Single Payer, Meet All Payer: The Surprising State That Is Quietly Revolutionizing Health Care
By David Dayen
Jul 24 2017
One unheralded reason for Trumpcare’s many difficulties was a sea change in public opinion. A new Associated Press poll finds that 62 percent now agree the federal government has a responsibility to provide health coverage to all Americans, up from 52 percent in March. Republicans looking to take away coverage ran headlong into this wave of support for a bigger governmental role in health care.
“Once you get something for pre-existing conditions, etc., etc. — once you get something, it’s awfully tough to take it away,” President Trump concluded.
Indeed, when Kansas Republican Jerry Moran issued the statement that effectively killed the bill’s hopes, his opposition was described in the press as having come from a conservative direction. And while it was cloaked in right-wing rhetoric around choice, the politics of the statement leaned decidedly left. “We must now start fresh with an open legislative process to develop innovative solutions that provide greater personal choice, protections for pre-existing conditions, increased access and lower overall costs for Kansans,” said Moran, fully aware that protections for pre-existing conditions, couples with lower overall costs, require a robust government intervention in health care.
Capitalizing on the new politics, progressive groups have distributed a “People’s Platform” that includes a Medicare-for-All single-payer system. And in state capitols, activists have demanded single payer, hoping a demonstration project proving the concept will catch fire, the way a universal system in Saskatchewan in the 1940s migrated to the rest of Canada.
The movement has won some incremental victories, but has yet to get over the top. Vermont passed the framework legislatively and then abandoned it. Colorado’s quiet effort was crushed at the ballot box. California has spent 25 years trying to pass something without success, and this year’s effort is stalled. A Medicaid buy-in bill in Nevada this year drew a veto from its Republican governor. New York’s odd conservative control of the Senate seems to foreclose a solution there in the near term.
There is one state, however, where a combination of fewer institutional barriers and existing health care structures could make health-care-for-all an achievable reality: Maryland.
It will take a grassroots groundswell and electoral victories, especially in next year’s governor’s race. One prominent gubernatorial candidate, former NAACP president Ben Jealous, has ardently endorsed single payer. “We have the opportunity in this state to make sure that we don’t have any more neighbors burying loved ones because they didn’t have access to health care,” Jealous said at an event where Sen. Bernie Sanders endorsed him for governor.
f elected, Jealous would face fewer procedural obstacles than those that have dogged California in its long battle to establish a single-payer system. While Maryland, like California, has robust Democratic supermajorities in the legislature, there is no two-thirds requirement to raise taxes, and no budgeting straitjacket mandating certain percentages of state spending to education or other priorities.
And while states do need federal waivers to incorporate programs like Medicare into a state-run program, Maryland is the only state to already hold a Medicare waiver. It enables a unique system known as all-payer rate setting, which serves as the basis for universal health care in several industrialized nations. In other words, while other states would have to begin from scratch to overhaul their health care systems, Maryland has a head start.