The path forward for single-payer, by @DavidOAtkins

The path forward for single-payer

by David Atkins

The always excellent Dave Dayen at Firedoglake analyzes the pathway forward for single-payer healthcare/Medicare for all, regardless of the Supreme Court's decision on Thursday:

However, if the ACA gets thrown out – even if just the mandate is stricken – the forces continuing to push for single-payer in California plan to make a big splash. Progressive organizations like the Courage Campaign, as well as NNU’s state Chapter, the California Nurses Association, plan to reintroduce an effort to pass single-payer at the state level, as the best option to providing quality, affordable health care for all citizens. Rick Jacobs, the head of the Courage Campaign, said he would like to see a broad-based coalition, including community groups dealing with a broken health care system on the ground, come in on this effort.

There’s an active bill for the single-payer framework, SB810, in the hands of state Senator Mark Leno. California’s legislature has grown a bit more moderate on the Democratic side over the years, and single-payer actually failed to garner a majority by two votes in this legislative session, unlike in 2006 and 2008. But the single-payer campaign would presumably make that a litmus test in future elections.

This would be a long road, however. Because of the 2/3 requirement for any tax increases in California, you could not pass any revenue-raising measures inside the single-payer bill without Republican support, which isn’t coming. So the idea has always been to pass the bill, and then put on the ballot a funding mechanism for single-payer in the next election. The ability to use federal funds for a single-payer system, by pooling funds from Medicaid and SCHIP and other sources, would be limited until the waiver to provide ACA-compliant coverage hits in 2017. So you’re talking about five years at a minimum before single-payer could approach reality in California.
I've been saying this for a long while, but Medicare for all simply is not going to happen at the federal level, probably for a generation at least. The dynamic that Digby mentioned earlier, in which seniors dramatically oppose extension of Medicare benefits to those who haven't "earned" them, is one factor. Another is the overwhelming opposition of healthcare business interests to the idea. Hacker and Pierson have noted, too, the ratchet effect of conservative opposition to such things at the federal level: there are numerous points at which such legislation can be blocked, from the House to the Senate filibuster to the Presidential veto to the various subcommittees and now, increasingly, to the conservative activist Supreme Court. All of which means that the chances of passing Medicare for all at the federal level are very dim.

But that's not as true of the state level in more progressive states. California is such a few good legislative votes short of being able to pass a single-payer system. If California and a few other states can get it done and make it work successfully, it can roll out via the states, ultimately providing a big moral and economic boon to the blue states that do it. Pressure would ultimately mount for Congress to make it universal throughout the country.

Unfortunately, that doesn't much help the progressive or simply down-on-their-luck family in Oklahoma. But it's better than despair or false hope in a federal solution that isn't coming.