Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont's Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009 (.pdf), in the U.S. Senate Wednesday. The bill is the first to directly take on the powerful lobbies blocking universal health reform in the Senate since Sen. Paul Wellstone's tragic death.
The single-payer approach embodied in Sanders' new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, both universal coverage and cost containment during the worst economic crisis since the Depression.
In contrast, Sanders' new legislation would cover all 46 million uninsured Americans, and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician.
The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.
"This is excellent news for the nation's health," said Dr. Quentin Young, national coordinator of Physicians for a National Health Program and a past president of the American Public Health Association. "There is now an affordable cure for our dysfunctional health care system. In the face of our present economic calamity, this is an urgent necessity."
Highlights of the bill include the following:
- Patients go to any doctor or hospital of their choice.
- The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.
- Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.
- While federally funded, the program is to be administered by the states.
- By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually - enough money to provide comprehensive, quality care to all.
- Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.
- To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.
"We are confident that Sen. Sanders' bill will accelerate the national drive for the only reform that we know will work," Young said. "A majority of physicians endorse such an approach. Fifty-nine percent of U.S. physicians support national health insurance. Two-thirds of the public also supports such a remedy. We remember well that President Obama once acknowledged that single-payer national health insurance was the best way to go. It still is."
Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).
A single-payer bill introduced by Rep. John Conyers Jr. (D-Mich.), H.R. 676, obtained 93 co-sponsors in the House during the last session. It has been reintroduced in the new Congress as the U.S. National Health Care Act with the same bill number.
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Sorry for mostly just the press release for now; more later:
I know it's "just" Bernie Sanders, so of course respectable insiders are not supposed to care. But he is on the other (n addition to Budget) Senate committee dealing with health care reform. So he does have an institutional platform to push for hearings and maybe get at least a CBO analysis.
It will be interesting to see if we can get any other Senators to sign-on to this.
Maybe Sanders, in combination with some pressure from Representative Conyers, McDermott, Charlie Rangel (chair, Ways and Means and co-sponsor of HR-676 in prior years) and Peter Stark (chair of health subcommittee of Ways and Means, and lead sponsor of a strong public option but not quite single payer bill) we can get at least hearings and the all important CBO analysis and mark-up.
Update 1: Suggest Senators to Target to Co-Sponsor:
Who are the better liberal/progressive and economic populists who might sign-on to this and whom we should be calling? In alphabetic order my list is:
Brown - supported HR-676 when in the House
Boxer
Casey
Dorgan
Feingold
Harkin
Kerry
Kloubacher
Merkley - time to begin to make good on campaign promise.
Leahy
Levin - used to be a real lefty, member of ADA.
Mikulski
Stabenow
Udall, Tom - supported HR-676 when in the House
Whitehouse
What do you think? Others?
Update 2: AdamB asks a legit question about paying for this.
I have done whole diaries on this such as "Paying for single payer-here's how" and "American exceptionalism and health insurance company costs".
Some Background: Remember that accroding to multiple independent analysis, by CBO & GAO in the 1990s and by Lewin Group for State single payer bills in the 2000's and Lewin for Commonwealth in analyzing Congressional bills a few months ago -- single payer is the only way to actually control total costs (e.g., %-of-GNP going to health care). The basic Obama/Baucus proposal at this point does not control total costs, indeed they continue to explode, which was why Baucus was presuring the CBO. Other alleged ways to control costs such as more/beter prevention, chronic disease care managment, electronic health records and other HIT, and use of comparative-effective and other evidenced based medicine approaches -- are all actually done better under single payer and, alas, either do not save money or do not do so for 10-20 years out.
Most recent single payer bills, including this one and HR-676 in the House use a combination of employer and employee payroll deduction taxes to fund the program. For HR-676 this was 7% and 4% (Dean Baker was one of the economists who did the analysis for this several years ago); Sanders uses a little bit more for empooyers and less for employees. I actually hate this and would much prefer to use a more graduated-progressive general income tax. Apparently payroll deduction is easier to score the calculations. And yes, even if you are self-employed, work for a small business that is exempted, or unemployed, etc. you are still covered. Everybody-in, Nobody-out. But any tax system or revenue stream could be used.
Employers who do provide health insurance benefits are currently paying 12-17% so for them this is a reduction. As with everything about single payer, it reduces costs, compared to those paying in now, by having a 100% universal pool with everybody paying in a little. So it is an increase for those who are currently paying nothing.
And most important to remember, this replaces all the other current payments going to insurance and care: Premiums, co-pays, deductibles, out-of-service and other refusals and out-of-pocket, taxes going to pay for Medicaid by both federal and state, etc. etc.
Update 3: Additional Commentary from PNHP's Don McCanne Quote of the Day listserv:
At a rare time in our history when comprehensive reform may become a reality, it is important that the single payer model be represented in the legislative process. The House already has Rep. John Conyers' H.R.676 and Rep. Jim McDermott's H.R.1200, and now the Senate has Sen. Bernie Sanders' S.703.
S.703 is very similar to H.R.1200, with two important additions regarding budgeting. Specified funds are budgeted for community health centers, and other specified funds are budgeted for the support of the National Health Service Corps, health professions education, and nursing education, including education of clinical nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and physician assistants.
These additions in budgeting are not simple tweaks to the bill. They provide a remedy for both the deterioration in our primary care infrastructure and the impaired access to care in underserved regions. There is an urgent need to provide the professionals and the facilities that can help fill the most serious voids in our health care delivery system today.
S.703 has been referred to the Senate Finance Committee, chaired by Sen. Max Baucus, who is determined to join with Senators Ted Kennedy, Charles Grassley and Mike Enzi to enact reform this year. Sen. Sanders will have some input as a member of the Budget Committee and a member of Sen. Kennedy's HELP Committee.
What happens now? Will Senators Baucus and Kennedy take a fresh look at single payer as a model that addresses many of the policy problems that they currently face with their model based on private plans? Or will they accept Sen. Sanders' contribution emphasizing the importance of health centers and primary care professionals? Or will they look at his budgeted numbers and decide that they can't add those to the deficits they already face with their unnecessarily over-priced model of reform? Will they simply say that they'll have to deal with that later, after they fix the insurance problem (the later that never comes)?
It's great that there is a single payer bill in the Senate, but now is not the time to sit back and watch the process unfold. We certainly support the emphasis on improving primary care access, but we need to support that within a financing framework that will make it happen - a single payer national health program.