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  September 11, 2017

Democrats Follow Bernie Sanders' Lead on Single-Payer

Top Democrats, including likely presidential hopefuls, are lining up to co-sponsor Sen. Bernie Sanders' Medicare-for-All bill, signaling universal healthcare is fast becoming a litmus test for 2020
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Adam Gaffney is a physician and writer with a focus on health care politics, policy, and history. He is an Instructor in Medicine at Harvard Medical School and a pulmonary and critical care physician at the Cambridge Health Alliance. He is the Secretary and a member of the board of directors of the single-payer advocacy organization Physicians for a National Health Program.


AARON MATE: It's the Real News, I'm Aaron Mate. During the 2016 primary Hillary Clinton had this to say about Bernie Sanders' call for single payer healthcare.

HILLARY CLINTON: Health emergencies can't wait for us to have some theoretical debate about some better idea that will never, ever come to pass.

AARON MATE: Well, what Clinton said will never, ever happen is now looking more and more possible. A number of prominent Democrats are lining up behind it, Sanders' bill for single-payer. Last week, Senators Elizabeth Warren and Kamala Harris jumped on board. Now, Senators Cory Booker of New Jersey, Jeff Merkley of Oregon, and Kirsten Gillibrand of New York are signing on as well. Bernie Sanders is set to unveil his Medicare for All Bill on Wednesday. Adam Gaffney is an Instructor in Medicine at Harvard Medical School and a member of Physicians for a National Health Program. Adam, welcome.

ADAM GAFFNEY: Thanks for having me back.

AARON MATE: Thank you for joining us. Your comment on just what we've seen in the past week, all of these senators, many of them who are seen as likely presidential contenders, lining up behind what Clinton just recently said was never, ever going to happen.

ADAM GAFFNEY: She certainly spoke too soon. This is a historic change. It's difficult to almost overemphasize what a change this last year has made. As you said, Democrats in the Senate are lining up behind Senator Sanders' Bill. We don't know how many yet, but I think it's going to be in the double digits. Meanwhile in the House, John Conyers' Bill has attracted the support of 117 co-sponsors overall, that's a majority of the House Democratic Caucus, that's unprecedented. We are seeing Democrats pull at last behind single-payer in a way we have not seen, certainly in my lifetime.

This is a major change, it's a historic change, and I think it's going to be the beginning of a somewhat longer story in which single payer becomes a reality.

AARON MATE: Right. The fact that all of these co-sponsors just that have come up in the past week are seen as likely contenders; Warren, Kamala Harris, Cory Booker, Kirsten Gillibrand of New York, that is quite striking. It suggests that their consultants and their people are looking at the polls and saying that, "Listen, if you want a chance in 2020 not supporting single-payer is simply untenable."

ADAM GAFFNEY: I think that's exactly right. This is a model for political change, in a way. You change the narrative around an issue, activists bring something to center stage, they make it a must-do policy, politicians will follow. That's what we've seen so far, and we're going to continue to see that. The reality is, is that we very well may have a pro-single-payer president in the not so distant future as well as a pro-single-payer Congress. When that happens these laws can move from aspiration to achievement at a rather rushed pace.

AARON MATE: Just to underscore this, I should mention one more prominent Democrat, and that is the former senator Max Baucus formerly of Montana. Now, he more than almost any other Democrat, except for perhaps Joe Lieberman, was responsible for undermining the push for a public option back when Obamacare was discussed. He refused to allow that to be seriously considered. Now, just recently he's come out, Baucus has come out and said that he supports single-payer, saying that the time has come for that. Adam, what do you think that reflects?

ADAM GAFFNEY: That reflects the phenomenon I was thinking about with my last comment, that there has been a change in the narrative of this country, certainly since 2008. We had Occupy Wall Street, that changed the narrative around inequality. We've had a progressive push in the healthcare realm exemplified by the relative success of Bernie Sanders in the primary last year, who really made single-payer a cornerstone of his campaign.

This speaks to the changing times. I think we're changing as a nation for the better despite the rather grim stranglehold the Republicans currently have, and certainly as demonstrated by Donald Trump's presidency. Things are changing and they're changing in the right direction. Now, you're right. I think that the embrace of these politicians of single-payer also reflects the popularity of single-payer. Most polls put it at more than 50% support, a Kaiser Family Foundation Fund put it at 53% support, and that's the general population.

Once you talk about Democrats, primary voters, you are going to see much higher levels of support for single payer. This very well may become a policy position that we see adopted by Democrats across the spectrum.

AARON MATE: Right, so speaking of the spectrum, let's address some of the pushback that advocates of single-payer might face. You're going to have some Democrats saying that it's too ambitious, we should pursue something more modest like a public option. Can you respond to why you think a public option is not tenable, not desirable at this point?

ADAM GAFFNEY: Well, a public option unfortunately would not solve any of the fundamental problems of the U.S. Healthcare System. The Congressional Budget Office did a scoring of a public option added to the Affordable Care Act Exchanges in 2013 and found that it wouldn't actually reduce the number of uninsured significantly at all. We now have 28 million people uninsured in this country this year. In addition to that we have rising numbers of under-insured. At some point we're all going to be under-insured the way deductibles are rising, even for people with so-called high quality private plans to their employers.

This is not just about covering the under-insured, this is about improving coverage for everybody. If that's our mission, if that's our end goal, then single payer is the way to get us there, not these incremental half measures.

AARON MATE: Okay Adam, speaking of private plans, let me ask you. I hear one criticism of single-payer is that, look, there are many people who don't want to transfer over to Medicare for All. They don't want to join Medicare, they want to stay on the current employer plan that they have. What's your response to that?

ADAM GAFFNEY: I think that nobody will want to stay on their current plan when they learn that the Medicare for All Plan has no networks, includes essentially all the doctors, and has no co-pays or deductibles. Who is going to miss their deductible? Who is going to miss their co-pays and who is going to miss being excluded from seeing a lot of doctors because they're not in their insurance network? It doesn't make sense. People are going to embrace this by and large once they learn the details of the bill. Now, that behooves us, those of us in the single-payer advocacy movement to be sure to be out there and make it clear that we are not just talking about expanding Medicare to everyone but improving upon it, such that we eliminate cost sharing and we extend its benefits to important things like dental care.

AARON MATE: Okay. I'm going to throw some more counterarguments at you.


AARON MATE: I've seen people cite the example of Colorado last year. Single payer was on the ballot in Colorado last year and it got defeated by voters. Many were turned off, supposedly, by the higher payroll taxes that the measure would have entailed. Then also, people will point to Vermont saying it was tried there but it just didn't work. How do you address that?

ADAM GAFFNEY: Well, I would address it in a few different ways. First, I think everyone agrees that there are advantages to a federal level program as a state level program. I'm not saying that we shouldn't approach this at the state level at the same time, but a federal program will produce the most savings. It will produce the greatest administrative efficiencies, and so there's a lot of benefits from the pure economic perspective doing this at the federal level. There were some aspects of the Colorado plan that I think did turn people off. There were worries about abortion access and other things.

Regardless, it does show that we have our work cut out for us. We have to be sure to fully educate the population about the details of this bill, how would it affect them, how it would affect their bottom line, and how it would improve their lives, so we have to do that. The reality is, is that this bill is not going to pass in this Congress, hate to break it to people, but it will pass in a future Congress, or it can pass. We have some time, to be sure, to fully educate both the media and the population about the benefits of this program and how would it affect them and improve their lives.

AARON MATE: There are variations on what single-payer could look like. Does the Sanders version in his bill that he's unveiling, does that comport with the kind of measure that you want to see ideally?

ADAM GAFFNEY: Senator's bill is coming out Wednesday so there will be more details fully available then. My general sense of things now is that, yes, this is a real single-payer bill. It may not be exactly the same as the Conyers Bill, but it will be close enough that it's something that we can rally around, coalesce behind, and fight for.

AARON MATE: Finally, Adam, the measure is coming out on Wednesday. As we mentioned at the top, you have all these prominent Democrats now coming on board. What do you then see as the biggest challenge to single-payer healthcare going forward in this national movement to help attain it?

ADAM GAFFNEY: There's a couple things. First, we need to really get everyone behind this single-payer concept as the road to universal coverage, and not be split into different camps and with different sort of approaches. This is really the way to go, and I think we need to rally around it as progressives. Second, look, things look promising now, but we have not yet seen the pharmaceutical industry and the insurance industry enter the fray. When they do I think we have reason to double down on our efforts because it's going to get ugly and we're going to be spinning a lot of misinformation, there's going to be a lot of alternative facts about the reality of single-payer.

I think those are two barriers that we'll face. I do think they can be overcome. I think with education, with activism, with advocacy, we can in fact make this happen.

AARON MATE: Right. One indication of that, speaking of the pharmaceutical industry, is the fact that Cory Booker, one of the new co-sponsors of Sanders' bill, he obviously has well known ties to that pharmaceutical industry, right?

ADAM GAFFNEY: Look, the reality is, is that there is healthcare dollars throughout Washington. There's tons of lobbying money that gets poured in year after year after year by these industries to all sorts of politicians. Well, we can combat that. We need to ... As I said, it's about education, it's about advocacy, it's about getting the word out there. I think that politicians will come around to this once they see that this is what they have to do in order to win elections, in order to win primaries. Yes, there's a lot of money out there but no, it should not be an insurmountable barrier to get politicians on our side.

AARON MATE: Right. I'm just saying the one indication of that is the fact that you have Cory Booker, who is heavily backed by the pharmaceutical industry. He's now coming on board, obviously seeing it as best for his political chances.

ADAM GAFFNEY: Yep, I would agree. That's how we make change and that's how we get politicians on board.

AARON MATE: Well, we'll leave it there. Adam Gaffney, Instructor in Medicine at Harvard Medical School. Also a member of Physicians for a National Health Program. Dr. Gaffney, thank you.

ADAM GAFFNEY: Thank you for having me.

AARON MATE: Thank you for joining us on The Real News.


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