Turn­ing aside risk, Dems rally to San­ders’ sin­gle-payer health plan

Cecil Whig - - OBITUARIES & REGIONAL - By AN­GELA JACOB Cap­i­tal News Ser­vice By CATHLEEN DECKER Los An­ge­les Times

WASH­ING­TON — The fight to put Har­riet Tub­man on the face of the $20 bill by 2020 has been re­vived with the in­tro­duc­tion of bi­par­ti­san leg­is­la­tion in the House cospon­sored by Rep. Eli­jah Cum­mings (D-7th District).

“Too of­ten, our na­tion does not do enough to honor the con­tri­bu­tions of women in Amer­i­can his­tory, es­pe­cially women of color,” Cum­mings said. “I am proud to in­tro­duce this bill with Rep. (John) Katko (R-N.Y.) to honor Har­riet Tub­man’s role in mak­ing Amer­ica a more free and more equal so­ci­ety.”

The bill comes al­most 17 months af­ter then-Trea­sury Sec­re­tary Jack Lew an­nounced that Tub­man, a fa­mous Un­der­ground Rail­road abo­li­tion­ist who was born as a Mary­land slave, would re­place An­drew Jack­son as the face of the $20 bill.

Lew’s depart­ment pledged sup­port to putting women on Amer­i­can cur­rency through changes to the $5 and $10 bills as well.

Sen. Jeanne Sha­heen (DN.H.) orig­i­nally spon­sored a bill in 2015, di­rect­ing the Depart­ment of the Trea­sury to put Tub­man on the face of the $10 bill, re­plac­ing Alexan­der Hamil­ton. But the switch to the $20 oc­curred af­ter his­to­ri­ans and fans of the mu­si­cal “Hamil­ton” ob­jected to al­ter­ing the $10 bill.

Trea­sury Sec­re­tary Steven Mnuchin faced crit­i­cism from leg­is­la­tors af­ter a Aug. 31 CNBC in­ter­view when he didn’t di­rectly say if he would con­tinue with the Obama ad­min­is­tra­tion’s plan to put Tub­man on the $20 bill.

WASH­ING­TON — Like pas­sen­gers leap­ing for a de­part­ing train, lead­ing Democrats are scram­bling to sup­port sin­gle-payer health in­sur­ance, a sys­tem that would rep­re­sent a huge ex­pan­sion of gov­ern­ment con­trol over health care and which the party’s pres­i­den­tial nom­i­nee de­clared last year would “never, ever” come to pass.

Sen. Bernie San­ders (IVt.), whose sup­port for uni­ver­sal cov­er­age was cen­tral to his 2016 pres­i­den­tial cam­paign, on Wed­nes­day un­veiled the lat­est ver­sion of his plan to ex­pand Medi­care to cover all Amer­i­cans.

Af­ter a pa­rade of tes­ti­mo­ni­als about the fail­ures of the na­tion’s ex­ist­ing health care sys­tem, San­ders cast his mea­sure as a moral and eco­nomic is­sue.

“To­day we be­gin the long and dif­fi­cult strug­gle to end the in­ter­na­tional dis­grace of the United States of Amer­ica, our great na­tion, be­ing the only ma­jor coun­try on earth not to guar­an­tee health care to all of our peo­ple,” San­ders said.

In the days be­fore San­ders’ an­nounce­ment, Democrats as ide­o­log­i­cally di­verse as lib­eral Sen. Ka­mala Har­ris of Cal­i­for­nia and con­ser­va­tive Sen. Joe Manchin of West Vir­ginia ex­pressed sup­port for his ef­fort. Their state­ments re­flect a sig­nif­i­cant shift within the Demo­cratic Party, driven by mul­ti­ple de­vel­op­ments: a be­lief that the win­dow has closed on Repub­li­can ef­forts to re­peal Oba­macare; a surge in sup­port for gov­ern­ment-run in­sur­ance among younger, more ac­tivist Democrats; and looming 2018 and 2020 con­tests that de­mand clar­ity on what Democrats sup­port — not just whom they op­pose.

Most of the party’s po­ten­tial 2020 pres­i­den­tial can­di­dates have now en­dorsed the sin­gle-payer idea, in­clud­ing San­ders, Har­ris, Sen. Cory Booker of New Jer­sey, Sen. El­iz­a­beth War­ren of Mas­sachusetts, New York Sen. Kirsten Gil­li­brand and Min­nesota Sen. Al Franken.

Com­pet­ing Demo­cratic health care plans are due out soon, in­clud­ing one that would al­low Amer­i­cans to buy cov­er­age through Med­i­caid and an­other that would ex­pand Medi­care, ef­forts less dis­rup­tive than San­ders’ pro­posal. But the au­thors of both have cast them as bridges to a time when a sin­gle gov­ern­ment plan can gain a ma­jor­ity.

The shift to­ward sin­gle payer brings risk for Democrats. The party suf­fered huge losses af­ter at­tempts to re­struc­ture the na­tion’s in­sur­ance sys­tem dur­ing the Clin­ton and Obama ad­min­is­tra­tions.

And although polls show ris­ing sup­port for a gov­ern­ment-run in­sur­ance plan, much of that in­crease comes among Democrats and Demo­cratic-lean­ing independents — mean­ing the party will be push­ing an ap­proach nearly as par­ti­san as Pres­i­dent Don­ald Trump’s re­cent ef­forts to re­peal the cur­rent health care law. (The pres­i­dent’s press sec­re­tary, Sarah Huck­abee San­ders, said Wed­nes­day that Trump con­sid­ers the new plan “a hor­ri­ble idea.”)

More­over, pub­lic opin­ion ap­pears less than solid. A re­cent Kaiser Fam­ily Foun­da­tion poll found sup­port gy­rat­ing wildly when crit­i­cisms of a Medi­care-for-all plan — in­clud­ing in­creased taxes and more gov­ern­ment con­trol over health care — were raised.

“Peo­ple don’t like un­cer­tainty,” said Lynn Vavreck, a po­lit­i­cal sci­en­tist at the Univer­sity of Cal­i­for­nia, Los An­ge­les. “Even the prom­ise of some­thing good might not be seen as bet­ter than what you have.”

Al­ready, el­e­ments in both par­ties are on the at­tack.

In Iowa, Repub­li­cans are ac­cus­ing Demo­cratic can­di­dates for gover­nor of sup­port­ing San­ders, cit­ing a $32 tril­lion es­ti­mate for the se­na­tor’s 2016 cam­paign plan. In Cal­i­for­nia, the fight has been be­tween com­pet­ing Demo­cratic fac­tions, lead­ing to the threat­ened re­call of the Demo­cratic Assem­bly speaker af­ter he set aside a sin­gle-payer bill pushed by a pow­er­ful nurses’ union be­cause, he said, its fi­nanc­ing was in­suf­fi­cient.

At his an­nounce­ment, San­ders glided over the tough topic of how to pay for his pro­posal, say­ing only that “the av­er­age Amer­i­can fam­ily” would be bet­ter off and in­creased taxes “will be more than off­set” by the ab­sence of in­sur­ance pre­mi­ums.

The swift em­brace of a sin­gle gov­ern­ment-run in­sur­ance pro­gram be­lies the long slog that vet­er­ans of the cap­i­tal’s health care wars pre­dict would be re­quired to sell the plan not only to a skep­ti­cal pub­lic but to leg­is­la­tors on Capi­tol Hill. For now, with a Repub­li­can pres­i­dent and both houses of Congress held by the GOP, the fin­ish line is a dis­tant one un­der most any cal­cu­la­tion.

“I hate to break it to any­body, but we are re­al­is­ti­cally not within four years of hav­ing a sin­gle-payer bill or a uni­ver­sal cov­er­age bill passed,” said Andy Slavitt, who over­saw Medi­care, Med­i­caid and in­sur­ance mar­kets dur­ing the Obama ad­min­is­tra­tion.

“I strongly ad­vise that Democrats in­vest the time in lis­ten­ing ... (to) how peo­ple think about the trade-offs and how they think about the op­tions and what fea­tures they’d like,” he said.

Back­ers of the plan dis­miss any po­lit­i­cal mo­tives. Har­ris said Wed­nes­day that the mea­sure “is a non­par­ti­san is­sue.”

De­spite ad­mo­ni­tions from ex­perts like Slavitt, sup­port for a uni­ver­sal gov­ern­ment pro­gram rapidly is be­com­ing a lit­mus test for the party’s na­tional and state can­di­dates.

“It’s go­ing to be hard to win a Demo­cratic pri­mary in 2020 with­out sup­port­ing sin­gle payer,” Demo­cratic poll­ster Celinda Lake said.

Some in the party dis­agree with the rush to­ward a new pro­gram on the heels of ex­ist­ing health care fights.

“Right now, I’m pro­tect­ing the Af­ford­able Care Act,” Demo­cratic House leader Nancy Pelosi, of San Fran­cisco, said Tues­day, re­peat­ing her long-stand­ing po­si­tion that talk of a sin­gle-payer plan, which she sup­ports in the­ory, re­mains pre­ma­ture. “None of th­ese other things ... can re­ally pre­vail un­less we have the Af­ford­able Care Act pro­tected.”

Lake and other poll­sters say there’s an even more ba­sic re­al­ity: Most vot­ers have lit­tle idea of what sin­gle-payer would do and how it would do it. In one fo­cus group, for ex­am­ple, a par­tic­i­pant ex­pressed frus­tra­tion over what “sin­gle payer” health care was, Lake said.

“What does sin­gle payer mean? The only sin­gle payer is me,” the fo­cus group at­tendee said.

The la­bel refers to a gov­ern­ment pro­gram that would pay for and reg­u­late health care for all Amer­i­cans. It would re­place the cur­rent sys­tem dom­i­nated by em­ployer-sup­plied pri­vate in­sur­ance and sup­ple­mented by Oba­macare’s gov­ern­ment-as­sisted in­di­vid­ual in­sur­ance plans.

It also would af­fect Medi­care, which cov­ers those 65 and older, and Med­i­caid, the pro­gram for lower-in­come peo­ple and the dis­abled that was ex­panded un­der Oba­macare and now cov­ers about 1 in 5 Amer­i­cans.

As San­ders al­luded to, it would elim­i­nate the need to pay pre­mi­ums to in­sur­ers for cov­er­age but would re­quire a very large tax in­crease.

The fact that most vot­ers aren’t fa­mil­iar with sin­gle payer could al­low can­di­dates who have en­dorsed it to de­fine for them­selves what they’ve signed onto. Then again, they will be de­fined by op­po­nents as em­brac­ing the most ex­treme ver­sion.

“There’s a lot of en­ergy for sin­gle payer,” said Bill Burton, a for­mer Obama spokesman and party strate­gist. But at this point, the pa­ram­e­ters of a bill are un­known, he said.

“It’s an idea that peo­ple are sup­port­ing, not ac­tual leg­is­la­tion.”

San­ders will de­ter­mine, in large part, how much flex­i­bil­ity his col­leagues have. While he re­mains an in­de­pen­dent, some­what dis­tant from the party whose nom­i­na­tion he sought last year, the Ver­mont se­na­tor has an un­par­al­leled abil­ity to draw in the young vot­ers on whom the Demo­cratic Party’s fu­ture de­pends.

Last year, that abil­ity came at the ex­penses of the party es­tab­lish­ment and even­tual nom­i­nee Hil­lary Clin­ton, with whom he clashed over health care.

San­ders ar­gued that uni­ver­sal cov­er­age was nec­es­sary both to pro­tect Amer­i­cans’ health and to break what he called the “cor­rupt” con­trol of the health care sys­tem by phar­ma­ceu­ti­cal com­pa­nies and other in­ter­ests.

Clin­ton coun­tered that his plan “will never, ever come to pass.”

Since the cam­paign — and the month­s­long, un­suc­cess­ful fight by Repub­li­cans to re­peal Oba­macare — things have changed.

A Pew Re­search poll in June found that the per­cent­age of Amer­i­cans fa­vor­ing a sin­gle-payer plan had risen to 33 per­cent, five points higher than in Jan­uary and 12 points higher than three years ear­lier. Two-thirds of Democrats younger than 30 fa­vored a sin­gle gov­ern­ment plan, as did 22 per­cent of young Repub­li­cans.

San­ders has said sup­port for his plan should not be a lit­mus test for can­di­dates, but some of his most loyal par­ti­sans dis­agree in words that con­jure a com­ing fight.

“It’s a lit­mus test,” said RoseAnn DeMoro, the ex­ec­u­tive di­rec­tor of Na­tional Nurses United. “The Democrats hate it when I say that.”

Any in­tra­party con­flict will be piled upon the ner­vous­ness that de­fines ev­ery ef­fort by ei­ther party to change the na­tion’s health care sys­tem. The per­sis­tent prob­lem: Although Amer­i­cans of­ten vote for change, they also fear it.

Vavreck said she was sur­prised at the quick shift among Democrats from de­fend­ing Oba­macare, which kept much of the in­sur­ance sys­tem in place, to fight­ing for what has been deemed a long shot.

“The idea that you go to the big­gest, bold­est idea seems to me an un­usual way to make progress,” she said. San­ders and other Democrats may have de­cided, she said, that “if you don’t push for a foot, you never get an inch.”

OLIVIER DOULIERY/ABACA PRESS/TNS

Sen. Bernie San­ders holds a press con­fer­ence on a “Medi­care for All” health care bill on Wed­nes­day on Capi­tol Hill in Wash­ing­ton, D.C. San­ders is set to in­tro­duce a new “Medi­care for All” health care bill with nearly a third of the Se­nate Demo­cratic cau­cus by his side.

WOOL­MAN

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