Ever so slowly, our national dialogue is turning away from dead terrorists and Pakistani collusion to the issues facing the American people right here at home. Mr. Obama has put immigration reform back on the table, and many are watching with slow dread the rising waters of the Mississippi River, waiting to see if our punch-drunk country is about to absorb another pasting from Mother Nature. Peeking around the corner, as well, is a return to the discussion of health care reform and the future of Medicare and the social contract.

The Paul Ryan plan to eviscerated Medicare is, at least at present, a dead letter. The GOP's congressional leadership apparently read the political tea leaves after enduring a storm of protest from constituents over their proposal to do away with the wildly popular program and decided to back off...which makes for some interesting math, seeing as how their whole balanced budget plan falls apart without the money they'd have after the end of Medicare. Part of their motivation to drop the whole scheme also stems from the simple fact that their plan stood little chance of surviving a Senate vote, and zero chance of ever being signed into law by Mr. Obama.

It was fun while it lasted - the media's praise for their "bold" proposal, the red meat they got to toss to their base - but in the end, the Ryan plan was exposed for what it is: a hot mess, and nothing more. This fact was further underscored by a report on the impact of the plan by the Kaiser Family Foundation and the Urban Institute. According to the Boston Globe:

    Under current laws, Medicaid is expected to cover 76 million people in 2021, the end of the 10-year estimating window used in federal budgeting. Of those, some 17 million would gain coverage under Obama's expansion.

    The study estimated that 36 million to 44 million people would lose coverage from the combined impact of the block grant and repealing Obama's law. Researchers said they gave a range to account for different approaches that states might take to reduce their Medicaid rolls. Under the worst case scenario, Medicaid enrollment would plunge by nearly 60 percent from current projected levels.

    The study found federal spending for Medicaid would decline by $1.4 trillion from 2012-2021, a reduction of about one-third from what is now budgeted. Southern and mountain states would face the steepest cuts. Florida, for example, would take a 44 percent hit, while Nevada would get hit 41 percent.

    Hospitals, community health centers, and other health care providers that serve low-income people would be disproportionately affected. In 2021, hospitals would face Medicaid funding cuts of $84 billion, the study said.

On the health care front, assumed presidential candidate Mitt Romney seems bound and determined to try and convince everyone he was against "Obamacare" before he was for it before he was against it. It will be a tricky maneuver, as Obama's health care overhaul was based very closely on the plan Romney unveiled while governor of Massachusetts. For the GOP base, this has been yet another strike against Romney, and represents a serious threat to his viability as a candidate in the GOP presidential primaries.

The Wall Street Journal certainly thinks so, anyway. As they wrote on Wednesday, "For a potential President whose core argument is that he knows how to revive free market economic growth, this amounts to a fatal flaw... More immediately for his Republican candidacy, the debate over ObamaCare and the larger entitlement state may be the central question of the 2012 election. On that question, Mr. Romney is compromised and not credible. If he does not change his message, he might as well try to knock off Joe Biden and get on the Obama ticket."

Ouch.

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In the end, however, the GOP leadership and Mr. Romney have contributed nothing but lip-flapping and bad noise to the health care debate. Mr. Obama's plan has its flaws, the Ryan plan is deranged on its face, and Romney is only trying to keep his nose above water. On this all-important issue, it has been exceedingly difficult to find anyone with anything worthy to say.

That may be about to change.

A pair of complementary bills, both titled "The American Health Care Security Act of 2011," have been introduced in both the House and the Senate. Sen. Bernie Sanders (I-VT) and Rep. Jim McDermott (D-WA) are the sponsors, and both aim with these bills to provide health care for every American by way of a Medicare-for-all single-payer system. They were joined at the press conference announcing the legislation by the executive vice president of the AFL-CIO, the co-president of the National Nurses United, and the president of the International Federation of Professional and Technical Engineers

"The United States is the only major nation in the industrialized world that does not guarantee health care as right to its people," said Mr. Sanders after revealing the legislation. "Meanwhile, we spend about twice as much per capita on health care with worse results than others that spend far less. It is time that we bring about a fundamental transformation of the American health care system. It is time for us to end private, for-profit participation in delivering basic coverage. It is time for the United States to provide a Medicare-for-all single-payer health coverage program."

"The new health care law made big progress towards covering many more people and finding ways to lower cost," said Rep. McDermott. "However, I think the best way to reduce costs and guarantee coverage for all is through a Single-payer system like Medicare. This bill does just that - it builds on the new health care law by giving states the flexibility they need to go to a single-payer system of their own. It will also reduce costs, and Americans will be healthier."

According to a report by Buzzflash:

    Last year's health reform law is projected to cover 32 million more Americans. Despite that important step forward, however, 23 million people living in the United States will remain uninsured by the end of this decade while health care costs continue to skyrocket. Some 60 million Americans, both insured and uninsured, have inadequate access to primary care due to a shortage of physicians and other like providers in their community.

    Under the current health care system, 45,000 Americans a year die because they delay seeking care they cannot afford. Health care eats up one-fifth of the U.S. economy, but we rank 26th among major, developed nations on life expectancy and 31st on infant mortality.

    Drug companies charge Americans twice as much or more for the exact same drugs manufactured by the exact same companies than citizens of Canada or Europe. Some insurers that gouge policy holders spend 40 cents of every premium dollar on administration and profits while lavishing multimillion dollar payouts on their CEOs.

    "This is unacceptable," Sanders said. "Until we put patients over profits, our system will not work for ordinary Americans."

In Sanders' home state of Vermont, Gov. Peter Shumlin will be signing a similar program called Green Mountain Care into law later this month. The legislation proposed by Sanders and McDermott, however, faces a steep uphill climb, especially in the Republican-controlled House. Even on the Democratic side of the aisle, Sanders and McDermott face the challenge of anemic enthusiasm; Mr. Obama rejected the idea of a single-payer health care plan during the debate over his own plan a year ago, and there has been no indication that he has changed his position, especially since his own health care legislation is under assault in the courts and in state capitols all across the country. Alas, the same lack of interest can be found in many congressional Democrats.

So, it seems this new proposal by Sanders and McDermott is also a dead letter, but the ideas they have proposed are highly intriguing and well worthy of public debate, despite all the evident obstacles arrayed before them. At a minimum, their legislation returns the conversation to a place of relative sanity, and away from the bat-belfry of GOP-inspired nonsense. It remains to be seen where this will go, if anywhere, but the proposal is worthy of study and conversation, at least. Sanders and McDermott are to be commended for re-introducing the issue, and for guiding it in the proper direction. As Mr. McDermott himself said, it is an idea whose time has come.

http://www.truth-out.org/single-payer-health-care-rises-again/1305133698

May 12, 2011