Sep 13, 2017

What Bernie's single-payer bill means (and what it doesn't)

Illustration: Lazaro Gamio / Axios

Single payer isn't going anywhere — in either direction. It's not going to pass anytime soon, obviously. But after today, it's also not going away anytime soon.

Sen. Bernie Sanders will introduce his "Medicare for All" legislation today and, in addition to Sanders, four more of Democrats' top 2020 prospects — Sens. Cory Booker, Kirsten Gillibrand, Kamala Harris and Elizabeth Warren — have already signed on as cosponsors.

The bottom line: Yes, this is a big deal. But if it's time to take single-payer seriously as a political concept, it's also time to start grappling with the policy.

  • Single-payer means different things to different people. But for so many powerful, viable Democrats to endorse just the conceptual idea of single-payer is still a huge political shift.
  • Even if some of them are only doing it because they feel like they have to, that's arguably a bigger change. It wasn't that long ago you had to say you opposed single-payer if you wanted to be taken seriously as a presidential candidate.

But here are the policy problems:

  • No one has a clear vision of what “single payer" actually means, and no one other than Sanders cares how Sanders's bill answers those questions.
  • The Democrats cosponsoring Sanders' bill will almost certainly treat it as a political proxy — a broad statement of support for a vaguely defined goal rather than a specific policy endorsement.

Where each Democrat ends up could be very different, and could stop far short of true single-payer. Even"Medicare for all" isn't true single-payer. Most Medicare beneficiaries buy private supplemental coverage to fill in gaps the government program doesn't cover. Its drug benefit is largely privately administered.

  • "Whether it's 'Medicare for All,' Medicare buy-in, Medicaid buy in, all-payer, utilizing Medicare as a negotiator — the constant theme will be policies that work constructively and aggressively to leverage the power of the federal government," said Chris Jennings, a veteran Democratic health care strategist.
  • No one — including Sanders — has truly reckoned with how to pay for whatever system they might support.

There's still political risk here.

  • Single-payer feels like it has a lot of momentum because so many potential presidential candidates are now supporting it. But Senate Democrats up for reelection next year in red states aren't signing on.
  • Even House Speaker Nancy Pelosi, who has said in the past that she'd love single payer but is also trying to win the House next year, declined to back Sanders' bill and said it's not a litmus test for Democrats.
  • Any form of single payer would require enormous tax increases, and as long as Democrats are in that ballpark, the details are all the same to Republican campaign committees.

The bill Sanders is introducing today doesn't just have a long way to go before becoming law. It's not even really on that road. It also has a long way to go before single-payer starts to represent a specific vision, and one that down-ballot Democrats want to entertain. But having Booker, Harris, Gilibrand and Warren all on board is a step in that direction.

  • "As long as the different approaches recognize that they have a common denominator, I think it can be quite effective," Jennings said.

Go deeper

Republicans sue California over mail-out ballot plan

California Gov. Gavin Newsom during a February news conference in Sacramento, California. Photo: Justin Sullivan/Getty Images

President Trump accused Democrats of trying "Rig" November's general election as Republican groups filed a lawsuit against California Sunday in an attempt to stop Gov. Gavin Newsom (D) from mailing ballots to all registered voters.

Driving the news: Newsom signed an executive order this month in response to the coronavirus pandemic ensuring that all registered voters in the state receive a mail-in ballot.

Coronavirus dashboard

Illustration: Aïda Amer/Axios

  1. Global: Total confirmed cases as of 7 p.m. ET: 5,383,582 — Total deaths: 344,077 — Total recoveries — 2,158,031Map.
  2. U.S.: Total confirmed cases as of 7 p.m. ET: 1,640,972 — Total deaths: 97,679 — Total recoveries: 366,736 — Total tested: 14,163,195Map.
  3. World: White House announces travel restrictions on Brazil, coronavirus hotspot in Southern Hemisphere Over 100 coronavirus cases in Germany tied to single day of church services — Boris Johnson backs top aide amid reports that he broke U.K. lockdown while exhibiting symptoms.
  4. Public health: Officials are urging Americans to wear masks headed into Memorial Day weekend Report finds "little evidence" coronavirus under control in most statesHurricanes, wildfires, the flu could strain COVID-19 response
  5. Economy: White House economic adviser Kevin Hassett says it's possible the unemployment rate could still be in double digits by November's election — Public employees brace for layoffs.
  6. Federal government: Trump attacks a Columbia University study that suggests earlier lockdown could have saved 36,000 American lives.
  7. What should I do? Hydroxychloroquine questions answeredTraveling, asthma, dishes, disinfectants and being contagiousMasks, lending books and self-isolatingExercise, laundry, what counts as soap — Pets, moving and personal healthAnswers about the virus from Axios expertsWhat to know about social distancingHow to minimize your risk.
  8. Other resources: CDC on how to avoid the virus, what to do if you get it, the right mask to wear.

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Updated 2 hours ago - Politics & Policy

Federal judge strikes down Florida law requiring felons to pay fines before voting

Gov. Ron DeSantis. Photo: oe Raedle/Getty Images

A federal judge on Sunday ruled that a Florida law requiring convicted felons to pay all court fines and fees before registering to vote is unconstitutional.

Why it matters: The ruling, which will likely be appealed by state Republicans, would clear the way for hundreds of thousands of ex-felons in Florida to register to vote ahead of November's election.