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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Update on Health Care Politics, Single-Payer Momentum

At The Daily 202, Paige Winfield Cunningham has an informative update on national — and internationsal — health care politics. As Cunningham writes,

…Republicans have focused on repealing the Affordable Care Act and replacing it with bills that would cover far fewer people and are deeply unpopular. Democrats are fixating on single-payer plans (see Sanders, Bernie) that Republicans will surely block.

After much fanfare, Sanders (I-Vt.) rolled out yesterday afternoon his “Medicare for All” proposal, which has gained support from 16 Democrats (many of them would-be 2020 presidential contenders — see Warren, Elizabeth). It’s certainly true that support for a single-payer system has been edging up in recent years among the public and among members of Congress.

Jeff Stein adds at Vox:

The majority of those backing Sanders’s Medicare-for-all bill tend to hail from blue states or are rumored 2020 presidential candidates. Still, as Vox’s Dylan Matthews has written, the endorsements are illustrative of a stunning shift among Democrats to embrace single-payer legislation — which was once circumscribed to the party’s far-left fringe.

In late August, Sen. Kamala Harris (D-CA) became the first Senate Democrat to back Sanders’s bill. She was quickly followed by Sens. Elizabeth Warren (D-MA), Sheldon Whitehouse (D-RI), and Kirsten Gillibrand (D-NY), as well as Cory Booker (D-NJ) and Brian Schatz (D-HI).

Sen. Tammy Baldwin (D-WI), who is up for reelection in 2018, became the first senator from a state won by Donald Trump in the general election to back the bill on Tuesday. (Though Wisconsin is a traditionally blue state that frequently elects Democrats.)

But several Senate Democrats have also said that they will not co-sponsor the legislation, and Senate Minority Leader Chuck Schumer has not formally stated a position on the bill.

Sen. Sherrod Brown (D-OH), widely seen as one of the most progressive senators in a red state, said that he would not be co-sponsoring the bill — though he is pushing a health care bill of his own aimed at expanding Medicare by lowering the enrollment age down to 55. Brown is expected to face a difficult reelection race in 2018.

“Right now, I’m focused on building bipartisan support for my bill to allow people to buy into the Medicare program at age 55, which will cut costs and expand choices for Ohioans,” Brown told Vox in an email.

Similarly, Sen. Tim Kaine (D-VA), Hillary Clinton’s vice presidential running mate in 2016, appeared to confirm in an interview that he wouldn’t be co-sponsoring the bill, citing his preference to give consumers options in choosing their health insurance. (Sanders’s single-payer bill would likely eliminate private insurance companies and replace them with a single, government-run insurer.) Kaine supports a government-run public option, and said he wants enrollees to be able to pick between the government plan and a private plan.

Meanwhile, some Senate Democrats haven’t made up their minds yet. Sen. Chris Van Hollen (D-MD) said he needed to scrutinize the text of the (still unreleased) Sanders bill, and Sen. Ron Wyden (D-OR) said much of the same.

MSNBC commentator Steve Kornacki tweets a revealing comparison: 1993: 4 of 56 Dem senators (7%) sponsor single-payer bill. 2017: 17 of 48 Dem-caucusing senators (35%) sponsor single-payer bill. Single-payer reform is gaining traction among Democratic elected officials.

Cunningham outlines the Trump-supported ‘Graham-Cassidy alternative.’ which “would actually rip even more deeply into the ACA than previous GOP-backed measures and is widely viewed as a last-ditch and far-fetched effort to fulfill their repeal-and-replace promise.” Additionally,

The measure would turn the billions of dollars spent on the ACA’s Medicaid expansion, tax credits and subsidies into grants managed by each state, allowing states to define their own rules for health plans that may be sold to residents and outline the help consumers should receive to afford that insurance, my colleagues Amy Goldstein and Dave Weigel report.

Cunningham sketches some of the systemic health care compromises in Europe and Japan:

Great Britain is often cited as the classic example of a single-payer system, where the government not only pays virtually all the bills (albeit funded by a hefty tax) but also runs the hospitals. But other wealthy countries have designed systems that interact heavily with the private market or require patients to kick in their own funds to keep costs lower.

Take France, for example. While on vacation in Paris last week, I had a chance to chat briefly with a senior French Senate staffer about his experience with his country’s health-care system — and was surprised to learn that it’s not quite the government-pays-all system many Americans imagine.

Philippe Bourasse, the Senate’s deputy head of international relations, told me that he carries a supplemental insurance plan to help pay the portion of his medical visits the government won’t cover, and then pays the rest of that share out of pocket. Indeed, around 95 percent of the French buy private coverage — or get government vouchers if their income is low enough — to cover cost-sharing and some uncovered benefits, according to the Commonwealth Fund.

In Japan, all enrollees must pay a 30 percent coinsurance for all medications and services they receive. In the Netherlands, the government contracts with competing private plans — much like how the U.S. Medicare Advantage program works. Successful health-care systems in other countries including Germany, Australia and New Zealand all work in somewhat different ways but still manage to achieve better health outcomes and less per-capita spending than in the United States.

Of course, more government health benefits also require steeper taxes to pay for them. French workers are required to pay 21 percent of their income into the national health system; even so, there’s a near-constant debate over how to put the program in the black. Tax hikes aren’t something Americans swallow willingly. And anyway, the conversation on Capitol Hill has centered on how to cut the government’s health-care spending, not increase it — at least among Republicans who control the power lines.

It might also be good to survey how South Korea, Spain, Sweden, Norway, Denmark and other nations mix the public and private sectors in their health care systems — and assess how well their systems work.

The political momentum behind single-payer health care reform suggests it will be a central component of many Democratic campaigns in both 2018 and 2020, while Republicans now appear more morally and intellectually-bankrupt on health care reform than ever. Democats may settle on a “public option” compromise or some other public/private sectors mix. But right now, the positive energy is with the single-payer movement — and that helps Democrats and hurts the idea-poor Republicans.

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