When I was a kid my father owned a small clothing store in Bed-Stuy, which was part of the Assembly district Shirley Chisholm represented. I used to work there frequently. Soon after I wen t off to college Chisholm was elected Brooklyn's first-ever African-America congressmember (as well as the first black woman ever elected to Congress in the U.S.)... talk about a pioneer and a game-changer. When she was first elected, the white men who ran Congress decided to demean her by appointing her to the Agriculture Committee. We're they in for a shock when she worked with farm state Republicans to turn the country's surplus food into a robust food stamp program that fed poor people and helped create the WIC program-- Supplemental Nutrition Program for Women, Infants and Children. There's one quote of hers that always inspired me and that I never forgot: "If they don’t give you a seat at the table, bring a folding chair." She'll always be one of my heroes. One day-- soon I hope-- we'll have a woman president. Shirley was the first woman to run for a major party nomination, something that I hope leads soon to President Warren.





NY Times that "single-payer, while it has many virtues, isn’t the only way to get [to universal health coverage]; it would be much harder politically than its advocates acknowledge; and there are more important priorities." He wrote that "some progressives-- by and large people who supported Bernie Sanders in the primaries-- are already trying to revive one of his signature proposals: expanding Medicare to cover everyone. Some even want to make support for single-payer a litmus test for Democratic candidates. So it’s time for a little pushback." I gave up reading this clown over a year ago and normally avoid him like the plague, but his stats from the The establishment and their shills-- some consciously so, others just instinctively-- are in an uproar about "litmus tests" and "purity." And, indeed, Pelosi's DCCC seem to have created a litmus test of it's own-- they are favoring Blue Dogs, "ex"-Republicans, wealthy self-funders and anti-Choice candidates over actual Democrats. Rahm made the DCCC a vehicle for this kind of garbage in 2005 but it's now become systematized under Steve Israel and Ben Ray Lujan. As we mentioned earlier, they also seem to be making health care a litmus test -- candidates campaigning for Medicare-For-All, which is backed my the majority of Democrats in Congress-- are being shoved aside in favor of candidates who refuse to say where they stand on the issue. Yesterday a centrist establishment economist who's been an anti-Sanders propagandist for some time now, wrote in thethat "single-payer, while it has many virtues, isn’t the only way to get [to universal health coverage]; it would be much harder politically than its advocates acknowledge; and there are more important priorities." He wrote that "some progressives-- by and large people who supported Bernie Sanders in the primaries-- are already trying to revive one of his signature proposals: expanding Medicare to cover everyone. Some even want to make support for single-payer a litmus test for Democratic candidates. So it’s time for a little pushback." I gave up reading this clown over a year ago and normally avoid him like the plague, but his stats from the Commonwealth Fund are interesting. It "compares health care performance among advanced nations. America is at the bottom; the top three performers are Britain, Australia, and the Netherlands. And the thing is, these three leaders have very different systems. Britain has true socialized medicine: The government provides health care directly through the National Health Service. Australia has a single-payer system, basically Medicare for All-- it’s even called Medicare. But the Dutch have what we might call Obamacare done right: individuals are required to buy coverage from regulated private insurers, with subsidies to help them afford the premiums." Of course, he favors the least progressive of the three approaches and claims the Dutch system is the way to go-- "incremental improvements in the A.C.A., rather than radical change. Further evidence for this view is how relatively well Obamacare, imperfect as it is, already works in states that try to make it work-- did you know that only 5.4 percent of New Yorkers are now uninsured?" And he claims "the political logic that led to Obamacare rather than Medicare for all still applies."

It’s not just about paying off the insurance industry, although getting insurers to buy in to health reform wasn’t foolish, and arguably helped save the A.C.A.: At a crucial moment America’s Health Insurance Plans, the industry lobbying organization, and Blue Cross Blue Shield intervened to denounce Republican plans.



A far more important consideration is minimizing disruption to the 156 million people who currently get insurance through their employers, and are largely satisfied with their coverage. Moving to single-payer would mean taking away this coverage and imposing new taxes; to make it fly politically you’d have to convince most of these people both that they would save more in premiums than they pay in additional taxes, and that their new coverage would be just as good as the old.



This might in fact be true, but it would be one heck of a hard sell. Is this really where progressives want to spend their political capital?



What would I do instead? I’d enhance the A.C.A., not replace it, although I would strongly support reintroducing some form of public option-- a way for people to buy into public insurance-- that could eventually lead to single-payer.



Meanwhile, progressives should move beyond health care and focus on other holes in the U.S. safety net.

He says he has nothing against single-payer... he just hates progressives and everything they stand for and... Hillary Forever. Matt Bruening at BuzzFeed, who writes that Democrats need to recognize that the Affordable Care Act is too flawed to save and that single payer is the only path forward , had a more sensible perspective-- one more in touch with reality-- than Krugman's stubborn centrism.

In the course of defending Obamacare, centrist pundits and institutions made a moral argument about the brutality of health uninsurance that also renders our current system totally indefensible. The Center for American Progress released a report showing that the Republican bill would cause around 200,000 more people to die over the next decade due to lack of health insurance, while Vox’s Ezra Klein described the CBO’s report detailing the collapse of health insurance coverage as “one of the most singularly devastating documents I’ve seen in American politics.”



If the 200,000 more deaths caused by switching from Obamacare to the defunct Republican plan is an unspeakable moral atrocity, then how do we justify sticking with Obamacare-- which still leaves millions uninsured-- rather than moving to a universal single-payer system? The math that produced CAP’s estimates, based on a study that concluded 1 person dies unnecessarily for every 830 people who lack health insurance, would imply that 300,000 additional deaths will be caused by Obamacare relative to a universal system where everyone is covered.



There is simply no longer a coherent centrist case for carrying on with Obamacare.



The Affordable Care Act did a lot of good, but the system it has left us with is still a disaster. According to Gallup, around 11.3% of adults currently lack health insurance. Despite the existence of Medicaid, uninsurance remains especially prevalent among those living in poverty. A Treasury study based on 2014 tax data concluded that the uninsurance rate for poor families was 10 times higher than it is for high-income families.



The problem is even worse than those numbers suggest. Tallies of people lacking health insurance are done at a particular point in time, meaning that they obscure just how often people move in and out of health insurance. Over half of the non-elderly population receive employer-sponsored insurance and, in a given year, over 40% of workers separate from their jobs. Not every separation results in an uninsurance spell, but many do.



Even if they manage to keep insurance when between jobs, workers and their families face the miserable hassle of draining their savings to preserve coverage through COBRA, signing up for health insurance on the Obamacare exchanges, or having to switch to an entirely different plan at their new job.



Even those who remain consistently insured face yet another coverage problem: high out-of-pocket expenses. According to the Federal Reserve’s most recent economic well-being report, 23% of Americans with health insurance forgo medical treatment every year because of an inability to pay.



A single-payer system is the most obvious way forward to finally achieve what all of our developed country peers did many decades ago: an easy-to-use, cost-effective health insurance system that covers everyone.



In many ways, the Obamacare experience provides the best argument for the universal alternative. Obamacare primarily increased health insurance coverage through two mechanisms: expanding Medicaid eligibility up the income ladder and creating an elaborate, subsidized individual marketplace. The Medicaid expansion, which closely approximates what a single-payer system would look like, was a smashing success. The individual marketplace, however, has been awful, with premiums increasing dramatically and insurance choices dwindling to two, one, or even zero options in some places.



Crucially, the superior performance of Medicaid was noted not just by wonks but also by ordinary people. Report after report after report has documented the existence of Medicaid envy: people bitter that they had been forced onto the individual marketplace because their income is too high for Medicaid. Contrary to the beliefs of Obamacare’s architects, it appears that people would much rather be on public health insurance, even on a stigmatized program for those on low incomes, than deal with private insurers.



The individual preference for public insurance is reflected in public polling as well. According to Gallup, 58% of Americans favor replacing the current system with a “federally funded healthcare program providing insurance for all Americans.” Among Democrats, support soars to 73%.



The Democratic party has generally ignored its voters on this issue, but that is starting to change. Around 60% of House Democrats are now cosponsors of John Conyers’ single-payer bill, the highest number recorded in the 12 years since it was first introduced. Democratic Sens. Elizabeth Warren and Kirsten Gillibrand, both of whom are rumored as likely 2020 presidential candidates, have recently announced their support for a single-payer system as well. The current frontrunner for the 2020 Democratic primary, Bernie Sanders, has long made single-payer one of his signature issues.



Now that the Republicans have failed, the time is ripe for a serious single-payer push. Policy institutions need to work hard to hammer out the details of a single-payer plan, and the Democratic party needs to stop fumbling around incompetently for a positive vision and instead unify behind the one already supported by the overwhelming majority of its voters.

I asked one of our most fearless congressional candidates, David Gill, if he would be interested in commenting on this post. He got back to me and said "Do I want to add a quote on this post? You bet I do!! This is IL-13 in a nutshell!"

I have been a dues-paying member of Physicians for a National Health Program for 25 years, a group of 20,000 doctors who have been advocating for Single-Payer healthcare for all these years. As a family physician and as an Emergency Department physician, I'm well aware of the many shortcomings of healthcare and healthcare financing, both pre- and post-ACA.



I ran for Congress in 2012 and defeated the centrist establishment-backed Democrat in the primary that year. I lost in the general by 0.3%, thanks to the presence of a liberal independent on the ballot that year who split the vote just barely enough to keep me out of Washington. Subsequent Democrats (moderates) have lost here by 50 to 60 times what I lost by, further evidence of the strength of my message. I'm running again, because the time is ripe to finally bring single-payer to fruition, and I look forward to helping lead the charge, speaking with a voice of authority, based on my nearly 30 years of patient care. But is the DCCC behind me? No, of course not. Instead, they've recruited a former fundraiser of Senator Dick Durbin, a woman who speaks in broad generalities about health care, offering such platitudes as "I want to fix what needs to be fixed with Obamacare, not throw it out."



With the help of Blue America, I'm looking forward to beating the DCCC again in our primary next March, and then finishing the job in November 2018. We've waited way too long for the system which will be great for our health and for our economy: single-payer. We are nearing the end of the era dominated by the for-profit health insurance industry.

David defines "courageous" among candidates we've worked with. Please consider helping him win his battle to end conservative domination of his sprawling central Illinois district that goes from Bloomington and Champaign in the north, through Decatur and Springfield to the outer suburbs east of St. Louis, by tapping on the thermometer on the right.