Our Common Good
Gerald Friedman: “Medicare for All” would save billions, and could be redistributive.

In Dollars & Sense, economist Gerald Friedman makes the case for single-payer:

The Expanded & Improved Medicare for All Act” (HR 676) would establish a single authority responsible for paying for health care for all Americans. Providing universal coverage with a “single-payer” system would change many aspects of American health care. While it would raise some costs by providing access to care for those currently uninsured or under-insured, it would save much larger sums by eliminating insurance middlemen and radically simplifying payment
to doctors and hospitals. While providing superior health care, a single-payer system would save as much as $570 billion now wasted on administrative overhead and monopoly profits. A single-payer system would also make health-care financing dramatically more progressive by replacing fixed, income-invariant health-care expenditures with progressive taxes. This series of charts and graphs shows why we need a single-payer system and how it could be funded.

Here are a few of the charts:

You can see all the charts and read more in this PDF of the article.

The New York Times reports that the cost of sequencing an individual genome will soon be less than $1,000. That’s not nothing, but given what most health care costs, it’s not much. And it means that an individual mandate — or something much like it — is inevitable.

In 2008, Congress overwhelmingly passed, and President George W. Bush signed, the Genetic Information Nondiscrimination Act. Ron Paul was the lone dissenter. The legislation bars insurers from denying coverage or raising premiums on individuals who show a genetic predisposition toward particular diseases. And in doing, it armed a time bomb beneath the health-care industry.


The policy that solves this problem is an individual mandate, or Medicare-for-All, or some other approach that forces the healthy to insure themselves alongside the sick. In its absence, there’s no way to make a risk-selection model work for the health insurance industry, as consumers will be armed with detailed information about their health risks that insurers are legally prohibited from pricing into their insurance premiums.

The Coalition of Labor Union Women (CLUW), meeting in September, 2011 in Orlando, Florida, for its 16th Biennial Convention, voted to “wholeheartedly renew its endorsement of HR 676, Expanded and Improved Medicare for All.” CLUW first endorsed HR 676 at its 2003 Convention, leading the way for many unions to join in pushing for national, single payer health care.

“Workers, their families and their unions are still waging an increasingly difficult struggle to win or to keep good health care coverage,” states the CLUW resolution. “Almost every union at every contract deadline must battle and sacrifice merely to sustain health care benefits. The rising costs of health insurance are blocking workers’ progress in wages and other areas.”

The resolution was submitted by Vera Newton, President of the Derby City Chapter of CLUW and a member Local 862 UAW which represents workers at two major Ford plants in Louisville, Kentucky.

Helen Ramirez-Odell, RN, of Chicago, Co-chair of national CLUW’s Women’s Health and Wellness Committee, commented on the resolution:

“CLUW has a long record of support for health coverage for all with single payer being the most efficient way to provide it. CLUW believes that health care is a basic human right and that quality health care must be accessible to all, not only to the wealthy or those able to afford an expensive insurance plan.”

The CLUW resolution points out that “More employers are forcing high deductible plans onto workers, resulting, according to Dr. Steffie Woolhandler, in a $1,000 annual pay cut for women due to the higher average health expenditures of women.”

The resolution notes that “About 50 million people in the U. S. are currently without health insurance and the high cost of premiums, deductibles, and co-pays forces even the insured to go without needed care.”

CLUW states the “a single payer program as provided by HR 676 is the only affordable option for universal, comprehensive coverage” and commits “to mobilize our members, our unions, and our communities at the grassroots to encourage other members of the House to sign on as co-sponsors of HR 676.”

On September 15, 2011, Representative Terri A. Sewell of Alabama’s 7th Congressional District signed on to HR 676, bringing the number of co-sponsors to 66 in addition to the sponsor, Congressman John Conyers.

The full CLUW Resolution is at the CLUW website here: http://tinyurl.com/3b5avnk


WE PETITION THE OBAMA ADMINISTRATION TO: host an open panel discussion about opening Medicare for enrollment by all citizens from birth to death

Given the current political environment, the recent healthcare reform legislation and the fact that much of it will not come into effect for another few years, additional reform is probably not possible at this time.

However, it would benefit the public and future policy to have an open discussion/debate about the pros and cons of a National Healthcare system such as Expanding and Improving Medicare for All.

We suggest a public form with representatives of both sides of the issue public expressing their views in a polite, moderated debate.

President Obama should participate so he could publicly ask questions and receive answers. However a non-partisan moderator would be necessary; someone like Charlie Rose.

This is a discussion our nation desperately needs.

Hope you will sign.

Thanks much for the reblog on this.  

Downward Mobility from the Middle Class: Waking up from the American Dream

By Gregory Acs
The Pew Charitable Trusts, Economic Mobility Project, September 2011

The idea that children will grow up to be better off than their parents is a central component of the American Dream, and sustains American optimism. However, “Downward Mobility from the Middle Class: Waking up from the American Dream” finds that a middle-class upbringing does not guarantee the same status over the course of a lifetime. A third of Americans raised in the middle class — defined here as those between the 30th and 70th percentiles of the income distribution — fall out of the middle as adults.

Extensive studies have shown that over the past few decades income has dramatically shifted upwards to the wealthiest individuals. This study adds to that data base by showing the impact on the middle class. A third of Americans raised in the middle class have fallen out of the middle (and this was before the economic downturn).

Because health care costs are now so high the middle class can no longer afford to fund an insurance pool that would be adequate to cover their collective health care needs. If the middle class is to receive adequate health care then it is imperative for the wealthy to contribute a greater amount through a progressive financing system (i.e., taxes).

What won’t work is an underfunded welfare program for the poor (Medicaid) and exchanges of low actuarial value under-insurance plans for the middle class, yet this is what the Affordable Care Act is bringing us.

What will work is a single comprehensive risk pool that is equitably funded and includes everyone. If the wealthy were allowed to have a higher standard for themselves with a lower, mediocre standard for everyone else then their support for the health plans serving the “commoners” would diminish. By having a single high standard for everyone, the wealthy would use their influence to see that the health care system met their standards, thereby pulling up the standards for everyone else.

Of course, that is precisely the goal of an improved Medicare for all.


Last week, two appellate judges in Atlanta — one appointed by President Bill Clinton and one by George H.W. Bush – held the Constitution doesn’t allow the federal government to require individuals to buy health insurance.

The so-called “individual mandate” is a cornerstone of the Affordable Care Act, President Obama’s 2010 health care reform law, scheduled to go into effect in 2014.

The whole idea of the law is to pool heath risks. Only if everyone buys insurance can insurers afford to cover people with preexisting conditions, or pay the costs of catastrophic diseases.

The issue is now destined for the Supreme Court (another appellate court has upheld the law’s constitutionality) where the prognosis isn’t good. The Court’s Republican-appointed majority has not exactly distinguished itself by its progressive views.  

 Chalk up another example of how the GOP has outwitted and outflanked the President and the Democrats.

Remember the health-care debate? Congressional Republicans refused to consider a single-payer system that would automatically pool risks. They wouldn’t even consider giving people the option of buying into it.

The President and the Democrats caved, as they have on almost everything. They came up with a compromise that kept health care in the hands of private insurance companies. The only way to spread the risk in such a system would be to require everyone to buy insurance.

Which is what the two appellate judges in Atlanta objected to. The Constitution, in their view, doesn’t allow the federal government to compel citizens to buy something. “Congress may regulate commercial actors,” they wrote. “But what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die.”

Most Americans seem to agree. According to polls, 60 percent of the public opposes the individual mandate. Many on the right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.

Had the President and the Democrats stuck to their guns during the health-care debate and insisted on Medicare for all, or at least a public option, they wouldn’t now be facing the possible unraveling of the new health care law.

After all, Social Security and Medicare – the nation’s two most popular safety nets – require every working American to “buy” them. The purchase happens automatically in the form of a deduction from everyone’s paychecks. 

 But because Social Security and Medicare are government programs they don’t feel like mandatory purchases. They feel more like tax payments, which is what they are – payroll taxes.

There’s no question payroll taxes are constitutional, because there’s no doubt that the federal government can tax people in order to finance particular public benefits.

Nor do Americans mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout “don’t take away my Medicare!” at rallies opposed to the new healthcare law.

Requiring citizens to buy something from a private company is entirely different. If Congress can require citizens to buy health insurance from the private sector, reasoned the two appellate judges in Atlanta, what’s to stop it from requiring citizens to buy anything else? If the law were to stand, “a future Congress similarly would be able to articulate a unique problem … compelling Americans to purchase a certain product from a private company.”

Other federal judges in district courts — one in Virginia and another in Florida — have struck down the law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli; the Virginia judge to asparagus.)

Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.

The Republican strategy should now be clear: Privatize anything that might otherwise be a public program financed by tax dollars. Then argue in the courts that any mandatory purchase of it is unconstitutional, and rally the public against the requirement. 

 Remember this next time you hear the GOP touting Paul Ryan’s plan for turning Medicare into vouchers for seniors to buy private health insurance.

So what do Obama and the Democrats do if the individual mandate in the new healthcare law gets struck down by the Supreme Court?

Immediately propose what they should have proposed in the beginning — universal health care based on Medicare for all, financed by payroll taxes.

Those who think that the for-profit (or even not-for-profit) insurance industry has to control any healthcare reform initiative have every right to be upset with the 11th Circuit’s ruling—which almost certainly will send the case of the Obama healthcare plan to the US Supreme Court.

But those of us who have no desire to perpetuate the insurance industry can and should recognize that the proper—and entirely constitutional—reform is an expansion of Medicare to cover all Americans.

There is no question that Medicare is a sound and popular program. (Just ask House Budget Committee chair Paul Ryan, R-Wisconsin, who took an epic political beating when he proposed a scheme to replace the successful single-payer system with a voucher scheme designed to enrich insurance firms.)

While Medicare is exceptionally popular, polling shows that the individual mandate is not—according to recent surveys, roughly 60 percent of Americans oppose it.

It also passes constitutional muster.

As former Labor Secretary Robert Reich notes: [No] federal judge has struck down Social Security or Medicare as being an unconstitutional requirement that Americans buy something. Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.”

“So if the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, “ says Reich, “I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all, financed by payroll taxes.”

The insurance companies would, of course, scream.

But let them complain.

Americans don’t need mandates. They need healthcare.

And they have every right to ask, as activists with Physicians for a National Health Program have,  that Medicare be expanded to cover all Americans —affordably, efficiently, capably and constitutionally.  

- John Nichols
in The Nation

justin84 asks:

Did the CBO ever get around to scoring HR 676?
I remember that was promised back in 2009, but it’s hard to tell if anything ever came of it.
Did any other reputable organizations estimate how much HR 676 would cost, if the CBO passed on it?

H.R. 676, better known as the “Expanded and Improved Medicare for All Act” or “United States National Health Care Act,” was first introduced by Rep. John Conyers Jr. (D-Mich.) in 2003, and has been introduced in every Congress since. As its first name implies, it creates a single-payer health-care system by enrolling all Americans in Medicare. This would be financed through administrative savings, negotiating down prices with providers and drug manufacturers, and a few new taxes, including a payroll tax, an income tax surcharge for high earners, and a financial transactions tax. Hospitals would have to go nonprofit, and private insurers would be banned from providing coverage similar to Medicare’s.

The bill got some attention last Congress, when single-payer advocates presented it as their alternative to bills coming from the House and Senate leadership, and the Congressional Budget Office looked set to score the bill. This was because then-Rep. Anthony Weiner got the House leadership to commit to giving H.R. 676 a floor vote. The CBO is required to score bills that are reported out of committee in either chamber, so such a vote would have required it to score H.R. 676. But because Nancy Pelosi and other House leaders thought a single-payer vote would hurt the chances of passing the main health reform bill, they rebuffed Weiner and the floor vote didn’t come, H.R. 676 never made it out of committee, and thus the CBO was not required to score it. It sometimes provides estimates for bills that have not made it out of committee, but in this case, it did not.

But that doesn’t mean there aren’t data on the budgetary impact of greatly expanding publicly-provided health care. In 2007 and 2009, Rep. Pete Stark (D-Calif.) introduced the “AmeriCare Health Care Act,” which would automatically enroll Americans in a Medicare-like public plan at birth and allow employers to choose between covering their employees or paying into the public plan to cover them.

The plan would be financed through these employee contributions as well as premiums and state contributions equal to their previous spending on Medicaid and S-CHIP, which would be rolled into the public plan. Unlike H.R. 676, the AmeriCare bill doesn’t force providers to go nonprofit, and, importantly, it maintains a role for private insurers. People are free to opt out of the public plan and keep their employer-based health plan if they wish. This means it’s not a single-payer plan, but it’s the closest thing for which we have reliable numbers.

Those numbers come courtesy of the Commonwealth Fund, which commissioned the Lewin Group to take a look at AmeriCare and a few other health-care proposals in 2009. The resulting study predicts that, because of a public plan’s lower provider reimbursement rates and administrative costs, as well as its ability to negotiate down drug prices, enacting the bill would have resulted in $58.1 billion less annual health spending in 2010. It would increase the federal deficit by $188.5 billion a year, and employers would pay $61.5 billion more annually, but state and local governments would save $83.6 billion, and households a whopping $224.5 billion.

The AmeriCare bill would cover all the uninsured, leaving 85 percent of all Americans enrolled in the public plan, 10 percent in Medicare, and only 2.1 percent in employer plans

Sen. Bernie Sanders [I VT] introduced a revised version of the “American Health Security Act,” a national single-payer “Medicare-for-all” healthcare bill, calling for the right to healthcare for all. The Bill, designated as S 915 is an updated version of S 730, submitted in 2009, and joins Rep. Jim McDermott’s [D WA] companion bill in the House of Representatives, HR 1200.

The bills strengthen our movement for a just, equitable healthcare system at a time when attacks are intensifying on our most successful social insurance program, Medicare. Several national unions and the AFL CIO joined to endorse these bills. This endorsement builds on the hundreds of endorsements by central labor councils, state, national, and international unions supporting HR 676.

Rep John Conyers, Jr.:

Countries in Europe, Japan, and Taiwan have been able to effectively contain their healthcare costs for decades through their very successful universal healthcare systems — without waiting lines, rationed care, and out of control taxes.

America can learn invaluable lessons from other nations on how to control healthcare costs, and the time has come to be open minded about their success and honest about our need to change course from our corporate-dominated and inefficient healthcare system.

Progressive Democrats of America

WHAT: Brown Bag Lunch vigils to protect Social Security, end wars, move dollars from Pentagon to communities

WHEN: Noon, Wednesday, March 16, 2011
WHERE: local offices of congress members all over the country

Find local details here: http://www.pdamerica.org/events/search/8fdd4d6f10c1f05d0273d80eb137b1ab

Join Us!

We will be demanding an end to the war in Afghanistan the same day General David Petraeus is questioned by the House Armed Services Committee and the day before the House is scheduled to vote on ending the war (resolution HCR 28).

"People everywhere have been supporting the activism in Madison, Wisconsin, this week," said PDA National Director Tim Carpenter. "We’ve seen a people’s movement compel Democrats to stand up straight and push back, a far superior outcome than continued ‘bipartisanship,’ in the view of most Americans. We’re taking that energy national this week to insist on a change in priorities. Our country is bankrupt morally, not financially. We need to move the money where it can do some good."

This month’s theme:

  • "Hands off Social Security" 
  • "Bring the troops home in 2011" 
  • “Move money from the Pentagon to our communities”

Legislation supported:

Find more information on Brown Bag Lunch Vigils here: http://www.pdamerica.org/get-active/brown-bag-lunch-vigils/

Please share - let’s build the Progressive Movement!

As the weakening of the federal health care law begins, a nationwide effort for more substantial reform—a national single-payer system, also known as improved Medicare for All—is taking place.