Even if you are agree that single payer is the goal, there will be disagreements as to how to get there.
Let the debate begin.
Tensions flared in the single payer community last week as details of Senator Bernie Sanders still not public single bill leaked out.
Physicians for a National Health Program, the leading single payer doctors group, said they couldn’t support the Sanders bill if it included co-pays or other cost sharing measures.
Jon Walker and Dr. Margaret Flowers have both been active in the movement to bring single payer to the United States.
But they disagree on how to get there.
Under Walker’s plan, if you are employed, then your employer is required to sign you up for MICA or a better plan.
If you are not employed, then you are automatically signed onto MICA and you pay for it through taxes.
The rich can opt out of MICA for private insurance. There are still multiple payers, but Walker believes that the public Medicare like payer — MICA — will dominate the field. People on the current Medicare can stay with it if they like, but Walker says most would go with MICA because it will be better.
Flowers supports HR 676, the single payer bill in the House. It’s one payer, based on the current Medicare, but better, with no co-pays and no deductibles.
Flowers has recently been critical of Sander’s watered down single payer bill.
“Sanders has it backwards,” Flowers said. “Rather than starting from a position of strong legislation and building support for it, he is starting from a position of weak legislation that he considers to be more politically feasible. By doing so, he is losing the support of the movement that he needs to pass expanded and improved Medicare for all.”
Walker’s plan is based on plans put forth by Jacob Hacker and former Congressman Pete Stark.
Walker says he would support HR 676 if it can be passed. But he doesn’t believe it can be passed. He says he crafted his proposal as a way to get to single payer without generating additional opposition.
Walker says that if you are going to do something as big as single payer, there are going to be people who are automatically opposed to it — the insurers, the hospitals, the drugmakers. They are going to oppose any plan, he says.
But there is another set of people who don’t like change or who might lose out if you change the tax structure of how you’re paying for different things, Walker says. “Those people you can win over if you do it right or you can lose if you do it wrong,” he says.
“My bill is aimed at those people,” Walker said.
Flowers said that Walker’s plan is similar to compromise plans put forth in the past.
“It has failed every time,” Flowers said. “Magically thinking that we are going to create a public plan that is better than the private insurers and they are going to just slink away into the night and then we will have single payer — it’s not a reality. To believe that we can put that money into a public insurance and have it outperform private insurers is another huge lift. What we are seeing even with our non-profit insurers is that they have to behave like the private insurers in order to keep their doors open. That means shifting as much cost onto people as possible and restricting and denying payment for care.”
“We already have this growing movement for single payer,” Flowers said. “This is the time to be pushing for single payer. If we are going to fight this fight, let’s fight the fight for what people want.”