Will the Push to Dismantle Obamacare Lead to States Passing Single Payer Bills?

The U.S. is the only one among modern, industrialized countries to not adopt some form of single payer healthcare. And Americans are paying dearly for it.

The U.S. is also the biggest spender on health care. An analysis by the Commonwealth Fund found that the U.S. spent 17.1 percent of its GDP on healthcare in 2013. That was much higher than what France spent at 11.6 percent of GDP and the U.K. at 8.8 percent.

High-priced healthcare

Private spending on healthcare is highest in the U.S. where the average spending per person in 2013 was $1,074 in out-of-pocket costs. France and the Netherlands spent less than one-fourth ($277 and $270, respectively).

The U.S. also spent much more than other countries in other private spending at $3,442 per capita, which was over five times more than Canadians spent at $654. Canada was the second highest spending country.

Riskier healthcare

A study comparing the U.S. and Canadian health care systems found that the Canadian system has “lower costs, more services, universal access to health care without financial barriers, and superior health status.” Researchers also found that Canadians have longer life expectancies and lower infant mortality rates than Americans.

The U.S. has the highest rate of deaths related to health care or the lack of it than among comparable countries, according to an analysis by the Kaiser Family Foundation. The disease burden is also higher in the U.S. and hospital admissions for preventable diseases occur more frequently than in comparable countries.

Increasing cost

Health care costs in the U.S. are expected to increase. Health Affairs projected that they will grow at 5.8 percent from 2015 to 2025, comprising 20.1 percent of the GDP.

The business world is taking note of the high health costs. Back in April, the American Sustainable Business Council launched the Business Leaders Transforming Healthcare campaign.

There are 128 companies supporting the campaign, ranging from small, mid-sized and large businesses in 30 states in sectors that include consumer products, finance, energy and real estate. The purpose of the campaign is to engage the business community in the U.S. to push for a single payer health care system.

Three states introduce single payer bills

California, New York and the state of Washington have all introduced single payer bills this year into their legislatures.

California

The Healthy California Act or SB 562, introduced in February, passed by the state senate in June. It now sits languishing in the Assembly.

The bill would create a Healthy California program to provide universal single-payer health care coverage. It would also create a health care cost control system.

The program would provide a “wide-range of medical benefits and other services.” It would incorporate in the “benefits and standards of other existing federal and state provisions,” including California’s Health Insurance Program (CHIP) and Medi-Cal.

The Healthy California board would use all “waivers, approvals, and agreements” so existing federal health care payments would be paid to the program.

 

Washington

Washington state House Bill 1026 would create a single-payer health care system by using the Affordable Care Act’s state innovation waiver 1332, which became available this year to state legislators.

With the waivers, states can use 95 percent of the federal funds provided to state residents for cost assistance to use for Affordable Care Act (ACA) alternatives. It would create the Washington Health Security Trust and create guidelines to establish board and advisory committees that would manage the health care of state residents.

New York

The New York Health Act passed in the state assembly in May. It would create a single payer health care system for the state of New York.

It would be paid for with payroll taxes and non-employment income such as capital gains. Introduced in February, the bill would seek “waivers and other approvals” that relate to federal programs such as Medicaid, the ACA, and Medicare.

An economic analysis of the bill found that the bill would save more than $70 billion in 2019, which is 25 percent of that year’s projected health care spending, with savings increasing over time. During the bill’s first year, it would save $44.7 billion, or almost $2,200 per person. The analysis also found that it would also create over 200,000 jobs, which would more than replace the jobs lost in insurance and billing.

Single payer healthcare makes sense

What states like those three understand is that a single payer system is not socialized medicine. Delivery of care would remain private, doctors would regain autonomy. The way to achieve universal, single payer health care in the U.S. just might be through the states. And if Republicans keep trying to dismantle the ACA, the states just might become emboldened to achieve what every other developed country has in place.

The way to achieve universal, single payer health care in the U.S. just might be through the states. And if Republicans keep trying to dismantle the ACA, the states just might become emboldened to achieve what every other developed country has in place.

And if Republicans keep trying to dismantle the ACA, the states just might become emboldened to achieve what every other developed country has in place.


Image credit: Michael Fleshman, courtesy Flickr

 

Steps on the Road to a Great Transition

Arguably one of the most important things to come out of the COP21 climate talks in Paris last December, aside from the Paris Agreement itself, is the signal sent solidifying the growing shift in the global consciousness. We seek a transformative path forward into the new century. But any desired transformational change requires both the vision for a long term outcome and a mechanism to achieve that outcome in the ongoing grind of our day-to-day reality.

In a  globalized economy powered by fossil fuels embedded in that reality is the expectation of ceaseless energy to drive nearly every aspect of our lives, at least for some of us. The rest must live either in the shadow of the waste and destruction brought as a consequence of a fossil fuel energy economy or start out on their own quest to catch up.  Many suffer. Some resort to violence and anarchy in their desperation.

The Paris Agreement sets in motion a renewed sense of urgency in our aspiration for climate action specifically and a more equitable and sustainable society in general. The more cynical among us might suggest we’ve heard all this before, half-hearted calls to action that bear little change, leaving the rhetoric in the dustbin of broken promises and hardened souls. It’s easy to be cynical.

What is harder is to accept the failures of the past, the circumstances of the present and challenges of the future, and determine that change is not only inevitable, but that we can shape it toward a desired outcome. This is the promise of the Paris Agreement.

Choosing our future scenario

In an essay entitled Great Transition: The Promise and Lure of the Times Aheadthree classes of future scenarios are outlined, each with two variants. First is the Conventional Worlds scenario, then Barbarization and finally Great Transitions. Each scenario is characterized respectively by essential continuity, fundamental yet undesirable change and fundamentally favorable social transformation.

The two variants to Conventional Worlds are “market forces” and “policy reform.” Market forces assumes no real deviation from business-as-usual, suggesting an eventual deterioration into one of the two variants of Barbarization, either “fortress world” or complete “breakdown.” On the other hand, the policy reform variant of the Conventional Forces scenario, working in the spirit of Keynes and Bruntland, offers the possibility of progress toward a Great Transition scenario. Here we have an “eco-communalism” or “new sustainability paradigm” worldview.

Some may pine after a world of eco-communalism rooted in “pastoral romance, human goodness and the evil of industrialism,” but the authors suggest the more likely and desirable possibility, given our present situation, is a new sustainability paradigm. This is a world built out of a philosophy of sustainability as progressive global social evolution organized around human solidarity, new values and “the art of living.”

Whether we end up in a scenario of Barbarization or Great Transformation, I argue that one thing is apparent: from our current perspective of Conventional Worlds, we have a choice, even if that choice is making no choice at all – or muddling through, as the authors in the essay define as the last option; simply turning a blind eye to the whole issue of future development. By default that will almost certainly lead to a fortress world or complete breakdown.

Our best choice from here is one of policy reform, defined by growth and environmental equity achieved through stewardship, better technology and management. The framework set in place through the Paris Agreement, as well as the Sustainable Development goals, is the first step toward policy reform in a Conventional World that might lead to the Great Transition of a new sustainability paradigm.

World Bank Group Climate Action Plan: policy reform for favorable transformation?

Earlier this month the World Bank Group announced its Climate Action Plan. The plan builds on the foundation of the Paris Agreement, reinforcing the ambitions of individual countries and the global community toward new policies for every sector of society.

Through capacity building, leveraging resources and creating a framework of transparency, the World Bank’s Climate Action Plan is an example of how we can get from here – a conventional world committed to policy reform – to there – a Great Transformation rooted in human solidarity and global social evolution.

Of course, it can be difficult to hold in our mind’s eye what this transformation will look like, and this is only a small step on the road to get there. But we must look at each step as part of the whole and keep in our hearts and minds the ambition and vision set forth in Paris.

Featured image credit: Stephan Ridgway, courtesy flickr

This post first published in our blog GlobalWarmingisReal.com

The Future of Sustainable Development : A Citizen Journalism Project

Beacon is a crowdfunding platform for journalists. For more than two years Beacon has supported hundreds of worthwhile projects, adding a perspective to journalism free from the internet echo-chamber or vagaries of the advertising business model (here’s one we recommend and support).

We’ve just launched our own campaign on Beacon to help fund a series of articles and interviews exploring the future of sustainable development. The capstone of this series is one-on-one discussions with global leaders in government, business and academia at the GRI Global Conference in Amsterdam this May.

We’ll look at the Sustainable Development Goals adopted by the UN last year as well as the Paris Agreement signed at COP21. We want to examine how these frameworks create a platform for progress, not only as aspirational goals but by defining steps for real action on the ground.

The revelations last week from release of the Panama Papers is clear evidence of how a lack of transparency leads to increased economic and social disparity.  It’s no surprise that the among the world’s most wealthy and powerful people, including top business and government leaders, use whatever means at their disposal to protect their wealth from the vagaries of economic, social and policy constraints.

On the other hand it is a stark reminder of the need to redouble our efforts to align our values with our functioning global economy if there is any hope of achieving the aims of our higher aspirations. 

The importance and nature of the “socially conscious enterprise” is changing rapidly and along with it sustainability reporting. Information exchange is opening up opportunities for sustainable investment and increasing corporate and government transparency.

Is all this just pie-in-the-sky rhetoric to greenwash us into believing such a change is possible? Can we possibly “consume” our way out of the challenges we face? Is the “Triple Bottom Line” (people, planet, profit) an effective business strategy? 

Help us find out!

From my previous conversations over the years with business leaders, scientists, engineers, NGOs and policy wonks, one thing is for sure: business-as-usual is fast becoming untenable. But as we acknowledge this urgent need for change, we need to define a clear and sustainable path forward. 

Help my colleagues Andrew Burger, Richard Matthews and I explore the changing business and public policy landscape in an ever more crowded, resource-constrained world. 

Support citizen journalism!

Contribute to Making Sustainable Development a Reality today!