We Can Have Single-Payer In Washington State by 2020, If We Want It

It's starting to seem a little more possible. JUSTIN SULLIVAN / GETTY

There are a handful of single-payer bills sitting in Olympia right now, just waiting to get some action. If you're tired of paying more money for worse health care coverage, if you count half a million Washington residents living without health insurance even with the Affordable Care Act in place as a moral failure, and if the thought of demonstrably inefficient health insurance companies profiting off the plight of the sick makes you sick, then what you need to do is call Rep. Eileen Cody, D-Seattle, and demand hearings on a bill sponsored by Rep. Sherry Appleton, D-Poulsbo (HB 1026). Then call Sen. Ann Rivers, R-La Center, and demand hearings on a separate bill sponsored by Sen. David Frockt, D-Seattle (SB 5701).

You should also call your own State Rep and Senator and tell them you want them to move on this. If you don't know who that person is, find them using this handy tool.

That's it. That's all you need to do right now. The next legislative session won't start until January 2018, but completely overhauling a state's health care system is time consuming, and there will be a few potential snags that I'll talk about here in a second, but we can't even start to argue about all of this stuff until constituents start applying pressure. So, for now:

Rep. Eileen Cody: (360) 786-7978 Sen. Ann Rivers: (360)-786-7634

The people you will call: Rep. Eileen Cody and Sen. Ann Rivers Washington State Legislature

Call them and tell them you want them to hold hearings on the bills.

But in case you want to know a little bit more:

Here's What's In Those Bills

Before we get going, you should know that there are three single-payer bills in the state Senate right now. Sen. Maralyn Chase, D-Shoreline, introduced the most ambitious bill, which is based on the California model that failed this summer. Sen. Bob Hasagawa, D-Seattle, also has a bill, but with a few minor exceptions it's the same bill as the ones introduced by Senator David Frockt and Rep. Appleton. Their proposals have been around for the longest time and seem most promising to me.

According to the language of Frockt's bill, legislators would create a board representing "Washington citizens, business, labor, and health professions" who have "expertise in health care financing and delivery." This group would be selected through "public hearings, research, and consensus building," and they'd be required to demonstrate "knowledge of the health care needs of diverse populations, including low-income, Native American, undocumented, non-English speaking, disabled, rural, and other minority populations."

They'll also set up a three separate committees (financial, citizens', and technical) to make appropriate recommendations about how to pay for stuff, what stuff to pay for, how to deliver that stuff to everybody in Washington, and how to monitor everything for "quality assurance and cost containment."

The benefits package they come up with "shall include but is not limited to":

(a) Inpatient and outpatient hospital care, including twenty-four hour a day emergency services and emergency ambulance services; (b) outpatient, home-based, and office-based care; (c) rehabilitation services, including speech, occupational, and physical therapy; (d) inpatient and outpatient mental health services and substance abuse treatment; (e) hospice care; (f) prescription drugs and prescribed medical nutrition; (g) vision and hearing care; (h) diagnostic tests; (i) durable medical equipment; (j) preventive care; and (k) any other benefits defined as 'essential health benefits' under the federal patient protection and affordable care act.

The proposal from Appleton and Frockt also instructs the board to come up with a plan for dental coverage the following year.

If all goes smoothly, which it probably won't, but it might if there's lots of pressure, then by May 2020 the the state of Washington will be the primary insurance company in town. (Private insurance companies would also exist to serve those who want to supplement their plan.)

Rep. Sherry Appleton and Sen. David Frockt Washington State Legislature

How Are They Going To Pay For It?

They're going to tax the blood of Republican children. Jk.

Like Bernie Sanders's Medicare for All bill, HB 1026 and SB 5701 provide a framework for discussion. And like Bernie Sanders's Medicare for All bill, people will dismiss them as meaningless shells that lack substance. Those people wouldn't be 100 percent wrong, but they wouldn't be right, either. HB 1026 and SB 5701 are built to be "shells." The idea is to describe the single-payer plan, talk about how we can pay for it over the course of several hearings, and hear out the opposition. In 2019, a bill responsive to all that input will be introduced. That bill will have all the substance that everyone's looking for.

But just because there's no exact financing information in the current legislation doesn't mean they don't know how they're going to pay for it.

In wildly simplified terms, the general goal is to take the money that people and corporations pay into the private health insurance markets and dump it all into one public market.

Right now, the private insurance markets are obscenely vast and complicated. There's large group, small group, and individual markets, along with Medicare, Medicaid, and the VA. All of those are separate insurance markets with separate rules, separate financing, separate benefits, separate everything, and it's all so confusing that at least 30 percent of our private insurance costs go to managing the administrative burden caused by that system. Plus, it doesn't even cover everybody! By switching to a single-payer system, those administrative costs would be significantly reduced, and every single resident of Washington state would have health insurance.

In addition to saving money on administrative costs, some of the funding for the bill would come from tax deductible "employer assessments" and personal premiums for adults. Basically, in lieu of offering benefits, employers would pay a fee to the state based on their size. And instead of individuals paying through their employers or through private insurance, they would pay a monthly fee and maybe a small co-pay as well. Overall, assuming we get sick at some point in our lives, everyone in Washington will be spending less money for health insurance over time.

Proponents of the bill also want to use a lot of existing state and federal money, but some of that will be a little tricky. We might, for example, be able to ask the federal government for an "innovation waiver" so we can apply the funds the state receives for the ACA to the statewide single-payer program, but those details are currently being worked out in "the bipartisan fix" to the ACA. (It's worth noting that Republicans know blue states want to do this, and they're actively trying to stop states from taking such measures.) Moreover, Washington state might be able to get Medicaid waivers, but no federal legislation exists yet to allow for Medicare or VA waivers. So, tricky given the current administration, but not impossible.

Some Things We Might Learn From Recent Single-Payer Failures

If you've been following the news of single-payer stalling out in New York and California, you're right to be skeptical about Washington's chances of passing a similar measure. But there are lessons to be learned.

The single-payer bill got held up in New York because Republicans control the state Senate, and, being Republicans, they killed the bill. Such a death will likely befall the bill here unless we flip the Washington Senate by electing Manka Dhingra. If you live in the 45th LD, or even if you don't, now would be a good time to be knocking on doors for Dhingra.

But even if Democrats gain control of both houses here in Washington, some centrist tool could kill the bill because he doesn't want to work hard, which is what happened this summer in California. The Speaker of California's Assembly, Anthony Rendon, pulled the measure because "the bill was 'woefully incomplete' because it did not address serious issues such as 'financing, delivery of care, cost controls, or the realities of needed action by the Trump administration and voters,'" he said in a statement.

A spokesperson for the California Nurses Association, who basically wrote that bill, told the New Republic that, by denying the legislature the opportunities to hold hearings and discuss amendments that would provide all the answers Rendon was looking for, the Speaker was basically saying that the Assembly didn't want to do its job.

The lesson: Democratic majorities like the one in California, and like the one we may get in Washington this November, are meant to be used, not maintained. If any centrist Democrat kills single-payer for some myopic political reason, or because they don't want to do the work of holding hearings and working through problems, they are not accurately weighing the financial and moral consequences of living in a state where over 500,000 people don't have insurance.

But if they work hard and work together, with a mob of patient and diligent and reasonably concerned constituents at their back, Democrats may be able to pass this thing. If they build a model that works, then other states will follow. And if those followers can show single-payer working at the state level, then the nation will follow.

Just to Review

If covering everyone in Washington State and paying less money to do so sounds good to you, call these people and tell them to hold hearings on the bill in January.

Rep. Eileen Cody: (360) 786-7978 Sen. Ann Rivers: (360)-786-7634

If Manka Dhingra gets elected in November, Sen. Annette Cleveland, D-Vancouver, will presumably take over as chair of the Senate Health Care Committee. If that happens, start calling her and demanding the same thing: (360) 786-7696.

If you want to do more than just call people, you can join an advocacy group called Health Care for All-WA. They've been around since 1998, but they're starting to gain some traction. I think it's because everything is so bad right now and everyone's dying and yet private health insurance profits are soaring. Anyway, they have a bunch of resources on their website, including a four-year plan to pass and implement this measure.