Time: D H M S

Single Payer

OK, here it is. I've linked to a PDF with the full legislative text at the bottom of this blog entry; here's the summary version, with some notes:


Establishes a Universal Medicare Program for every resident of the United States, including the District of Columbia and the territories. Guarantees patients the freedom to choose their health care provider. Provides for the issuance of Universal Medicare cards that all residents may use to get the health care they need upon enrollment. Prohibits discrimination against anyone seeking benefits under this act.

OK, so it apparently would cover undocumented immigrants, and every doctor/hospital/clinic/etc. would be required to participate, with anyone in the country being covered by any healthcare provider nationally.

For the past year and a half, of all the proxy battles between "Team Hillary" and "Team Bernie" on the left side of the aisle, no issue has been more repsentative of both how passionate people are or how much each "side" misunderstands the other than the future of the American healthcare system.

"Team Bernie", in essence, consisted of progressives (and Democrats) who believe that while the ACA may have improved things to some degree in some ways, it not only isn't enough long-term, it isn't nearly enough short-term either; the next step (and for many, the only acceptable next step) must be moving the entire U.S. population over to a universal Medicare-style Single Payer system, with everyone in the country being covered through a single, comprehensive healthcare program funded entirely (or nearly entirely) by taxes.

Last month I wrote an extensive piece about Colorado's Amendment 69 initiative, aka "ColoradoCare", which would be the latest attempt to achieve a state-level single payer healthcare system (or at least near-single payer; if enacted, it would replace all current healthcare coverage except for Medicare, the VA/TriCare and the Indian Health Service).

While I was generally supportive of the idea overall, I also concluded that:

For me, however, ColoradoCare addresses many of the criticisms I've had of Bernie's plan. I'm not necessarily "endorsing" it (I still have a lot more to learn about the details and the criticisms before I can do so), but the bottom line is that it's more realistic and far better thought out than Bernie's national plan is. This is the best opportunity for achieving single payer that you're likely to see anytime soon.

Many single payer advocates have been either confused or angry with me (to put it mildly) for not being a fan of Bernie Sanders's proposed national SP plan.

I've explained repeatedly that while I am a SP proponent, I just don't see it happening at the national level all at once. There are too many barricades and too many logistical, economic and political problems in doing so to make it remotely feasible to bring SP to the country in this fashion. In addition, I have major problems with the utter lack of detail in Bernie's plan.

HOWEVER, I've also repeatedly stated that I do strongly support getting the ball rolling at a smaller level first--either by partially expanding existing SP programs such as (Medicare, Medicaid, CHIP); consolidating existing private systems into larger risk pools (ie, merging the risk pools of the individual & small group markets, as a few states have done already); and/or by getting SP enacted at the state level, then using that as a model for other states and/or as a national model if it works out.