Should universal care advocates bite their tongues on single-payer?
Rother did not explain how those unintended consequences would come to pass. And other organizations have not found it difficult to simultaneously advocate for successful implementation of the ACA and against dismantling the Medicare and Medicaid programs. These organizations also point out that, while the ACA is a big step forward, it will not cure all of the country’s problems with access, coverage and benefits, and therefore advocate for taking other, additional steps to address those issues.
Jodi Reid is the executive director of the California chapter of the Alliance of Retired Americans (ARA), a national advocacy group focusing on issues affecting seniors that claims 4 million members. CARA has been spending much of its time lately organizing a campaign around the recently introduced single-payer bill in California.
“Health care reform [as reflected in the ACA] was a step in the right direction,” Reid said. “But we need to keep moving forward. There’s no conflict in our position [on both issues]; we simply have to explain a slightly more nuanced view.”
Reid also pointed out that an organization can have a nuanced view of single-payer legislation, suggesting modifications to specific proposals that it doesn’t agree with. Rother acknowledged as much, saying that it would be possible to propose various benefit “floors” and various financing mechanisms.
Ask for more, get more?
“The key issue underlying all this is trust in government, and that’s the exact thing that’s most lacking in the public debate today” Rother said. “To go to a single-payer you do have to trust government. The climate we’re in right now is a very hostile climate for something like that.”
Rother acknowledged, however, that AARP views itself as having the power to shape the debate and influence the political climate, both through its direct advocacy work and its educational initiatives.
In that context, then, why wouldn’t AARP attempt to reframe the political debate over health care, so that the ACA no longer looks like the ultimate goal but simply a positive step in the right direction?
Rother said that advocating for more by way of benefits, eligibility and coverage in order to open the debate up and increase the likelihood of achieving meaningful steps “works in a collective bargaining context, but doesn’t work in the U.S. Congress…because there’s no necessity of coming to an agreement. There’s no incentive for people to reach a final outcome.” He didn’t explain why “asking for more” would not help shape debate in the Congressional context.
According to Richter and other single-payer advocates, AARP’s position represents exactly the attitude that has marginalized efforts on behalf of single-payer in the past. “In Vermont, we were lucky to have some officials at both the state and national level that were open to single-payer,” Richter said. “We had to increase the political pressure on candidates and the more hesitant officials to get the bill passed, which we successfully did.”
Green Mountain Care
At the end of last month, Vermont Governor Peter Schumlin signed into law a framework bill that outlines the process through which the state will convert to a single-payer health insurance system over the course of the next several years. The new system, to be called Green Mountain Care, would be available to all Vermont residents, and would use money from the federal and state governments as well as private insurers, such as Blue Cross/Blue Shield, which is the state’s biggest insurer.
The bill still faces several obstacles, however. For one, it does not specify how, exactly, the single-payer system will be paid for. And it does not specify what the benefit package will look like, though it does say that Medicare recipients will receive no less than they currently do, along with several other “floors” for coverage. The bill sets up an independent board, which will produce a draft of the benefit plan by September 2012, and a financing package to be delivered to the legislature for a vote during the 2013 legislative session.
And these activities are contingent upon receiving several waivers from the federal government to incorporate funds from Medicare and Medicaid into the single-payer system. While some states have successfully received Medicaid wavers in the past, no state has ever received one for Medicare. And under the Affordable Care Act, the earliest that a state can even apply for some of these crucial wavers is 2017. Members of Congress from Vermont and other states are currently trying to get the date moved up to 2014, so that Vermont can begin the transition earlier.
If fully enacted, the bill would equalize payments rates across Medicare, Medicaid and private insurers, create a uniform package of benefits, and, according to advocates, greatly reduce administrative costs while providing robust, universal coverage.