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Give States an Option to Lead on Single-Payer | The Nation

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John Nichols

John Nichols

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Give States an Option to Lead on Single-Payer

The goal of real reformers is clear: a "Medicare for all" single-payer national healthcare system.

Getting there could be a little tough this fall.

But America will get there.

The current system is broken; it fails to serve 45 million Americans and underserves another 45 million. It costs too much and it delivers too little to a country where life expectancy rates are rapidly falling below those of developed nations with universal healthcare programs.

The compromises of a weak "public option" or less are insufficient to the point of being laughable, and potentially more costly than the current monstrosity.

So we will get to single-payer.

The only question is how and when.

One answer, perhaps the best, is offered by Congresswoman Tammy Baldwin, D-Wisconsin, who has proposed and promoted the idea of allowing states to experiment with different healthcare systems.

Under Baldwin's plan, a progressive state such as Oregon or Vermont could develop a "Medicare for all" program within its borders. At the same time, a more traditionally conservative state such as Mississippi or Alabama could muck around with so-called "medical-savings accounts" and other gimmicks developed by the insurance industry and its political mouthpieces.

Then it would be a case of may the best state win -- with the evidence of which model works best developing over time.

Canada went this route, experimenting first with single-payer in Saskatchewan.

Slowly, other provincial governments recognized that the "Medicare for all" model delivered quality healthcare at affordable prices and adopted it. And, eventually, the reforms initiated in once province went national.

Baldwin has introduced a House resolution expressing the determination of the Congress to facilitate state-based innovation in national healthcare reform. And she has encouraged moves -- by Congressman Dennis Kucinich, D-Ohio, and others -- to insure that this sort of flexibility is a part of any plan that comes out of the House.

This is important, since federal rules regarding Medicare and other programs can limit the options for states. And a mangled healthcare reform plan passed in rush by legislators who just want to "do something" could further constrain progressive initiatives.

Baldwin's gotten a number of co-sponsors for her resolution -- including a few Republicans. It's important that single-payer backers sign on now, as part of the broader push to make sure that if the feds fail us, states can lead.

Washington may not give us real reform this year. But it should at least give progressive states a chance to move in the right direction.

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