Advocates for a single-payer “Medicare for all” health system are fanning out across Capitol Hill this week, lobbying members of Congress.
But years of mostly fruitless struggles – and watching the intense opposition to the much less sweeping Affordable Care Act – appears to have left them with a much more clear-eyed view of what it will take for them to accomplish their goal.
“This is tough stuff,” Sen. Bernie Sanders, D-Vt., told a roundtable of advocates he convened in the Dirksen Senate Office Building. “Single-payer health care bills – it ain’t going to take place here in Washington. I suspect it’s going to take place, as it did in Canada, with a state [Saskatchewan] going forward. I hope it will be my state.”
Indeed, Vermont in 2011 passed legislation that would make it the first state to create its own single-payer system, called “Green Mountain Care.” The experiment is set to launch in 2017, the first year that’s allowed under the Affordable Care Act. But key decisions about exactly how the plan would work, in particular how it would be financed, have yet to be made.
Meanwhile, those who have been pushing for a system that would effectively end private insurance say there’s no question they have the facts on their side.
“What we know about single-payer has zero to do with the merits,” said Robert Weissman of Public Citizen, referring to widespread charges by opponents that single payer systems are inefficient and can deny care. “We have proven alternatives in every other industrialized country in the world – better outcomes at less cost.”
That’s challenged, of course, by single-payer opponents who maintain that other countries keep costs down less by being more efficient and more by rationing care.
The advocates even took on the ongoing scandal at the Department of Veterans Affairs, where former service members have reportedly been dying while waiting to get care – despite the fact that the VA system is fully government-run, and not the same as single-payer, where doctors and hospitals would remain private, with payment from the government.
“If the VA had the resources it needed to work, it would be a model for government-provided health care,” said Michael Lighty of the National Nurses United union.
For the moment, however, the single-payer advocates recognize that their mission is to convince a public that is clearly unhappy with the status quo in health care that a single-payer system is a potential option.
“The most important thing is to show people that change is possible,” said Gerald Friedman, an economics professor from the University of Massachusetts-Amherst. “That’s the role that Vermont has had – showing that it’s possible to get something done.”
And the Affordable Care Act may in fact be nudging the effort along, panelists said. With predictions that many employers will eventually push their workers onto the new health exchanges, “we face a fundamental choice in the long term,” said Lighty of the nurse’s union. “We either are going to have single-payer or individual purchase.”
And single-payer advocates are increasingly confident that’s a fight they can win. Even if it may not be any time soon.