There was no Senate vote on the single-payer health care amendment on the floor December 16, thanks to the parliamentary obstruction of amendments by Republican senators in their battle to prevent any and all health care reform this year.
Sen. Bernie Sanders (I-Vt.) attempted to introduce his Medicare-for-All, single-payer health care substitute amendment, but when he requested the usual unanimous consent to dispense with the reading of the entire bill, Sen. Tom Coburn (R-Okla.) objected, and under Senate rules, clerks were obligated to read aloud the entire 700-plus page amendment – a process that would have consumed nearly eight hours.
After 2 hours and 43 minutes, Sen. Sanders withdrew his amendment in order to allow the Senate to proceed with other business in the dwindling days before the Christmas recess – but he then gave a rousing, blistering speech on the Senate floor, condemning the insurance cartel, anti-reform obstructionists in Congress, and promising that the day will come when America has true universal healthcare.
Had Sen. Sanders’s amendment been allowed to proceed to debate and vote, it would have been the first time a complete single-payer plan had been considered on the Senate floor, a milestone in the history of nearly 60 years of effort to reform the nation’s health care system.
Sanders was proposing the amendment as a substitute for the compromise bill put together by Majority Leader Harry Reid (D-Nev.) and other Democrats, and supported by the Obama Administration. That bill has been so watered down in an effort to please enough Senators to reach the 60 votes necessary to stop a Republican filibuster that some progressives now say it is worse than no bill at all, but others strongly disagree. Whether one agrees with that or not, even the compromise bill’s supporters acknowledge that after its likely passage, much work will have to be done in future Congresses to expand coverage and reduce costs. Sen. Tom Harkin (D-Iowa) likened it last week to the basic structure of a house that will need a lot of remodeling.
That’s putting it mildly. Still, we recognize that members of Congress have been in a very hard place throughout this debate. Senators Harkin, Ron Wyden (D-Ore.), and Jay Rockefeller (D-W.Va.), for example, have labored to rescue even moderate reform from the jaws of anti-reform Republicans and so-called moderate or “centrist” Democrats such as Ben Nelson (D-Neb.) and Mary Landrieu (D-La.), and the nominal independent, Joe Lieberman (I-Conn.).
As of this posting, it seems the Senate majority will approve its version of reform, and go to conference with the House version in the next two weeks and then to final vote in both chambers. In the end, most congressional single-payer supporters, including champions Senators Sanders, Sherrod Brown (D-Ohio) and Rep. Anthony Weiner (D-N.Y.), seem likely to support the final bill. They have both policy and political reasons to do so, and they deserve our thanks for their hard work to bring some sanity to the public debate.
The status of single-payer now
We knew that single-payer would not come near to winning a majority of votes, but it was the first opportunity for pro-reform Senators to go on record voting for the only real viable long-term reform. It also came at a time when more of Washington commentariat and members of Congress are saying, “maybe we should be thinking about single-payer … ” Thanks to the eruptive, tortured course of the health care debate this year, we are seeing a ripple of renewed interest in single-payer, but not enough to upend the incrementalist reform currently supported by the Obama Administration and the Democratic leadership in Congress.
Regardless of whether or not the final bill has some version of the public option, Public Citizen remains committed to the vision of true reform – the only proposal that will actually deliver what the vast majority of Americans really want: cost control, greater efficiency, total coverage for all citizens, and high quality health care unencumbered by a bloated private insurance industry that does nothing but reduce care and drive up profits.
Earlier this year, a number of members of Congress acknowledged that while single-payer would be best, it could not garner enough votes this year to make it a serious legislative path – that a “moderate” reform package might placate the insurance cartel, Big Pharma and other powerful economic interests, and that a “bipartisan” bill could get the votes needed and provide the basis for sustainable reform, i.e. not be gutted or overturned by a subsequent Congress.
What if …
In the face of this, could a single-payer bill have made it through this Congress if it had not been taken off the table by the President at the beginning? Had it been at the core of the debate, supported by the White House and Congressional leadership, could it have gained the 60 Senate votes needed to stop filibuster? Could it have gotten the needed 218 votes in the House?
Well, maybe – because, as this year has shown, some of the forces that were supposed to be neutral in this compromise incremental reform approach eventually wound up trying to defeat or dilute major portions of the bill anyway; and the insurance cartel would, of course, oppose single-payer with all its might. But even with the attempt to buy its support, insurers fought against this bill at various stages as well, and the latest version now brings them millions of new customers. Critics contend that privately, the insurers are very happy now.
Yes, single-payer would provoke many of these same groups to raise holy hell – the insurers, faced with an existential threat, would spend every dime they get their claws on to defeat it. But despite its perceived vulnerability to the “socialized medicine” charge, a serious single-payer effort by Congress and the White House would attract a broad array of support – some guarded, but much enthusiastic – across the country. Some small business leaders, for example, would reflexively oppose it; but many more would see the economic sense of it all. Go down the list of interested parties, and they would break in opposite directions at various points – but without the illusion and chaos of this year’s compromise effort that tried to please everyone – even trying to accommodate an entrenched minority opposition in Congress that is pledged to fight everything this White House proposes.
Here we offer but three reasons (there are more) that single-payer would move differently:
1. Simplicity – do not underestimate the power of a simple idea to engage the imagination of people, including those with profound differences on many other issues. Complexity is often necessary, but it is also the soft underbelly of many reform efforts – just study the rhetoric of the far right and you’ll understand.
2. The security of universal coverage goes to the heart of middle class fears of coverage denied.
3. Physician choice – A seemingly small point, but viscerally important (remember the attacks on “Hillarycare” in the 90s?). Even though the compromise bills never threatened this right, its complexity and reliance on private insurers made it seem as though it might.
The political lesson is that trying to achieve permanent buy-in among all the groups with an economic interest in the current system inevitably leads to drop-outs from the deal. Some may hold their fire up to a point, but in the end, they will not stand by as contradictory elements are introduced or adjusted – the piecemeal reform approach winds up antagonizing as many as it pleases. Through 2009, the daunting complexity of trying to balance two utterly incompatible goals — guarantee that the insurers would be protected, yet serve the just demands of both the insured and uninsured public — made this bill vastly more complex, incomprehensible to the public and ripe for soundbite destruction, that greatest of weapons for the reactionary right.
Compared to the Senate or House reform bills, single-payer does not have that problem. Politically, it has tremendous potential appeal in a way that the compromise packages never could. It just takes committed national leadership – say, a charismatic, transformative President – to put it before the nation and drive the political debate to it – simultaneously, in effect, driving the center to single-payer, and single-payer to the center, which in terms of its policy benefits, is where it really is anyway.
There is some good news:
1. Even if the final bill contains some needed restrictions on insurance company behavior and expands coverage to perhaps as many as 30 million Americans, the lack of a true alternative to benefit-reducing, inefficient private insurance will help sharpen our case in coming years at the state level on what needs to be done. State single-payer movements can draw renewed support from what we have witnessed at the federal level.
2. Allies and moderate Democrats, as well as more progressive groups, can draw some valuable lessons from the attempt to achieve “moderate, bipartisan” reform in the current polarized climate – that is, they can see that the other side, despite its focus-group-tested claims to the contrary, is not remotely interested in reform. This recognition will inform future strategies – and give added urgency and power to the message of those of us who advocate the genuine reform that will work, and not start out with half-measures in a vain attempt to placate certain interests.
Single-payer advocates should express their appreciation to our heroes in Congress. Fortunately for us, their ranks include some of the most resourceful and dogged members in the House and Senate.
Now with the bitter experience of 2009 behind us, single-payer advocates will have the strongest political case ever in the months and years ahead. Reform never happens easily, and while incrementalism often fails the test of real reform, it can sometimes provide the dramatic witness needed to make true reform impossible to ignore.
John Sparks is a health care lobbyist for Public Citizen.