I'm getting frustrated, confused and angry now - the House is pushing Single Payer by STATE?

[Phoebe Loosinhouse]

http://www.dailykos.com/storyonly/2009/7/17/754446/-Urgent-Call-to-Action
Urgent Call to Action
by DennisKucinich

Urgent Call to Action Fri Jul 17, 2009 at 04:07:58 AM PDT

Update: The Amendment has passed - 27-19-2! Thank You! Every Republican - even those who ardently support states' rights - voted against the amendment. Please call those Democrats who voted against the amendment asking them to support it in the general House vote. Thank you for your hard work and dedication towards attaining healthcare for EVERY American! - Dennis

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The Amendment would let individual states create single-payer healthcare systems even if Congress fails to create a nationwide single-payer system. Given the corporate-funded resistance to single-payer in Congress, this is a strong option in moving forward.

What I was looking for from this President and this Congress was NATIONAL Healthcare reform, not a return to the patchwork of confusing state by state mandates, programs, regulations, etc.etc.

Single care was always my first choice, but on a NATIONAL level. If Congress wants to fight for single payer, God Bless them, but let them submit it for costing by the CBO on a National level. As far as I know that STILL hasn't been done, although it's been discussed for weeks. I think Schumer said Rangel should be the one to do it.

I can't see how having some few states, only three are mentioned in the Kos Diary by Kucinich - California, Illinois and Pennsylvania - attempting to do single payer on their own is going to benefit NATIONAL reform. I personally find it hard to believe that Illinois and Pennsylvania will be the front runners in single payer healthcare, although I could be wrong.

If you're going to fight for single payer, do it for all of us, or don't do it at all. This could be a poison pill that kills a real public option as now Repubs and others can say - hey! if your state wants single payer they can go ahead and do that - now we don't need a public option.

Sometimes I could just weep at the lack of cohesion and co-operation among our Dems.

Now, how do others view this amendment in the house - Do you think this hurts or helps National healthcare reform?

[redqueen]

1. Canada's healthcare system started out in one province.

We won't get Single Payer through this Congress. That's a fact.

This leaves the door open for states to do so individually if they'd like, which is no small thing.

[Texasgal]

4. This is very true

except my state will never go for it! :cry:

[Oregone]

13. Doesn't matter. It only takes 1 or 2 surceases to base national reform on

Again, referencing Canada.

Look, if 1 state runs away with it, and nothing gets better for the other 49 in 5 years, then it definitely has a strong case if reform is revisited. Yes, it sucks to have to wait, you know. But maybe Americans need an American example before they can open their eyes.

[Oregone]

12. And it remains ran provincially

With a whole lot of federal funding

[Juche]

44. Gay marriage will probably be carried from state to federal level someday

I think after enough states achieve critical mass with gay marriage (right now I think there are 6) that a federal law becomes more feasable. I think the same could happen with single payer, maybe after enough states have it it becomes more realistic on the federal level.

[lumberjack_jeff]

2. It is an amendment to the house tri-committee bill

What it does is allow states to run their statewide exchange, and substitute their own single-payer coverage for the plans (including the national public option) which would otherwise be available.

It's unclear to me how this would work, but I don't really need to know. Given my state's budget, I can't imagine them exercising that option successfully.

[mmonk]

10. Higher medicaid costs, state employee plans and hospital subsidies.

[John Q. Citizen]

22. You seem confused as to the cost. Single Payer costs far less than what we now have or than what

is currently proposed by the HELP Senate Committee, the Senate Finance Committee, or the House Bill.

I'm constantly amazed that there are still people who believe that Canada or France, or England, or even Cuba for that mattewr are spending more on health care than we are.

If your state is strapped for cash, then this is exactly what they would do, since spending less is always better when you are strapped for cash.

[lumberjack_jeff]

47. It costs less in the long run but it costs the state more initially.

The state would have to scrape together enough money to fund initial claims in the system, before any premiums begin rolling in.

I am aware of the relative level of spending between the various countries. Single payer is cheaper, but it would be tremendously expensive for a state to start an independent system from whole cloth.

Remember, only a small percentage of healthcare costs are currently shouldered by the state. Even if you wave a magic wand and cut the total expense in half, it would still be a huge new financial burden for them.

The reality, at best, is that state-by-state single payer would stop healtcare cost inflation or perhaps reduce it 10% over the next decade. Also, a single state doesn't have the power and leverage to force meaningful cost reductions on the huge healthcare companies. In fact, those huge companies could easily shut down healthcare in that state to force political changes.

[John Q. Citizen]

48. No. The state would take it's federal Medicare, Medicade, Chip, VA and all it's own

contributions for it's own workers monies as well as city and county monies, teachers, police, and stick them into a single payer pool. All the refunds due on private insurance could also go into the pool (since the state would be covering the cost of providing the care) and it could be tax financed instead of premium financed, which would mean more money coming in since there are lots of people who have an income but currently pay nothing toward health care except on an out of pocket basis, if that.

This is what the Kucinich amendment does, it allows states to use federal dollars in a state run single payer pool.

Currently about half of all health care expenditures in the country are government expenditures. If you think the private companies can operate without those expenditures, i would disagree with you.

I don't know where you get your 10% savings figure from. But I would like to see the source.

[lumberjack_jeff]

51. The 10%? I pulled it out of my ass.

It's an projection with no greater level confidence than any other.

A single state which implements single payer insurance is not going to see a dramatic immediate change to the economic reality; americans pay $5,800 dollars per year per capita for healthcare. Simply creating a replacement insurance company will not have an instant effect.

Reduction in paperwork costs will be modest because each clinic still needs to maintain a parallel billing system so that the insurance of visitors to the state can be billed.

The unamended house bill will have a greater effect, by eliminating the uninsured.

[John Q. Citizen]

56. Canada has the second most costly health care system in the world. They pay around 50% per capita

what we do, and everyone is insured.

And I disagree with your conclusion. Saskatchewan was the first province in Canada to institute single payer. There saving were so dramatic and obvious (and everyone was covered) that other provinces soon followed suit. They didn't do that because the savings were negligible or slight. They followed suit because it was obvious to everyone that a single payer system has very significant immediate cost saving advantages.

You can just bill the out of staters at double and help defey the costs of your system.

The unamended house bill offers no savings according to the CBO scores. Which means that costs will soar and coverage will become a joke.

I can find you the CBO scores if you wish.

I'd rather talk facts than numbers pulled out of... well you know.

[Hannah Bell]

59. "a single state doesn't have the power and leverage" - which is why state-by-state = dumb.

they'll get bled.

[mmonk]

3. It may be the only way a single payer system can grace the US.

It will never make it through our bribery system of federal government.

[kath]

8. "bribery system" is exactly what we have.

:cry:

[Warpy]

5. I said a long time ago it might have to be state by state

after reform makes for profit insurance less profitable and it starts to pull out of the least profitable markets.

They're making their bucks now by cheating us out of what we've paid for. If they have to knock it off and cough up, they'll start to find ways to leave.

The Fed would then be in the position of setting minimum standards for state run insurance plans. Those plans would be in the position of taking bids for everything from bandaids to MRI machines. Costs would be saved all over the place, taking the sting out of socialized insurance for our backwards, conservative brethren.

[dana_b]

6. I think it helps

If the states mentioned can pull it off successfully, then it would be a good model for other states and maybe, just maybe, the federal govt. would pay attention. Of course this would take decades and truthfully, unless we get a progressive governor in 2010, i can't see this passing in California. We are too broke right now and if they don't raise taxes, fuggedaboutit.

[superduperfarleft]

7. Canada's current system is run by individual provinces.

This is exactly what needs to be done, instead of the joke that is a "public option."

[Phoebe Loosinhouse]

16. I have always thought statehouses are filled with even more cronyism & corruption

than national politics.

I NEVER thought of state by state single payer as a goal. Canada has far fewer provinces than we have states and was probably a lot easier to bring together and unify. I could see regionalizing single payer for various reasons, but I think the idea of 50 state single payers is a nightmare.

I think this amendment is a distraction at best from a national focus.

[anonymous171]

24. Do you pay attention to National Politics? Do K Street and/or C Street mean anything to you?

National politics is just as corrupt, if not more.

[Blue_Tires]

30. as someone who used to cover small-time politics

it has been my experience that the smaller the office or jurisdiction, the more corrupt, petty, vindictive, lawless, power-mad and outright evil the person can be...they just don't get much attention because the damage they do is limited to the relatively small scope of the office (which helps them get away with that much more) -- I'm talking small school boards, small-town mayors and councils, county or state legislators from podunk regions, and the worst of the worst; satan's own hellspawn: The Civic/Neighborhood Association President...You wouldn't think it, but i've seen it too many times...

[mmonk]

25. What are the populations of those provinces?

[superduperfarleft]

27. What does that have to do with anything?

Off the top of my head, the city of Toronto alone has 4.5 million in their greater metropolitan area, and their particular plan runs spectacularly, probably better than anywhere else in Canada. Not sure what point you were trying to prove...

[mmonk]

31. I was addressing post 16. I was trying to figure out their position.

[superduperfarleft]

32. Sorry, my mistake. I misinterpreted. n/t

[Phoebe Loosinhouse]

33. My position on what? nt

[mmonk]

36. As to why such a scenario would be a nightmare

based on Canada having fewer provinces than we have states if I'm understanding you correctly.

[superduperfarleft]

28. And the voters of those states get the system that they want.

In states full of evil socialists, the healthcare system will run smoothly and will be adequately funded. In the third-world hellholes like Texas that bitch and complain about taxes or radical socialist concepts such as helping their neighbors, the system will be a disaster. Seems fair to me, and a lot better than the way it is now when the right-wing hicks from flyover country are pretty much dominating the debate on this to the detriment of the rest of us.

[Canuckistanian]

9. That's basically the system Canada uses

Each province manages it's own system. BUT the federal department, Health Canada, sets the guidelines. And that means single-payer only.

And in return, the provinces receive funding from the federal government in "transfer payments". If any province threatens to go against the 1984 Canada Health Act, their transfer payments are gone.
http://en.wikipedia.org/wiki/Canada_Health_Act

I see the problem of giving states TOO much leeway, though. It would create "have and "have not" states.

[cascadiance]

38. This sounds kind of like the way unemploment insurance is deployed here?...

I think the feds set the guidelines, but each state runs its own programs with that.

Now, I'm having a nightmare trying to get proper unemployment insurance claim set up between two states (California and Oregon), which perhaps should be a separate thread once I get it sorted out.

But I'll likely get more per week from Oregon than I would from California per week given their max rates, etc. (which might total $150 or so per month). You'd expect the opposite, given the cost of living differential, etc.

I'm wondering if that's another reason that David Wu did a "pass" vote. If Oregon were to pass a single payer health system, it would be one more reason for the masses in California (like me) to move to Oregon to get better health coverage and break our state's "rainy day fund" and get us into the red like our neighboring states Washington and Oregon are already.

Still I'm glad that the measure passed, so that we have some way of at least incrementally getting a start on getting Single Payer deployed soon.

[sharesunited]

11. What state can afford to do this?

Only the U.S. Government can do it, because it controls creation of the currency to fund it.

[Oregone]

14. It would need the federal subsidies in lieu of indvidual "credit" payouts

But aside from this, it would need a tax raise, which isn't the end of the world. Why? People already pay premiums. Just get them to pay a lesser amount in taxes

[mmonk]

15. The first state that does it will have businesses

move into the state quickly when they learn they don't have to provide health insurance to their employees.

[John Q. Citizen]

21. If, Saskatchewan , Alberta, and Quebec could do it, why couldn't we? It's way cheaper than what we

currently spend, after all, so what's the problem?

[superduperfarleft]

29. Alberta is hardly a left-wing paradise, either.

I've often heard it described as the Canadian version of Texas. If even they can get their shit together, it says a lot that USAmericans can't.

[wroberts189]

41. What if a bunch of states got together...? (just an idea) nt

[bvar22]

17. It is a way to leave the door open for Single Payer.

My concern for the (as yet undefined) Public Option is that it would contain language that would actually forbid Single Payer from ever happening. There is some language in the Senate Bill that could do that.


At least the inclusion of this amendment codifies the possibility of a Single Payer system.

[drm604]

37. How could it forbid it?

Suppose, for the sake of argument, the private companies were all driven out of business by the public option. Would we be required to bail them out in order to prevent a de facto single payer?

[John Q. Citizen]

18. I view this amendment with relief and happiness. the original house bill would have outlawed

states from creating a single payer system.

Have you read the original bill? It makes access to the so called "public option" very difficult for most Americans. In fact, people currently receiving private health insurance through their employer would have no access.

The other big problem with all the non-single payer bills introduced so far is that they are unaffordable. They do almost nothing for cost containment and as such are bound to fail in the long run since resources are not infinite.

We know single payer contains costs because it has everywhere it's been tried, in many countries around the world. We also know that everywhere a hybrid system (like the current house bill, and the current HELP Committee Senate Bill, and the Baucus Bill) has been tried, it has failed because it becomes too expensive to subsidize private insurance companies with public tax dollars.

I'm confident that if a state can pass single payer, it won't be long until it's passed almost everywhere and then it will be done on the national level.

If passing a national plan that is doomed to fail is what you really want, don't worry. They will do that too. Then when it fails, we will at least have a back-up option. Instead of just being stuck for perpetuity in a failed system, this way we have a plan B.

[BlooInBloo]

19. Yah, yah. We know. Anything that isn't EVERYTHING is worthless.

[undeterred]

20. No this just means the states won't be prohibited

from introducing their own single payer systems.

[anonymous171]

23. That would be a good idea actually.

Having a gigantic federal system would probably be more complicated, especially if you are trying to build it from scratch. I say start from the state level and eventually make it federal.

[Phoebe Loosinhouse]

26. Nothing has EVER prevented any state until now creating a single payer program

And it's not like the health crisis is anything new. So why are the states suddenly going to pop up now and create single payer programs on their own? In other words, the only thing this amendment does is to continue to allow them to not do what they have not been doing. Big deal.



This link shows the CURRENT state by state coverages available to the uninsured
http://www.ncsl.org/?tabid=13878

[mmonk]

43. Has single payer been introduced at the state level?

[John Q. Citizen]

54. With all due respect, you are asking the question of someone who doesn't have the facts

available.

The California legislature has passed single payer repeatedly and the Gubinator has vetoed it repeatedly.

[mmonk]

62. Do you think the Gubinator will pay politically?

[John Q. Citizen]

49. Yes it has. States recieve federal dollars for Medicare, Medicade, Chip, and lots of other

dollars as well.

That is why way back in 1994 Paul Wellstone introduced a bill in the Senate that would allow up to 5 states to take the federal healthcare dollars coming into thier states and use them for a single payer system.

His bill was never passed.

The California legislature has passed single payer bills 3 times, but the bad Governator has vetoed the bill all three times.

[chill_wind]

34. Why it's good:

Why is the Kucinich Amendment Necessary and Important?

The healthcare legislation currently under consideration in Congress would prevent states from improving on what Congress creates. The Kucinich plan would change that, leaving the federal initiative as is but permitting states to do better. This battle pits states’ rights against the much less spoken of insurance company rights. And it calls the bluff of every individual or group who opposes single-payer healthcare at the federal level on the grounds that it is not “viable.” That argument would seem to provide no basis at all for denying states the right to create single-payer healthcare or any other solution they see fit. READ MORE

http://www.democrats.com/node/19872

State by state. That’s exactly how Canada evolved towards single-payer: one province at a time. Given the corporate-funded resistance to single-payer in Congress, the U.S. may have to follow the Canadian path.

Progressive activists in California and Pennsylvania are leading the way for single-payer systems and the Kucinich Amendment would remove the legal roadblocks they face.

http://canarypapers.wordpress.com/2009/07/16/call-to-action-the-kucinich-amendment-supporting-true-health-care-reform-one-state-at-a-time/

[BattyDem]

35. Well, at least single-payer is on the table

I would prefer a national plan, but if the only way to get it done is to have it begin in the states, so be it.

Unfortunately, I'm not optimistic about Corzine's chances for reelection and I seriously doubt that Christie will be in favor of single-payer, so NJ is screwed. :-(

[harun]

55. Hopefully, it will be on 50 tables. Living in PA I know we would get on it

like white on rice. For those in the red states I feel your pain but I think this would speed reform there as well.

[Stevepol]

39. Great!! K&R!!

[librechik]

40. This is the best news I've heard all day

Thanks Dennis! Kick them in the knees until they bend a little bit!

Really, this is Progressives maneuvering against the Blue Dog Coalition--I'm on Dennis' side.

[Juche]

42. Get some big democratic states to support it and unify

If California and New york both push for single payer as a way to avert budget crisis, and they have a single overhead then about 50 million americans will be covered by single payer in those 2 states alone.

[Cleita]

45. It should help or single payer may disappear from the dialogue

altogether. Apparently the train wreck of an insurance exchange is going to happen. When it crashes, there will be this hopefully to fall back on.

[GeorgeGist]

46. This is a ploy to divide the states ...

and destroy single payer.

[justinaforjustice]

50. No, Kucinich is Right!

Kucinch's presidential platform policies were far and away superior to any of the other candidates, including his positions on providing universal single-payer health care coverage. As it has become clear that even the so-called "public option" will be watered down to the point where it is almost guaranteed to fail, shifting the battle to the states is a brilliant strategy. This is exactly how Canada got its universal health coverage. It was started by Tommy Douglas and the New Democratic Party in Saskatchewan and spread thereafter to all the other provinces.

There are states with heavy Democratic majorities which have the clout to start single-payer, if allowed and given some subsidies by the federal government. I know that my own state, Hawaii, would be very likely to pass such a program. I expect Massachusetts and Vermont would do the same. Lobbying for single payer at the state wide level would be much easier to accomplish too. Yes, the private insurers will throw massive amounts of money towards defeating it, but they will have to buy a lot more politicians and voters can more easily throw out the bought and paid-for anti-single payer politicians.

Thank you Dennis Kucinich! You will be the Tommy Douglas of the U.S. if you can get this passed. Kucinich for president may be a real possibility if this works.

[anonymous171]

57. You know, I would totally vote for him if he managed to pull this off. nt

[superduperfarleft]

53. It's how single-payer is done in Canada.

It's the public option that will destroy single-payer.

[NightWatcher]

52. Which state's politicians have not been bought off by Big Pharma and Big Ins, and would limit them?

Oh yes, I guess that would be NONE OF THEM.

So the Dems in the Congress get to say "We tried, now re-elect us in 2010 and 2012", when they know that they are just passing the buck.

[nadinbrzezinski]

58. Some people in Congress read CANADIAN history

serious

they know they cannot get it at the national level at this time

But they know they can get it state by state... so be it. Saskatchewan led the way.

[SeattleGirl]

60. Exactly. Sometimes you have to start at a smaller level, in order to

ultimately triumph at the larger level.

[jcarterhero]

61. Canada's system started out in a similar way

So it's better than nothing, I guess.