A Preview of the Bloody Uphill Battle for Single-Payer

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Sens. Debbie Stabenow and Tammy Baldwin introduced a bill today that would allow people over the age of 50 to buy into Medicare. It’s a very limited gesture toward expanding healthcare, one that would do nothing for millions of people who are currently without healthcare or unable to afford their insurance, co-pays, or deductibles. The bill doesn’t say what premiums would be.


Of all the Medicare buy-in or public option plans, this kind—the kind that expands care by expanding the eligibility age—is arguably the most laughable, since it doesn’t even try to help people under 50. Still, it is something, in that it is literally not nothing.

And yet, despite its limited scope, two key healthcare industry lobbying groups have already come out to trash the bill. The Federation of American Hospitals, which represents for-profit hospitals, attacked the bill by saying it would weaken coverage for everyone else and make it harder for hospitals to provide care. What they mean is that Medicare pays hospitals much less for procedures than private insurance does—if more people have Medicare, that’s less money for them.

When asked for comment, a spokesperson for the industry group America’s Health Insurance Plans, which represents health insurers, told Splinter:

While we have not offered a position on lowering the Medicare eligibility age, it’s important to understand that the majority of people in this age group get their coverage through the employer provided market – so it’s unclear whether these proposals would truly improve accessibility. We need broad participation in all our markets to ensure affordable coverage choices for everyone.

The basic translation: They aren’t explicitly saying it’s bad, but they want everyone to stay in the private or employer-provided market. (That is, the ones they make money off of.)

Our good friends at the Partnership for America’s Health Care Future, a lobbying group formed specifically to fight single-payer proposals, also blasted out a very telling statement (emphasis ours):

“We can all agree that every American deserves access to affordable health coverage and high-quality care, but this proposal – whether you call it Medicare for All, Medicare buy-in, single-payer or a public option – moves us toward a one-size-fits-all health care system that is wrong for America. Today, approximately 90 percent of Americans are covered, and more than 180 million receive affordable, quality care through their employer. American patients have strong legal protections for pre-existing conditions, a high level of choice and control over their doctors and treatments, and polls show they rate their care highly. So, rather than upending that important progress, we should come together to build upon all that is working and fix what is broken in our current system,” said Lauren Crawford Shaver, Executive Director.


What PAHCF (and the insurance, drug, and hospital companies it represents) is doing here is what we’ve already seen it do in its first TV ad: explicitly and shamelessly rolling a public option in with very different, much bolder, and much better ideas like single-payer.

What does this tell you? It tells you that these groups do not want any change at all and will fight hard to oppose any plan—including a public option. It tells you that they apparently do not distinguish in their messaging between single-payer plans that would cover everyone and include dental, vision, and drug care, and weak-ass public option plans that would likely cost almost as much as private insurance—which does not bode well for any Democrat who thinks that sneaking a public option through in 2021 is a viable path to reform.


Yes, the industry would fight single-payer harder, because it would cost them far more in profits. But the fact that they’re currently treating even the weakest proposals exactly the same way they would likely treat the boldest ones should tell Democrats something, too.

Anything that harms profits will be opposed by the industries currently making bank off our revolting, predatory system, but the only way to make that system better is to remove those profits. But the industry is operating on an entirely different set of premises and motivations. They don’t want the best policy that ensures healthcare for all; they want the one that allows them to keep making billions in profits. You can’t compromise with people whose aims are fundamentally opposed to yours.


That’s why going offering meek proposals won’t save you from healthcare industry lobbying cash. In fact, going in with the weakest possible version of reform as your starting offer is the way to end up with nothing in the end.

When you’re faced with an enemy whose aims are diametrically opposed to yours, the way to win isn’t to compromise with them—it’s to beat them.


Update, Feb. 14, 2019, 8:41 a.m. ET: America’s Health Insurance Plans provided the following, fuller statement to Splinter criticizing the bill:

This is a slippery slope to government-run health care for every American. The American people want health care that works – not a one-size-fits-all health care system.

Today, health coverage works for hundreds of millions of Americans – not only for the 22 million covered through Medicare Advantage, but the 180 million Americans who are covered through their jobs, 55 million covered through Medicaid managed care, and 20 million who buy their own coverage. The vast majority of Americans are satisfied with the coverage they have today. They have choice and control over their coverage, options, and treatment.

Instead of taking away the coverage that works for them today, let’s focus on protecting and improving what’s working and fixing what’s not. That’s the most effective way to guarantee that every American has affordable coverage and high-quality care.

Splinter politics writer. libby.watson@splinternews.com