percent in 2020 and would be eliminated in 2021 and 2022.

--McCain will continue his treatment for brain cancer in the Washington area as he continues his regular responsibilities as a senator, his office said Tuesday.

McCain was receiving treatment at home in Arizona, and a statement from his office said he had gotten an MRI at the National Institutes of Health in Bethesda, Md.

“Following the advice of his doctors, Senator McCain will continue to receive targeted radiation and chemotherapy treatments at NIH while maintaining a regular work schedule in the United States Senate,” the statement said.

McCain was diagnosed over the summer with a glioblastoma, an aggressive brain cancer.

"I'm facing a challenge, but I've faced other challenges," McCain said in an interview on CNN’s “State of the Union” on Sunday. "And I'm very confident about getting through this one as well."

The statement from McCain’s office did not include an update on the senator’s exact condition.

--During the third of four hearings so far on stabilizing the ACA, HELP Chair Alexander acknowledged Democrats and Republicans had not yet settled on a compromise for such things as ensuring government subsidies for low-income Americans who participate in Obamacare.

“I would caution members that there are still significant differences to deal with,” Alexander said Tuesday, The Hill reported. "A true compromise requires Democrats to accept something Republicans want— more flexibility for states— and Republicans to accept something Democrats want — continued funding for cost-sharing payments.”

Politico detailed some of what lawmakers have discussed in the hearings so far: “Alexander is looking at a bill that would fund Obamacare’s cost-sharing program for two years, allow for people to buy “catastrophic” health care plans that were restricted under Obamacare and make changes to a state waiver program. The waivers, dubbed 1332s, have proven to be the most controversial element, as Democrats say the changes shouldn’t eliminate consumer protections and Republicans say structural changes are needed to reduce costs in the health system.”

Politico noted some Republicans are concerned that the plan amounts to a bailout of the insurance industry. 

"All I see so far are suggestions for further bailouts of insurance companies and no real reform," said Senate Majority Whip John Cornyn (R-Tex.), adding it "may be" better not to come up with a plan at all. 

Alexander said he wants to have a plan by next week.

-- Senate Democrats are planning to introduce a measure to increase childcare for working families this week, Politico's Burgess Everett reports this morning, looking to show up the lack of support from Republicans on one of Ivanka Trump's key issues.

The move, Politico noted, "is intended to showcase broad Democratic buy-in on the bill compared to President Donald Trump and congressional Republicans' halting progress on the issue." 

Ivanka Trump has previously met with Republican lawmakers on legislation to improve childcare and family leave, though no plan has yet moved forward. 

Here's what the plan includes: "The legislation will make federal funding mandatory for lower- and middle-class families to ensure child care doesn't eat up a disproportionate share of their budget, focus on preparing 3- and 4-year-old children for kindergarten and make new investments in the child care workforce, according to a summary. The full proposal will be rolled out on Thursday by Murray, Sen. Bob Casey (D-Pa.) and Rep. Bobby Scott (D-Va.)," Everett writes.

House committee to hold hearing on opioid epidemic (The Hill)

The Single-Payer Insanity (Politico)


--Oh well: President Trump’s director of legislative affairs admitted the administration could have done a better job of working with Republican lawmakers in what ended up a failed attempt to repeal and replace Obamacare in July.

At a breakfast hosted by the Christian Science Monitor on Tuesday, Short referred to tensions talked about GOP tensions that hampered the efforts.

“One of the things that we could learn from the last battle was that in many cases, we did not get all of our allies on board with the path forward,” Short said, according to Talking Points Memo. “And so therefore the Republican base was splintered, and some of the reform packages were tagged early on as ‘Obamacare lite.'”

Short also suggested the aggressive timeline of the repeal effort meant that the full fire-power of Trump's administration could not be leveraged.

“I will say that that process began that first couple days in January. We were inaugurated at the end of the month and didn’t have our team really on the field,” he said. “So we do believe that was a process that we had a lot of our conservative allies already out attacking the House package before we were even in office.”

Here are a few more interesting reads from The Post and beyond:


Former CDC chief launches $225 million global health initiative (Lena H. Sun)

Age matters when it comes to screening for cervical cancer (Stat News)

Researchers find hint of a link between flu vaccine and miscarriage (Lena H. Sun)

I used to support legalizing all drugs. Then the opioid epidemic happened. (Vox)


  • Health Affairs holds a briefing on “Understanding the Value of Innovations in Medicine.”
  • The Hill hosts an event on the opioid epidemic featuring Sen. Rob Portman (R-Ohio) and Rep. Paul Tonko (D-N.Y.)
  • The House Energy and Commerce Subcommittee on Health will hold a hearing on FDA’s regulation of over-the-counter drugs.
  • Sens. Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson, and former Senator Rick Santorum will hold a news conference on the Graham-Cassidy-Heller-Johnson health care bill.

Coming Up

  • The Senate Committee on Health, Education, Labor and Pensions holds a final scheduled hearing on how to stabilize the insurance marketplaces on Thursday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “Examining Workforce Programs Under the Public Health Service Act” on Thursday.

Senate Minority Leader Charles E. Schumer (D-N.Y.) says he wants to work with Republicans to make the ACA better:

Sen. Chuck Schumer (D-N.Y.) spoke on Sept. 12 about improving the Affordable Care Act. (Video: The Washington Post)

Lin-Manuel Miranda wants to bring arts funding back to the table at the Capitol:

Award-winning writer and actor Lin-Manuel Miranda is accepting the 2017 Freedom Award from the U.S. Capitol Historical Society on Sept. 12. (Video: Jenny Starrs, Paul Kane/The Washington Post)

Watch a police officer help ease an elderly woman’s anxiety about Irma with a dance:

A police officer in Kissimmee, Fla., helped ease an elderly woman’s anxiety about the effects of Hurricane Irma with an adorable dance at a on Sept. 11. (Video: Osceola County Sheriff's Office)

Jimmy Kimmel calls Hillary Clinton's new book "Losie the Pooh":