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ObamaCare Clusterfuck: PA state single payer efforts actually garner Republican support

And if you knew PA Republicans, you'd understand how remarkable that is. HuffPo:

Single Payer: Alive and Still Remarkably Well

As the country prepares for open enrollment October 1st in the insurance exchanges of the Affordable Care Act (aka Obamacare), a small group of dedicated artists and politicians in Pennsylvania have been working toward a broader solution. Catalyzed by a study by Professor Gerard Friedman of the University of Massachusetts at Amherst that estimated savings of $17B for Pennsylvania with a single payer approach, State Senator Jim Ferlo and an energetic group of young artists in Pennsylvania, decided they needed a comprehensive statewide system that would offer affordable health care to every citizen in Pennsylvania.

In March 2013, PA Senator Jim Ferlo and Representative Pam DeLissio re-introduced SB400, a bill Ferlo had introduced a year before to little fanfare and support. This time, Ferlo garnered support from a businessman and former Republican legislator, David Steil, as well as the activist group HealthCare4AllPA.

Noting the economic impact study, Steil said "As a business owner, we must get business out of health care because it perpetuates an already financially unsustainable system. A single payer system costs less, promotes free market principles, and creates jobs by improving the delivery of health care."

...

While Senator Ferlo was working the legislature this time, Julie Sokolow, a young artist, began collecting the stories of other young artists in need of affordable and quality care. She wondered if other artists had the same problem with lack of health insurance as she did, artists who worked part-time or in service industry jobs without insurance. ....

The enthusiasm and interest generated by this short video led Julie's group "Healthy Artists" to work with HealthCare4AllPA. With the support of pediatrician and HealthCare4All activist, Dr. Scott Tyson, the young artists were able to create over 30 documentary shorts in a year's time, exposing the struggles of uninsured Pennsylvanians. With the organizational support of Healthcare4All and the passion and creativity of the artists, they were able to keep what had seemed like a quixotic venture alive and well in the political arena. It didn't hurt that filmmaker and progressive celebrity Michael Moore gave them a prominent place on his website earlier this year.

Uh oh. Michael Moore. Not that I'm cynical....

While the goal of Healthy Artists is a single payer approach to health insurance, they view Obamacare as a step in the right direction and have been promoting the expansion of Medicaid and the state exchanges. As they point out, the ACA encourages individual states to experiment with single-payer universal health care.

That is the part where I started to scream silently. At their best, young creative class types are naive. At their worst, they're cynical and corrupt Obots. Obviously, since Obama threw his single payer support overboard when he no longer needed to pass as a liberal on whatever Chicago's equivalent the Upper West Side is, these guys aren't Obots, since with Obots, because Obama. But the naivete is breathtaking. Since when does a wait of four years and a Federal waiver constitute "a step in the right direction"? And can't they see that pushing for ObamaCare destroys institutional suppoort for single payer? (Let it happen, say I; some will benefit. But don't do the marketing, because then you're tarred with it!)

Pennsylvania is one of 22 states in an organized national single-payer network, ready to utilize the provision in the ACA allowing for innovation as of January 1st 2017.

I don't know about that network, and I thought I was keeping track. Sounds interesting, and especially interesting would be the funding. Readers?

The single payer advocates in Pennsylvania envision single-payer eventually replacing the exchanges.

How does that work? The Exchanges serve to perpetuate a payment system that shouldn't exist. You can't buff a turd. Again, I applaud the energy, and it sounds like good news from PA, but the artists.... It's like watching a mouse sniff the cheese in the trap. "No! Don't do it!!!!! [Ooohhhhhhhh.....]."

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Rainbow Girl's picture
Submitted by Rainbow Girl on

Here's one strange bit about the effort (besides the Obotism and Moore endorsement):

"A single payer system costs less, promotes free market principles(*), and creates jobs by improving the delivery of health care."

Huh? What kind of single-payer system are we talking about that involves "market competition"?

BDBlue's picture
Submitted by BDBlue on

It could be that the "free market" it promotes is among providers. I don't know if that's what he means or not, but it may not be the insurance market competition that he's talking about.

Alexa's picture
Submitted by Alexa on

plan or system may be a "pseudo-single-payer system" in scope and/or scale--sort of like the Dems supposedly favored (pushed by Schumer?, I believe) during the so-called health care debate.

Now, I admit, I haven't taken the time to scrutinize the artists' website. If anyone can and does, show me differently--well, I will stand corrected, obviously. ;-)

I don't so much view this as solely "the doing of Obots." It appears to me, from what I've read and observed, that this is the doing of a large number (or broad swaths) of very toxic Democratic Party corporatists--period.

I wish that I could believe that it would change with another Democratic President, but sincerely believe that there is not a "snowball's chance in h*ll" for this to happen--at least not in the lifetime of the average "Boomer."

I can't think of a single Democrat lawmaker (past or present) who would be willing to fight for and/or support a single-payer system.

And I mean beyond the usual meaningless "lip-service" during an election.

I would include Senator Bernies Sanders in that--IMHO, his main function, as a member of the Democratic Party "caucus," is to mollify the base.

I predict that if it is not repealed (and clearly it won't be before Tuesday, 10/01/13), the ACA, and an even FAR WORSE version of it, will be the "law of the land" for many decades to come.

I would personally like to see progressives spend their time not on a pipe dream, but on attempting to see the Medicaid program dismantled, and those who would have been thrown into it, put instead, into the Medicare system.

That would be a tall order, but it might be doable (in a couple of decades, or so). That is, if Medicare is not completely dismantled.

Remember that Geithner said in Congressional testimony that the Administration HAD TO hold off on raising the Medicare eligibility age until they saw if the SCOTUS upheld the ACA.

And many Democratic Party shills (like Alice Rivilin, who co-wrote a "voucher plan" with Paul Ryan) actually support the idea of moving to a voucher system--just more incrementally.

Later, I intend to post the audio of a panel discussion which includes a moderator and three so-called experts--including none other than former TN Governor Phil Bredesen (who, as Lambert pointed out, was the founder of HealthAmerica Coporation, an insurance company).

In this town hall or forum, they discuss the fact that "Phase One" of the ACA is simply implementing the "individual mandate," so that everyone has "some skin in the game."

The end game is "Phase Two""--shredding our public health system (my words, obviously). This was not included in the original ACA legislation (although some fairly deep cuts have been included in the ACA, and are included in the Administration's 2013-2014 Budget) for the obvious reason that it would not have garnered popular support for passage.

I have a feeling that at least two of the panelists would wholeheartedly support Ezekiel Emanuel's hideous positions on "rationing of healthcare." [Although they did not say so, or cover this topic--except to point out that we're going to have to learn to "buck up," and live with a few more aches and pains, in order to cut out so many hip and knee replacements--spoiled wimps that the American people are! And that's because "Americans don't like to pay taxes."]

BTW, one of them did actually say words to this effect, and quite unapologetically.

That is "why" I would have no problem with a "repeal."

I truly believe that "we ain't seen nothing yet!"

Submitted by marym on

Re: "shredding our public health system"

The proposal of some governors to accomplish the Medicaid expansion by using the funds to purchase on insurance on the exchanges is functionally pretty much a voucher system. Arkansas got federal approval this week.

Last year Durbin said he'd be ok with raising the Medicare eligibility age once the exchanges were up and running.

Totally moving in the wrong direction.

Submitted by lambert on

... if people weren't trapped in their cubes by employer-provided health insurance. Also, providers can be private. It's Single. Payer. Not NHS....

Rainbow Girl's picture
Submitted by Rainbow Girl on

I thought NHS is a single-payer system. Taxes paid by everyone fund NHS and private providers give fee for service care to everyone and then get paid by NHS, which regulates the prices of health care services and products.

nihil obstet's picture
Submitted by nihil obstet on

NHS (National Health Service) is a health provider, not a funding mechanism to pay providers. It's like VA hospitals. The doctors, nurses, and so on are government employees. The hospitals are government facilities.

Single payer is a funding mechanism. It's like Medicare, and it is as you describe, a system in which private providers get paid by the single payer.

I would prefer an NHS, which would convert medical personnel into professionals rather than business people, and would take the profit motive out of the judgments on which medical procedures you are told you should have.

Submitted by hipparchia on

nhs can be thought of as a special sub-type of single payer - govt is still the only "payer" (or the biggest payer, if some private insurance is allowed) but they also own most (or all) of the hospitals, clinics, etc, and employ all (or most) of the doctors, nurses, etc.

Submitted by lambert on

.... that the usual suspects are trying to gut it, and that the Serco contract for ObamaCare paperwork and call centers is some kind of weird Transatlantic neo-liberal reacharound -- Serco is a UK firm -- to help them use their ObamaCare Exchange "expertise" to gain privatization contracts in future in the UK.

I don't think NHS is nearly as much "settled law" in the UK as Medicare is in Canada.

Stressing this is just Spidey sense stuff.

Submitted by lambert on

... what I had not thought of hitherto as an assignment, I tossed out the idea in case anybody knew more than I did. I have other research to do right now and -- this may come as a shock to you -- there is more research to do than any one person can possibly do.

nihil obstet's picture
Submitted by nihil obstet on

The NHS began in 1948. The British right has tried to get rid of it ever since. It seems to be as much settled law as Social Security in the U.S., and certainly as much as Medicare, both of which are under attack. I can't see from history that any program for the general public good as opposed to the ruling class's benefit is ever safe.

Rainbow Girl's picture
Submitted by Rainbow Girl on

Very grateful for the important clarification.

So to have a single-payer where providers (and pharmas) are not employees of the paying government entity -- but where the health care would be affordable -- the payment-only government would also have to create price controls (which is what NHS and, I'm assuming (please correct me if I'm wrong), the Canadian system do). I know that this is what VA, Medicare and Medicaid do, for example. Yes?

Something we may need to be concerned about in the US if single-payer (state-based or, eventually, federal) get traction, is the use of cost-shifting within such a system which could end up giving us a single-payer resembling a skinny-plan-HMO (Medicaid style minus the dental care) where premiums, copays, deductibles, not-covered, etc. would end up defeating what many of us see as the benefits of single-payer -- affordable, quality, care with providers of our choice.

I'm tuned in to this aspect of the problem because I've been learning about the cost-shifting creep that has occurred in Medicare during the past 10 years in order to help a family member has now entered Medicare and is completely overwhelmed with the amount of opaque and poorly disclosed actual costs that she is having to shoulder and the insane complexity of the different aspects of what is and isn't covered and/or paid for (it's very RubeGoldbergian and the amounts in question are very significant for anyone living on the basic SS monthly stipend.)

Submitted by hipparchia on

yes, all other industrialized countries have price controls imposed by their govts on their medical systems. some are considered "soft" controls, some "hard" controls, but all of them do use price controls to one extent or another.

medicare used to be MUCH simpler than it is now, but the congresscritters have over the years made it more complex, more privatized, and less doctor- and patient-friendly.

and yes, this seems to have happened in a lot of other countries too. margaret thatcher was gung-ho on privatizing britain's nhs, and her political descendants have continued that trend, though it hasn't been entirely dismantled yet. quebec has been the most privatizer-friendly canadian province so far. the dutch used to have a very govt-controlled system and have been experimenting with privatizing it in bits and pieces since about 2006 or so (and their health care spending went from about 9% of gdp to about 12% of gdp in three years).

Submitted by marym on

http://www.healthcare4allpa.org/what-is-single-payer/

A single-payer system would create one insurance plan that has one single payer, to cover all Pennsylvania taxpayers. The premiums for The Pennsylvania Health Care Plan would be a flat rate of 3% of income for individuals and 10% of payroll for businesses. The Pennsylvania Health Care Plan would place you and your healthcare provider in charge of you and your family’s healthcare. The plan will be a public/private hybrid with the insurance function provided by the state government and the medical care would be privately delivered.

Alexa's picture
Submitted by Alexa on

I wish these activists well!

A bit of my skepticism comes from the descriptions that I've heard from so-called left pundits during the 2008 and 2012 elections, in which more than one "talking-head" pretty much described "rural PA" as a sort of "transplant of Alabama." Note: I did say "rural" Pennsylvania.

I mean, just look at Pat Toomey--for a fact, his brand of fiscal conservatism would sure "fit" in many parts of Alabama, Georgia, Mississippi or Louisiana.

At any rate, I truly believe that their is only a tiny window, if at all, left for a single-payer system to be implemented.

As the ACA demonstrates, the changes to our "entire public insurance system" are very vast--and VERY much intertwined. There have been a number of "test pilot" programs in Medicare, etc., with some of the changes to the ACA depending on the outcomes of these programs.

Once all of these changes become very entrenched, it will become acutely difficult (I would think) to effect changes. But maybe "Healthy Artists" can do it.

Thanks for the link--bookmarked. ;-)

Notorious P.A.T.'s picture
Submitted by Notorious P.A.T. on

Obviously, since Obama threw his single payer support overboard when he no longer needed to pass as a liberal on whatever Chicago's equivalent the Upper West Side is, these guys aren't Obots, since with Obots, because Obama.

What now?