By the AP –

WASHINGTON (AP) — Two Senate rebels jumped into Congress’ cut-the-deficit competition on Tuesday, proposing to raise the age of Medicare eligibility to 67 and increase monthly premiums for millions of current beneficiaries.

“We can’t save Medicare as we know it,” said Sen. Joseph Lieberman, I-Conn., who authored the plan with Republican Sen. Tom Coburn of Oklahoma. “We can only save Medicare if we change it,” he added in an apparent jab at President Barack Obama and congressional Democrats.

Democrats reacted with criticism of the proposal, which Coburn said was designed to rescue the financially imperiled program and help the nation confront a “wall of debt.” Republicans betrayed no sign of support either.

If nothing else, the response underscored the difficulty of legislative free-lancing at a time the Obama administration and congressional leaders are struggling to negotiate a compromise that cuts future deficits and clears the way for an increase in the nation’s $14.3 trillion debt.

Without a debt limit increase by Aug. 2, Treasury Secretary Timothy Geithner has warned, the government could default, risking calamity for the U.S. economy and serious effects worldwide.

Republicans walked out of bipartisan talks last week but nevertheless said negotiations had been fruitful. In the days since, Obama has stepped up his personal involvement in the effort.

After meeting separately with the Senate’s Republican and Democratic leaders on Monday, he invited the Democratic leadership to a White House meeting on Wednesday.

In the earlier talks, led by Vice President Joe Biden, key lawmakers had outlined a series of proposals to cut several hundred billion dollars over the next decade.

Other proposed cuts were on the table, including nearly $1 trillion from the assumed end of the wars in Iraq and Afghanistan. Officials familiar with the negotiations say Republicans are reluctant to count that money toward any agreement, saying they want more tangible cuts in domestic programs before agreeing to vote for an increased debt limit.

Also in the way of an agreement is a partisan dispute over taxes, which Republicans don’t want raised, and Medicare benefits, which Democrats don’t want cut.

Lieberman and Coburn were not nearly as reluctant, including both in their prescription for Medicare.

“Nobody’s going to like this plan, we understand that,” said Lieberman, who was the Democratic vice presidential candidate in 2000 but is now an independent who regularly picks spots to challenge his former party.

His statement that Medicare can’t be saved in its current form seemed a direct rebuttal to Obama, who said earlier this year that a House Republican proposal would “end Medicare as we know it” — something he vowed would not happen while he was in the White House.

Coburn is a conservative Republican. But he challenged his party orthodoxy earlier this year when he said he was willing to include higher revenues as part of any deficit-reduction deal.

The plan the two men outlined includes a gradual increase over the next five years in the monthly premium that seniors pay for doctor and other non-hospital services. Aides said it would translate into a monthly increase of $15 to $20 initially.

The age of eligibility would rise gradually from 65 to 67.

For the first time, better-off seniors would be charged more money for Medicare Part A, which covers hospital care.

The same group already pays more for doctor visits as well as for prescription drug coverage and, under the plan, would face even higher monthly premiums.

A major source of savings would come from making sure seniors pay out of pocket for at least a portion of their care. To accomplish that, Lieberman and Coburn proposed barring insurance companies from selling Medigap policies that offer first-dollar coverage.

The plan by Lieberman and Coburn would preserve Medicare as a government program, unlike a House GOP proposal that would require millions of future beneficiaries to purchase coverage from private insurance companies.

Additionally, the plan includes a $7,500 limit on out-of-pocket costs for doctor or hospital coverage, a provision designed to protect seniors who face potentially catastrophic costs.

According to the most recent report by the Medicare trustees, the giant program’s insurance fund is projected to run out of money in 2024, five years earlier than last year’s estimate.

By J. Lester Feder for Politico –

Defenders of Medicaid have been fighting hard against Republican proposals to cut the program, but they’re just waking up to the threat of one proposed by the Obama administration.

It’s an idea to change the way federal matching funds work and save money in the process — and it would probably do it by shifting costs to the states. If that happens, Medicaid advocates fear, the states will just pass on the cuts to providers and, ultimately, the patients.

In the budget blueprint unveiled in April, President Barack Obama proposed adjusting the way federal matching funds paid to the states are calculated for Medicaid and its companion, the Children’s Health Insurance Program. Sources close to the administration tell POLITICO that White House officials have been trying to develop the idea into a version that could become part of a deal in the ongoing deficit reduction talks.

Today, state dollars in these programs are matched at different rates for different populations. For the Medicaid population, under the matching formula known as the Federal Medical Assistance Percentages, the federal government pays an average of about 57 percent of the national costs. For CHIP, the rate is about 70 percent.

And when the Patient Protection and Affordable Care Act expands Medicaid coverage starting in 2014, the federal government will initially pick up all of the costs of the new population entering the program, then scale back to 90 percent in later years.

The administration wants to create what’s known as a “blended rate” for these programs, recalculating the levels so states receive federal dollars at the same rate for all populations in joint state-federal health programs. And in the process, they want to contribute to Medicaid savings totaling $100 billion.

This has Sen. Jay Rockefeller (D-W.Va.) nervous.

“What we know is that in order to generate ‘at least $100 billion’ in savings, any blended-rate proposal would have to severely reduce federal Medicaid and CHIP payments to every state over time, with some losing a lot more than others,” Rockefeller said. “And the underlying needs and costs don’t disappear — they just move from the federal side of the ledger to the state side.”

“Such a substantial cost shift to already financially strapped states would force states to reduce or eliminate Medicaid coverage, cut provider payments even more and completely undermine the Children’s Health Insurance Program. This is not a viable option and would spawn a formula fight among the states,” he said.

One reason little attention has been paid to the blended-rate proposal is that the administration has been noticeably silent on it. The only public information it has released on the plan came in the fact sheet accompanying the president’s April speech, which contained a single sentence on the issue that also references introducing a new mechanism for enhanced federal support during hard economic times.

“The president’s framework would replace the current complicated federal matching formulas with a single matching rate for all program spending that rewards states for efficiency and automatically increases if a recession forces enrollment and state costs to rise,” it reads.

But despite the public silence since then, White House officials have been actively developing a detailed proposal that could be part of a budget deal, sources close to the administration say.

This information void has led advocates to hold their fire, especially in the face of threats that were getting a lot of public attention: block-granting the program, capping federal expenditures or repealing Affordable Care Act prohibitions on cutting the program in the run-up to 2014.

Read more…

Last week, the Arizona Supreme Court announced that it will not be taking action to stop planned Medicaid cuts or an enrollment freeze.

By Zaid Jilani for ThinkProgress –

Since last year, low-income Arizonans have been feeling the impact of a series of brutal Medicaid cuts that officials predict will kick at least 135,000 people off the state’s health care rolls by next year. Now, thanks to these cuts, a Yuma man may be unable to afford a heart surgery he needs to survive.

Steven Stephenson recently quit his job over health issues. While he was working, his income fell under the federal poverty limit, and he would have been covered by the state’s Medicaid system, the Arizona Health Care Cost Containment System (AHCCCS). Yet when he quit his job, he enrolled in Social Security. His income actually increased thanks to this, and while he would have been still covered under AHCCCS just a few years ago, the new cuts actually will make it impossible for him to enroll.

Why? Because thanks to his Social Security payments, he earns $12 too much to apply. Due to his medical condition, he has been ordered by his doctor to not work, and he desperately needs surgery:

Stephenson said he cannot work anymore based on doctor’s orders and has been told not to do anything to avoid stressing himself out. This is a problem for Stephenson. “I love working. I can’t sit around and do nothing,” Stephenson said, evidently frustrated with his situation. [...]Stephenson did not have heart problems until he reached his 40s. While he has not had a heart attack, both of his parents died from one. “It’s what you inherit from your parents. Too bad it wasn’t good looks, I’d be better off,” Stephenson said with a laugh. [...]

[Stephenson's best friend] Weissman said he plans to organize a series of fundraisers in the community to help his best friend out with his medical bills and to get the heart surgery under way. “You know how somebody passes away and all of a sudden they hold carwashes to help bury them … Well, I’m going to do fundraisers to keep mine alive,” Weissman said.

Last week, the Arizona Supreme Court announced that it will not be taking action to stop planned Medicaid cuts or an enrollment freeze; activists had hoped their lawsuit would compel the state to reverse some of its harsher cuts, much like the Washington state supreme court reversed some cuts in that state. While Stephenson’s situation is a direct result of Arizona choosing to cut its Medicaid program, it bears repeating that the United States is the only rich country that does not provide comprehensive universal health care coverage to all of its citizens. In no other wealthy country would a man be told he can’t afford a life-saving surgery.

The National Organization for Women wrapped up its 45th National Conference in Tampa, Fla. on Sunday, June 26, setting NOW’s policy and agenda for the coming year and looking toward the 2012 elections and beyond. Topping NOW’s policy agenda are improved Social Security benefits for women and a “Medicare for All” single-payer health care system as the solution to our health and fiscal crisis, including supporting Sen. Bernie Sanders’ American Health Security Act of 2011 (S 915).

“Women need jobs, not cuts,” said NOW President Terry O’Neill. “We oppose any cuts to Medicare, Medicaid and any health benefits derived from the Social Security Act. And candidates who want women’s support need to stand with us in support of single-payer healthcare legislation on the state and federal levels.”

Celebrations erupted throughout the conference when the New York state senate passed the marriage equality bill by a 33-29 vote. “This was a historic moment,” said O’Neill, “New York is the largest state to recognize same-sex marriage and we want other states to follow suit quickly. I’m proud of NOW’s long support for LGBT rights and even prouder that the conference passed a resolution calling for stepped-up activism for marriage equality.”

Other resolutions passed on the final day of the conference included pressing for reproductive civil rights legislation, using Title IX action networks to help end sex discrimination in education, ensuring inclusion of women and girls with disabilities in the U.S. Department of State programming and more.

The conference presenters, speakers and honorees, who included influential women in politics, groundbreaking activists and leaders in the medical field, were inspiring and motivating to the hundreds of NOW leaders gathered in Tampa.

O’Neill concluded: “The energy of the women that filled the rooms made this year’s NOW conference one to remember. I’m thrilled by the success of our gathering, and re-energized to win women’s long struggle for equality.”

By ThinkProgress –

The National Institute for Health Care Management Foundation’s new report finds that annual American health care spending is now at $8,100 per person in 2009, for a total $2.5 trillion dollars or 17.6 percent of the GDP in 2009. “Higher utilization of medical technology, rising treated prevalence rates for chronic diseases, and increased provider consolidation and market power” have all contributed to the national increase in costs, the study concludes:

By Mike Alberti for Remapping Debate –

It was not so long ago that a universal, single-payer health insurance program administered and financed by the federal government looked like a viable policy option. Barack Obama supported a single-payer system on the campaign trail in 2008, and, in the early stages of the subsequent battle over health care reform, both a single-payer framework and a “public option” that would compete with private health insurance were solidly backed by many Democrats and a significant portion of the general population.

But by the final stages of the debate, amidst united Republican opposition, single-payer had largely been excluded as an option by the Administration. What became known as the Patient Protection and Affordable Care Act (ACA) did not include even a public option. And for the last year, as Republicans attempt to repeal the ACA and hobble it by underfunding, Democrats and health care advocates have rallied behind it. For many, the fact that the ACA represents far less than they had originally wanted has been put aside, with the legislation recast as a victory to be defended.

There is still a vocal group of advocates, however, who believe that the ACA does not go far enough in providing guaranteed access to quality, affordable health care. And indeed, at both the state and national level, there has been a resurgence of interest in moving the United States past the Affordable Care Act and into a single-payer system. Single-payer bills have been introduced at the federal level and in several states; this year, Vermont became the first state to pass a framework bill that could introduce a single-payer system in the next several years.

But these single-payer proponents are finding it hard to recruit those organizations who favor increased access and affordability, but who feel that support for single-payer could make the ACA more vulnerable, and that support for the ACA is obligatory because the legislation constitutes the only “realistic” policy choice. According to advocates who continue to press for a single-payer system, however, the acquiescence of those sympathetic to pro-access arguments has had a significant impact on narrowing the debate over how the health care system in the U.S. should work — and on moving the center of gravity of that debate further to the right.

Continue reading or download the full report (.pdf).

By Healthcare-NOW! –

Sen. Bernie Sanders [I VT] introduced a revised version of the “American Health Security Act,” a national single-payer “Medicare-for-all” healthcare bill, calling for the right to healthcare for all. The Bill, designated as S 915 is an updated version of S 703, submitted in 2009, and joins Rep. Jim McDermott’s [D WA] companion bill in the House of Representatives, HR 1200.

The bills strengthen our movement for a just, equitable healthcare system at a time when attacks are intensifying on our most successful social insurance program, Medicare. Several national unions and the AFL CIO joined to endorse these bills. This endorsement builds on the hundreds of endorsements by central labor councils, state, national, and international unions supporting HR 676.

Some notable improvements have been made to S 915/HR 1200 in this most recent version, including:

• A more equitable tax structure putting the burden on the wealthy to pay fairly into a national healthcare system
• Provides for union/company benefit plans to be maintained if desired, but solely to provide extras other than the medically necessary care that is covered for everyone.
• Dedicated funding to ensure that transitional benefits would be available for insurance industry and administrative workers who may be displaced as a more efficient and streamlined healthcare system is adopted.
• Full funding for community health centers giving the 60 million Americans now living in rural and underserved areas access to care.
• Addresses the critical shortage of nurses, primary care physicians and dentists with dedicated funding.

As with earlier versions of the American Health Security Act, this is not a direct companion bill to HR 676. For example, HR 676 builds on the existing structure of Medicare, which may permit an easier, quicker, and less expensive transition to universal single-payer. S 915/HR 1200  emphasizes state administration which, some activists believe, may facilitate coordination with the various state-level single payer movements and build on the effort in the states required to set up the exchanges under the insurance reform bill passed in 2010. 

HR 676 eliminates the role of for-profit hospitals and care centers by calling for conversion to non-profit with a provision to compensate for-profit providers with financial losses incurred in the conversion.  S 915/HR 1200 does not call for the conversion of providers to non-profit. Significant evidence shows that non-profit providers deliver higher quality care at less cost. 

On the crucial question of eligibility, Healthcare-NOW! has always advocated for inclusive eligibility policies and will continue to demand that all legislative vehicles have strong language providing healthcare to everyone living and working in the United States.  Leaving undocumented brothers and sisters out of our system is unfair, bad public health policy, and should be strongly opposed. We recognize the challenge for our movement to change the political dynamics that permits lawmakers to exclude certain residents from our healthcare system.  Everybody in, nobody out!

We urge you to review this statement, and welcome S 915/HR 1200 as additional legislative vehicles with HR 676 in the 112th Congress. Organized support for HR 676 continues to bring in cosponsors (currently 60 in the 112th Congress) and endorsements nationwide. As always, please contact Healthcare-NOW! to help support these efforts at info@healthcare-now.org or 800-453-1305.

You can read the full text of  S 915 and HR 676.

By Yvonne Yen Liu for New America Media –

Vermont, land of rolling green hills dotted with black and white Holsteins and picturesque red barns. White people, everywhere, lots of them. Home of state-sanctioned town hall meetings that are models for participatory democracy. And now, the first state in our republic to enact universal health care for all. Two weeks ago, Gov. Peter Shumlin signed into law H. 202, “An act relating to a single-payer and unified health system.” It’s the first state to plunge into a single-payer system to implement national health care reform, which Harvard economist William S. Hsiao found was the best method to both reign in spiraling costs and diminish disparities.

Nationally, the need is perhaps more dire now than ever as safety net hospitals close down across the country. These hospitals are often places of last resort for care for the uninsured and for undocumented immigrants—populations that are disproportionately comprised of low-income people of color. According to the Kaiser Family Foundation, 44.4 percent of Latinos lack insurance, as well as 28.5 percent of black people and 21.2 percent of Asian Americans. In contrast, 16.5 percent of whites don’t have coverage.

Vermont takes one bold step towards reversing these disparities by extending coverage to the thousands of undocumented workers who toil in obscurity, hidden by the state’s rural isolation. That victory comes after a two-year, people-led movement to fight for single-payer care, under the banner of Healthcare is a Human Right—an effort that included a heroic, last-ditch campaign by the Vermont Workers Center to repeal an amendment that would have excluded undocumented workers.

Workers like Jose Obeth Santiz Cruz, who traveled a long way to toil without rights on Vermont’s farms. Santiz Cruz’s relatives and friends told him of opportunities to work in dairy farms—it would be hard work and a lonely life, but he could save money to send back to the village of San Isidro, in the Chiapas mountains, where he supported his parents and two siblings. So in early 2009, Santiz Cruz made the trek of over 3,000 miles, stopped at the Mexican border for 20 days before heading North.

His new home, framed by snow-capped Green Mountains to the east and New York’s Adirondacks to the west, was so different from Chiapas. But Santiz Cruz found work at a dairy farm in Franklin County and used his earnings in the initial months to repay the thousands of dollars he owed to the coyotes, as smugglers are called, who helped him cross the border.

One night two years ago, close to Christmas, Santiz Cruz’s coworkers found him dead in the barn. His clothing had gotten caught in a gutter cleaner, a chain-driven motor machine that scrapes out the gutter where cow waste collects. Unable to extricate himself, he was pulled into the motor and strangled to death. Santiz Cruz was only 20 years old.

Santiz Cruz’s death was a wake-up call to local residents that the farmworker community needed support. Migrant farmworkers, most hailing from Mexico or Guatemala, are a relatively new population in Vermont. They began fulfilling the need for labor on small family farms in the state roughly 10 years ago, after children of Vermont farmers chose to not follow the path of their parents into a profession that is increasingly hard to sustain. In 2009, 33 family dairy farms closed down. Those that remain open depend on migrant labor. A third of Vermont’s farmworkers are from Chiapas, many are indigenous Tojolabal, said Brendan O’Neill, cofounder of the Vermont Migrant Farmworker Solidarity Project.

The dairy industry in particular relies heavily on imported labor, with most farms employing one to two workers, the largest with 10 workers. Most of those workers are undocumented, like Santiz Cruz, having traveled north out of economic need; others come through guest worker programs. Farmworkers in Vermont earn anywhere from $5 to $10 an hour, the average is $7, working 12 to 15 hour days. Most stay for under two years, sending remittances home, before returning themselves.

These workers have until now gone without access to health care, without oversight of their working conditions for safety and health violations, and without recourse to other services that our social safety net extends to most of our citizens. (Well, it’s now a fight to preserve those services for anyone in this age of budget cuts). A 2007 report by the Vermont Department of Health found that farmworkers face many barriers to health care, including lack of language translation, transportation to providers, and fear of deportation.

“People live with bad injuries, through sickness; they don’t go to see doctors, because of fear of deportation,” explained O’Neill. “Up at the border, we have a really tense ICE presence: [it’s] pretty common to talk to workers close to the border who literally never leave the farm. [They’ve] been there for two years and never stepped foot off the farm.”

As the migrant labor force continues expanding, the problems caused by their isolation from health care, among other services, is becoming more critical.

“We’re seeing more undocumented workers in different industries. Primarily, up til now, they were in the dairy industry, but now they’re at vegetable farms and doing construction,” said James Haslam of the Vermont Workers Center. “We’ve operated a workers rights hotline since 1998. We occasionally got calls [from undocumented workers] and they’ve increased, despite the fact that up til now all our materials are in English. Still, somehow, people find our number.”

The number of Latino farmworkers in Vermont peaked between 2,000 to 2,500, in 2005, according to Cheryl Mitchell, cofounder of the Addison County Farm Worker Coalition and former deputy secretary for Vermont’s Agency of Human Services. The population has gradually decreased as border control has stepped up efforts. With 3.9 percent of Vermont’s total population being people of color, it’s easy to target anyone not white. “Vermont is such a homogenous state, so the potential for racial profiling is scary,” said Mitchell.

Five years ago, at the first public forum on farmworker solidarity, organized by Mitchell’s Addison County Farm Worker Coalition, the Mexican consulate reported that Vermont at the time had the most number of deportations per capita among all states in New England.

After Santiz Cruz’s death, local Vermonters organized a candlelight vigil in his honor. However, fellow farmworkers were afraid to attend, concerned that the border patrol would be present. O’Neill and other organizers with the Vermont Migrant Farmworker Solidarity Project raised funds to bring Santiz Cruz’s body to his home in Chiapas for burial. They also created a film, “Silenced Voices,” about their journey to San Isidro with Santiz Cruz’s coffin. The village initially subsisted off of growing coffee, but was unable to sustain itself when global coffee prices fell and free trade agreements (like NAFTA) eliminated Mexican-government subsidies.

For now, O’Neill and his colleagues try to establish links between rural Vermont and the mountain villages of Chiapas—lands separated by vast distances, but united by farmers and workers who struggle under the same forces of global capitalism.

The victory to include undocumented farmworkers in universal health care is a temporary one. Haslam, of the Vermont Workers Center, anticipates more fights ahead. “What we’re doing in Vermont is going on the offensive for human rights,” he said, “building a proactive movement, not just defending what we have, but pushing for and really turning things around.”

By David Gorn for California Healthline –

Only in San Francisco can a guy wearing a rainbow rasta wig be a voice of reason.

But there he was, among an estimated 400 boisterous protesters, trying to keep the sidewalk clear so pedestrians could pass through the colorful event. Event organizer Don Bechler also was busy keeping the gathering legal and peaceful.

“America deserves a health care system that’s not broken,” said Bechler, chair of California-based Single Payer Now. “We want to get rid of the insurance companies and their bureaucracy of denial. It’s crazy that doctors need to spend so much time dealing with insurance companies — that’s madness to deal with that kind of bureaucracy.”

Health care providers, labor groups and single-payer advocates turned out on the street outside of the annual convention of America’s Health Insurance Plans, a national trade group of health insurers.

Inside, political luminaries addressed the health care insurance industry — from former Senator Tom Daschle, a Democrat from South Dakota, to Republican presidential hopeful and Minnesota Gov. Tim Pawlenty.

Outside, protesters chanted, speakers orated, a pair of giant puppets battled each other (nominally an American citizen taking on insurance groups, but you really had to use your imagination) — and at one point the crowd was treated to the singing of a well-dressed group of ladies who called themselves the Raging Grannies of the Peninsula. They held signs reading “Survival of the Richest” and “Let Them Eat Advil.”

It was good theater, but critical care nurse Bobby Roberts came from San Pablo for more serious reasons.

“I see it all the time, insurers turning down health claims left and right. You see that they’re more worried about profits than patients,” Roberts said. “I have stories and stories, I could go on for days.”

National health care reform is a start, Roberts said, but he’s hoping to one day see the end of health insurance companies altogether. “It’s too much,” he said. “Too much profit, too much paperwork, too many people not getting the care they need. The insurance companies are fleecing us, that’s just so clear.”

Organizers estimated the crowd at about 400 people. San Francisco police reported no complaints.

By Kay Tillow –

In 2009 when the Washington beltway was tied up with the health care reform tussle, Montana Democratic Senator Max Baucus, chairman of the all powerful Senate Finance Committee, said everything was on the table–except for single payer. When doctors, nurses and others rose in his hearing to insist that single payer be included in the debate, Baucus had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”

Yet when Senator Baucus needed a solution to a catastrophic health disaster in Libby, Montana, and surrounding Lincoln County, he turned to the nation’s single payer healthcare system, Medicare, to solve the problem.

Baucus’ problem was caused by a vermiculite mine that had spread deadly airborne asbestos killing hundreds and sickening thousands in Libby and northwest Montana. The W. R. Grace Company that owned the mine denied its connection to the massive levels of mesothelioma and asbestosis and dodged responsibility for this environmental and health disaster. When all law suits and legal avenues failed, Baucus turned to our country’s single payer plan, Medicare.

The single payer plan that Baucus kept off the table is now very much on the table in Libby. Unknown to most of the public, Baucus inserted a section into the health reform bill that covers the suffering people of Libby, Montana, not just the former miners but the whole community—all covered by Medicare.

They don’t have to be 65 years old or more.
They don’t have to wait until 2014 for the state exchanges.
No ten year roll out—it’s immediate.
They don’t have to purchase a plan—this is not a buy-in to Medicare—it’s free.
They don’t have to be disabled for two years before they apply.
They don’t have to go without care for three years until Medicaid expands.
They don’t have to meet income tests.
They don’t have to apply for a subsidy.
They don’t have to pay a fine for failure to buy insurance.
They don’t have to hope that the market will make a plan affordable.
They don’t have to hide their pre-existing conditions.
They don’t have to find a job that provides coverage.

Baucus inserted a clause in the Affordable Care Act to make special arrangements for them in Medicare, and he didn’t wait for any Congressional Budget Office scoring to do it.

Less than two months after the passage of the health reform bill on March 23, 2010, Nancy Berryhill of the Social Security Administration in Denver joined personally in setting up an office in Libby to sign up these newly eligible people. “This is a new thing,” Berryhill told the Missoulian. “No other group like this has ever been selected to receive Medicare.” Berryhill issued a nationwide alert to inform anyone who had lived or stayed in Lincoln County of their eligibility. She opened a storefront in Libby at the old downtown city hall where she signed up 60 people on the first day. She plastered the towns of Whitefish and Eureka with pamphlets explaining the program and added three new staffers to the office in Kalispell.

Berryhill said she did not know how much the care would cost. That kind of analysis was beyond her directive to sign the people up. There have been no reports of competition from the private for-profit Medicare Advantage plans. The sick are not profitable.

No one should begrudge the people of Lincoln County. The mine wastes were used as soil additives, home insulation, and even spread on the running tracks at local schools. Miners brought the carcinogens home on their clothes. The W. R. Grace Company dumped much of the clean up costs onto the federal government. A June 17, 2009, order by the Environmental Protection Agency, the first of its kind, declared Lincoln County a public health disaster. The Libby Medicare provision in the health reform law is based on the area covered by that EPA order.

Baucus gave his reasons to the New York Times for its only story on this unique benefit: “The People of Libby have been poisoned and have been dying for a decade. New residents continue to get sick all the time. Public health tragedies like this could happen in any town in America. We need this type of mechanism to help people when they need it most.”

Health tragedies are happening in every town. Over 51 million have no insurance. Over 45,000 uninsured people die needlessly each year. Employers are cutting coverage and dropping plans. States in economic crisis are slashing both Medicaid and their employees’ plans. Nothing in last year’s reform law will mitigate the skyrocketing costs. Most insurance is threadbare and doesn’t cover. More than 50% of us now go without necessary care. As Baucus said of Medicare, “We need this mechanism to help people when they need it most.” We all need it now.

Bill Clinton recently stated that the U. S. could give coverage to all for one trillion dollars a year less than we now pay if we adopted the system of any other advanced nation. (Unfortunately, he did not say this when it would have mattered most during the 1993 and 2009 health care reform debates.)

Other industrialized countries have found that to cover everyone for less they must remove the profit-making insurance companies. Congressman John Conyers has reintroduced HR 676, the Expanded and Improved Medicare for All Act, which does exactly that. There are 60 cosponsors. It would cover all medically necessary care for everyone including dental and drugs by cutting out the 30% waste and profits caused by the private insurers.

So as the Ryan Republicans try to destroy Medicare and far too many Democrats use the deficit excuse to suggest cuts in its benefits, let us counter with the Libby prescription to clean up the whole mess. Only a single payer, improved Medicare for All, can save and protect Medicare, rein in the costs, and give us universal coverage.

Medicare will celebrate its 46th birthday on July 30, 2011, and all are invited to join in the festivities. Medicare was passed in 1965 and implemented within less than a year. When we pass HR 676, this single payer bill, we can all be enrolled in the twinkling of an eye.

www.unionsforsinglepayer.org

All Unions Committee for Single Payer Health Care–HR 676

By Ray Stever for Times of Trenton –

In 1777, the Commonwealth of Vermont became the first sovereign state in the world to abolish slavery. On May 26, 2011, Vermont became the first state in the U.S. to commit itself to establishing a truly universal single-payer health care plan. Thus, Vermont could lead the rest of the United States to do what all of the other major industrialized countries have already done: Establish a not-for-profit, single-payer national program to provide health care for all of us. Single-payer movements have already made important progress in California and Pennsylvania. The New Jersey One Plan One Nation coalition is leading the campaign in New Jersey.

Both the abolition of slavery and the establishment of a truly universal health-care system were based on human rights. The Universal Declaration of Human Rights, which was drafted in 1948 by a committee chaired by first lady Eleanor Roosevelt, holds that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care.” It is truly an embarrassment that the United States is the only major industrialized nation that fails to ensure that all its people have access to medical care.

There are also solid business reasons to expand Medicare to cover everything for everyone. A single, efficient, not-for-profit, single-payer public system for paying for health care would provide many important economic and social benefits to the people of New Jersey, and not just to our 1.3 million uninsured.

Health insurance companies have been increasing their premiums by up to 20 percent per year, even while providing less coverage. The average annual cost of employee-based family health insurance in New Jersey is $13,750. Health insurance companies charge a 31 percent overhead. Medicare’s overhead is only 3 percent. Under Medicare for All, individuals and families will pay less for health insurance. Patients will pick their own doctors. Patients and doctors, not insurance companies, will make treatment decisions. Patients will also be freed from the fear of medical bankruptcy. In the United States today, 62 percent of cases of personal bankruptcy result primarily from illness and medical debt. Of these cases, 70 percent had health insurance when the bankrupting illness or injury arose.

Large and small businesses, nonprofit organizations and state and local government will also benefit from the single-payer system because it will provide comprehensive medical insurance to all of their employees at a much lower cost. This cost savings will reduce the cost of government and provide a substantial boost to the competitiveness of businesses.
A single-payer system would largely solve New Jersey’s budget problems. The state government would save $2.6 billion per year on employees’ health care, charity care and workers’ compensation. New Jersey would also eliminate more than $60 billion in unfunded obligations for retirees’ medical care. The City of Trenton would save $18.2 million per year. Camden would save $17 million per year. (Seventy five percent of Camden’s budget comes from the state of New Jersey.)

Health-care providers will also benefit from the single-payer system. Under the current system, doctors often find their professional judgment second-guessed by anonymous insurance company clerks. Then, doctors and their staff must navigate a complicated bureaucratic maze if they hope to be paid. A single-payer system eliminates this bureaucratic nightmare, providing instead a simple and streamlined billing system. It will be like today’s Medicare system, except more inclusive, more comprehensive and potentially more generous to health-care providers.

Congress should be working to expand Medicare to cover all necessary care for everyone. Instead, some members of Congress are threatening to cut Medicare funding, even though 92 percent of Democrats, 73 percent of Republicans, 75 percent of independents and 70 percent of Tea Party members oppose cuts to Medicare, according to a McClatchy-Marist poll conducted in April.

Like abolition, women’s suffrage and the civil rights movement, the passage of Green Mountain Care in Vermont was the product of a grassroots political mobilization. The movement for a simple, economical and humane system for providing health care is the civil rights movement of our generation. New Jersey One Plan One Nation is leading that movement here in the Garden State. Join us.

Ray Stever is president of the New Jersey One Plan One Nation Coalition (njoneplan.org).

By Emily P. Walker, MedPage Today –

Several hundred members of National Nurses United held a rally here on Tuesday to call for a single-payer healthcare system, an end to tax breaks for big corporations, and workers’ rights.

The nurses started their march in front of the White House and walked across the street to the U.S. Chamber of Commerce chanting “Hey Chamber, you can’t hide, we can see your greedy side.”

The union wants Congress to levy higher taxes on Wall Street, which would include the big companies that the Chamber of Commerce represents, Dan Rec, RN, of Jamaica Plain, Mass., explained.

The nurses then bussed over to the Capitol where they were serenaded by a singer/guitar player who belted social justice tunes, and then heard brief speeches from Sen. Barbara Boxer (D-Calif.) and Sen. Bernie Sanders (I-Vt.).

Sanders, like the 175,000-strong nurses union, is a major proponent of a single-payer healthcare system.

“If you have the money, you have good healthcare,” Rec told MedPage Today. “If you don’t have the money, it’s ‘oh well.’ It needs to be healthcare for all.”

Boxer spoke out against Rep. Paul Ryan’s plan to drastically change Medicare for those who are currently under 65, saying many in Congress don’t want to change the insurance program for the elderly.

As leaders debate ways to reform healthcare, politicians repeatedly tell a worried public that Britain will not turn the National Health Service into an ‘American-style’ private system.

By Henry Chu, Los Angeles Times –

Two years ago, Britons were outraged when U.S. politicians like Sarah Palin, in the debate over healthcare reform, turned this country’s National Health Service into a public whipping boy, denouncing it as “evil,” “Orwellian” and generally the enemy of everything good and true.

It’s time for some payback.

Britain is now embroiled in a healthcare argument of its own, prompted by a proposed shake-up of the NHS. And the phrase on everyone’s lips is “American-style,” which may not be as catchy as the “death panels” that Palin attributed to socialized medicine but which, over here, inspires pretty much the same kind of terror.

Ask a Briton to describe “American-style” healthcare, and you’ll hear a catalog of horrors that include grossly expensive and unnecessary medical procedures and a privatized system that favors the rich. For a people accustomed to free healthcare for all, regardless of income, the fact that millions of their cousins across the Atlantic have no insurance and can’t afford decent treatment is a farce as well as a tragedy.

But critics here warn that a similarly bleak future may await Britain if a government plan to put more power in the hands of doctors and introduce more competition into the NHS succeeds — privatization by stealth, they say.

So frightening is the Yankee example that any British politician who values his job has to explicitly disavow it as a possible outcome. Twice.

“We will not be selling off the NHS, we will not be moving towards an insurance scheme, we will not introduce an American-style private system,” Prime Minister David Cameron emphatically told a group of healthcare workers in a nationally televised address last week.

In case they didn’t hear it the first time, Cameron repeated the dreaded “A”-word in a list of five guarantees he offered the British people at the end of his speech.

“If you’re worried that we’re going to sell off the NHS or create some American-style private system, we will not do that,” he said. “In this country we have the most wonderful, precious institution and also precious idea that whenever you’re ill … you can walk into a hospital or a surgery and get treated for free, no questions asked, no cash asked. It is the idea at the heart of the NHS, and it will stay. I will never put that at risk.”

Cameron’s eagerly declared devotion to the NHS illustrates the totemic role it plays in British society, an institution so cherished that some describe it as the closest thing here to a truly national religion. Created in 1948, as the country struggled to rise from the ashes of World War II, the NHS is widely hailed as the welfare state’s biggest triumph.

Since then, it has bloomed into a behemoth that gobbles up nearly $170 billion a year in taxpayer money — an amount set to grow along with Britain’s aging population — and is one of the nation’s largest employers.

Governments of all stripes have taken office pledging to reform the system, to streamline it and make it more efficient, but none has fully succeeded, knowing that they tinker with the NHS at their peril. The current Conservative Party-led coalition, which has embarked on the most radical public spending cuts in a generation, has promised not to take a penny from the health service.

To each other, Britons love to complain about the NHS, retailing gruesome tales of substandard care, of long waiting lists for simple operations like hip replacements, of snotty surgeons and naughty nurses. But when Americans began citing the NHS as the epitome of socialized medicine gone wrong, people here bristled.

Fear that Britain is becoming more like the U.S. extends beyond healthcare. “American-style” is also the epithet of choice to describe the direction of Britain’s higher-education system.

To make up for lost state funding, many public universities, including Oxford and Cambridge, have decided to take advantage of a new law allowing them to charge students a maximum of $14,750 in annual tuition, nearly triple the current price tag. Shelling out huge sums for college may be part of the American way, but Britons don’t like it.

Last week, well-known philosopher A.C. Grayling caused a stir by announcing the creation of a private university, featuring top British and U.S. academics, that will charge nearly $30,000 a year.

There have also been demonstrations over the proposed NHS overhaul. Britons are so uneasy about the changes that a sheepish Cameron was forced to put them on hold and ordered his ministers to go on a two-month listening tour to hear out voters.

“We recognize that many people have had concerns about what we were doing,” Cameron said. “This has been a genuine chance for people … to work together to strengthen the institution we all love and hold dear.”

The results of the review, and the government’s expected concessions, are to be unveiled this week.

The changes will be debated in the public arena and fought over in Parliament. Doctors’ groups will no doubt say one thing, patients’ advocates another. In the end, lawmakers will probably approve a messy healthcare compromise that will anger many and please few.

Which just goes to show that maybe Britain and America aren’t so different after all.

A Capitol Police Officer oversees us deliver 2,100 letters to Rep. John Boehner asking him not to cut Medicare, Medicaid, or Social Security.

Thanks to all of our supporters, over 2,100 people signed our petition asking Speaker of the House John Boehner not to cut or privatize Medicare, Medicaid, or Social Security.

Many of you shared your personal stories with the Speaker in the hopes that he will take those who are uninsured, underinsured, and/or living in poverty into consideration before he calls for cuts to our social insurance programs.

As promised, on June 7th we–a handful of members of Healthcare-NOW!, Progressive Democrats of America, Physicians for a National Health Program, and the Grey Panthers–delivered a stack of all 2,100 signatures and letters to John Boehner’s office. We asked to meet with the Speaker, but he was unavailable. Then we asked to meet with his health legislative aide, but he/she wasn’t available either.

So we asked to read your letters aloud in his office until the Speaker was available to meet with us. Before we finished reading the first letter, the Capitol Police arrived and asked us to leave. We handed the stack of letters for John Boehner to his receptionist and then were immediately escorted from the office. The police locked the door behind us as we left.

Determined to have our stories heard, we continued reading your letters in the hallway in front of John Boehner’s office. We posted photos from our visit to John Boehner’s office here. And Alison McLeod, RN, BSN created a great video of the visit below.

Here’s Alison’s account of the visit:

“In D.C., I had the honor of participating in (and videotaping) an action at Speaker of the House John Boehner’s office. Katie Robbins of Healthcare-Now collected hundreds of testimonials from people who have suffered under the present profit –driven system – and will suffer more if Medicare and Medicaid are further defunded and privatized. These stories made us cry, and since John Boehner has a tendency for weepiness, we each came armed with a box of Kleenex. Boehner wasn’t there, and his aide called the security guards, so we had to read the testimonials in the hall.
But we left behind the stories – and the Kleenex.”

Alison McLeod, RN, BSN
Southern Arizona Field Organizer
Progressive Democrats of America

By the AP –

TRENTON, N.J. — As states across the country look for ways to trim billions off their spending on Medicaid, New Jersey is garnering particular attention for a proposal that opponents characterize as an unprecedented and draconian attempt to balance the state’s precarious budget on the backs of society’s most vulnerable populations.

The debates taking place in statehouses, clinics and living rooms crystalize the unfortunate truth about economic recessions: Citizens rely most on public services just when the government has the least money to spend on those services.

In New Jersey’s case, changes would mean a parent of two earning more than $103 per week would be ineligible.

As a joint federal-state venture, Medicaid changes provide endless opportunities for political collision. New Jersey’s proposal to cut more than half a billion dollars occupies the delicate intersection between the Republican governor’s budget, the Democratic Legislature’s priorities, President Barack Obama’s health care reforms and U.S. Rep. Paul Ryan’s proposed entitlement overhauls.

The 46-year-old Medicaid program provides government-funded health care to low-income people at risk due to disability, age, chronic illness or other circumstances. It was expanded in 1997 to cover more individuals through the Children’s Health Insurance Program, known in New Jersey as NJ FamilyCare. States have substantial flexibility to determine the “who,” ‘’what” and “how” of services offered.

At issue in New Jersey is a $540 million cut to state Medicaid funding that Gov. Chris Christie proposed for next year’s budget. About $240 million comes from specific program cuts, such as $140 million dropped from nursing home coverage.

“If the cuts go through, it could mean more dangerous falls, not getting my medicine,” said Maureen Liberatore, 77, whose care in a Cinnaminson, N.J. nursing home is Medicaid-funded.

Christie hopes to save $300 million through a “comprehensive Medicaid waiver.” States submit waivers to the federal government requesting permission to restructure their program outside the core parameters for what they must cover.

A provision of the health care changes Obama championed prevents states from turning away previously eligible residents without such a waiver. It’s a stop-gap measure until 2014, when another part of health care reform will expand Medicaid to anyone earning less than 133 percent of the poverty level.

“The state is effectively telling these families to wait until 2014 to get coverage again,” U.S. Sen. Robert Menendez, D-N.J., said Friday. “Unfortunately, there is no such thing as a waiver for getting cancer.”

About 1 million of New Jersey’s nearly 9 million residents are enrolled in Medicaid or NJ FamilyCare. Even with the proposed cuts, the state will spend almost $5 billion to fund the programs in 2012. The federal government chips in about an equal amount.

“We must do these things, not only to fill the hole created by the loss of over a billion dollars of federal stimulus money since 2010, but because it is the right thing to do,” Christie said in his budget address. “Medicaid’s growth is out of control.”

Continue…

Last night, June 8, Healthcare-NOW! hosted a national conference call featuring members of the Vermont Workers’ Center to discuss their Healthcare is a Human Right Campaign and the impact it had on universal healthcare legislation in their state.

If you missed the call but want to hear it, you can download it here (right click and save as) or listen on this webpage right now.

Our featured speakers, James Haslam, Mary Gerisch, and Cindy Perron from the Vermont Workers’ Center, along with Anja Rudiger of the National Economic and Social Rights Initiative, led a thoughtful discussion on how they built a statewide people’s movement of thousands of Vermonters demanding a universal, equitable, and accountable healthcare system. Don’t miss this opportunity to listen in on this discussion about movement-building, grassroots organizing tactics, and the human right to healthcare.

By Andy Coates for Labor Notes –

A year after President Obama signed his health care reform with strong support from the labor movement, advocates of a single-payer system might be tempted to ask, “How’s that working out for you?”

At last weekend’s conference of the Labor Campaign for Single Payer, a Plumbers and Pipe Fitters delegate pointed out that his members are paying $12.31 per hour for their health benefits.

The activists marshaled their forces once again in D.C. last weekend, where campaign coordinator Mark Dudzic reported progress on the group’s mission: “to establish and expand within labor the idea that labor has got to lead this fight” for single payer, or improved and expanded Medicare-for-All.

Indeed, the conference began June 3 at AFL-CIO headquarters and heard from President Richard Trumka himself. Trumka spoke of the reluctance of the AFL-CIO Executive Council to embrace single payer but pointed to disappointment with the president’s Affordable Care Act at the council.

He recalled meetings 20 years ago when he fought for single payer on the council and Karen Ignagni, then assistant to the AFL-CIO president, was “doing her damnedest” to thwart the effort. (Today Ignagni is CEO of America’s Health Insurance Plans, the lead lobby for health insurance corporations.)

Trumka referred to single payer as “the only way to cure the health care problem.” He proposed that labor should “continue to educate about Canada. It’s a big myth about Canada. I go there all the time. You sit down with someone over coffee and ask them: ‘Tell me about your health care.’ They say: ‘Oh, it’s a godsend.’ We need to get that message out.”

The AFL-CIO president also continued to gesture toward political independence for labor, saying, “We should strengthen our support for our friends and do less for our acquaintances.”

As signs of progress, Dudzic noted the federation’s financial support for the Labor Campaign, participation by Vice President Arlene Holt Baker in a press conference announcing single-payer legislation, and the fact that the AFL-CIO sent staffer Nick Unger to help the single-payer efforts in Vermont. (Unger was the same staffer who in 2009-2010 campaigned for single-payer activists to embrace the public option.)

Dudzic also reported progress within the Labor Caucus for Single Payer, a group of nine internationals chaired by Greg Junemann of the Professional and Technical Engineers. Dudzic suggested several unions in which single-payer activists should “insist that our leaders follow the direction of the members.”

Without the White House

The deafening silence coming from the White House was a recurring theme as participants discussed the state-by-state assault on labor, ongoing unemployment, and the relentless rise in the costs of care. Stuart Acuff of the Utility Workers counseled, “Our job is not to follow Obama. Our job is to hold Obama accountable.”

Although the chances of passing a single-payer bill this year are less than remote, delegates welcomed Representative Jim McDermott of Washington by conference call and Representatives John Conyers and Dennis Kucinich, co-sponsors of HR 676, in person. HR 676, which calls for a publicly financed, privately delivered health care system, has been introduced every year since 2003.

McDermott, a psychiatrist, recently introduced a single-payer House companion to one introduced by Senator Bernie Sanders of Vermont.

Delegates agreed to support both the McDermott and Conyer bills, yet took note that HR 676 covers the undocumented, forces for-profit hospitals to convert to non-profit status, and requires federal, instead of state-by-state, administration.

On more immediate efforts in the states, delegates heard a panel from Vermont, where the Act for a Universal and Unified Health System was signed into law May 26. Mari Cordes of the Vermont Nurses/AFT recalled that only two years ago single-payer advocates were called “bomb throwers” by Vermont legislators for sticking to a cause labeled “too hard” and “not possible.”

Jill Charbeonneau, president of the Vermont AFL-CIO, cautioned that the legislation was the first in a series of steps toward single payer—”a skeleton this year,” followed by a year-long process of defining the scope of health benefits under the plan, followed by a second to third year process “to decide how to finance the system,” and ultimately a need for waivers from the federal government.

A video excerpt from the Vermont Workers Center illustrated the grassroots campaign, predicting: “If Vermont Leads, the Rest of the Nation Will Follow.” On a panel about the effort in California, Cindy Young of the California Nurses Association laid out a multi-year strategy for achieving single payer in that state.

Don Tremontozzi, a local president who is running for the No. 2 job in the Communications Workers national union, described how his members phone-banked for single payer in Vermont this spring.

“Once it was, ‘I want what the unions have,’” Trementozzi said. “Now it’s, ‘Why should you have 100 percent coverage?’ We need to get to the public.”

He roused the room with a call to defend the existing benefits companies are trying to claw back.

Drawing parallels between his union’s upcoming contract negotiations with Verizon and talks now under way with General Electric, Trementozzi said, “Yesterday at the CWA headquarters Verizon made a presentation about how costly health care is. These companies make billions in profits! They pay their CEOs millions!”

Trementozzi said “these companies act like they make no money at all” when they come crying to jack up insurance rates and cut health benefits for retirees.

“I say, ‘Over my dead body!’” Trementozzi said. “When a company makes billions and pays no taxes—we won’t stand for it!”

We invite you to join Healthcare-NOW! tonight, Wednesday, at 8 pm (Eastern time) for a national conference call with speakers from the Vermont Workers’ Center. Vermont’s governor recently signed a bill — the first of its kind in the country — that lays out the framework for a universal, publicly-financed healthcare system, and puts Vermont on the course to establishing a single-payer healthcare system.

Our featured speakers are members of the Vermont Workers’ Center’s Healthcare Is a Human Right Campaign. These committed organizers have built a statewide people’s movement of thousands of Vermonters demanding a universal, equitable, and accountable healthcare system.

Please join this important discussion about movement-building, grassroots organizing tactics, and the human right to healthcare. RSVP here to receive the call in number and code.

Featured speakers:
- James Haslam, Vermont Workers’ Center, Director
- Mary Gerisch, Healthcare Is A Human Right Campaign Co-chair Policy Committee
- Cindy Perron, Heathcare Is A Human Right Campaign Steering Committee Leader
- Anja Rudiger, National Economic & Social Rights Initiative, Human Right To Health Program Director

Moderator: Katie Robbins, Healthcare-NOW! National Organizer

To learn more about the movement’s recent success in Vermont you can watch Vermont Can Lead The Way (8 min, 2010) and/or A People’s Struggle (4 min, 2011).

The people’s victory in Vermont is a huge breakthrough for the universal healthcare movement in this country, yet they face real battles on the road ahead to implement the system. As national opposition will spend millions to derail this effort, there will be a huge need for national solidarity. Contributions can be sent to www.workerscenter.org/donate or mailed to the Vermont Workers’ Center, 294 N. Winooski Ave, Burlington, VT 05401.

Healthcare-NOW! is an endorsing organization of Progressive Democrats of America’s Healthcare NOT Warfare Campaign.

To support the growing demand that we end foreign wars and bring money home for domestic needs, please sign this letter to the Senate Democratic Caucus asking them to support the DNC Afghanistan Withdrawal Resolution and Sanders’ American Health Security Act of 2011 (S.915).

This letter will be distributed to the members of the Senate Democratic Caucus on June 7, as part of the June 7 Rally and Lobby Day with the Nurses.

Many of our allies in the progressive movement have endorsed and signed this letter: we hope you’ll join them. Sign here.

Our goal is to gather at least 25,000 signatures between now and midnight, June 5. Click here to sign, and then please post this to your Facebook page and forward this message with your like-minded friends and family members.

By the Editors of the Nation –

The day after Democrat Kathy Hochul scored an upset victory in a special election deep in upstate New York’s Republican territory, former President Bill Clinton was getting real chummy with Congressman Paul Ryan, whose plan to privatize Medicare was widely seen as costing the Republicans the race and imperiling as many as a hundred GOP House seats in next year’s Congressional elections. Backstage at an event on national debt at the Peter G. Peterson Foundation, Clinton told Ryan, “I hope the Democrats don’t use it [the election] as an excuse to do nothing” on Medicare. Clinton may be right—but not in the way he seemed to mean.

The Democrats do need a winning Medicare plan, but they’re not going to find it by meeting Republicans in the middle (as Clinton’s former budget chief Alice Rivlin does with her Ryan-lite voucher proposal). And they’re not going to find it by only running against Republican ideas.

Indeed, the main strategy Democrats seem to have adopted in the wake of Hochul’s victory is to force Republicans to double down on Ryan’s agenda and pray that voters, particularly seniors, remain alarmed enough about the right’s shock doctrine tactics to throw the bums out. That might be a winning electoral formula, but how about some leadership and a plan to deal with rising healthcare costs? Where Democrats should look is Medicare itself—Medicare for all.

The chief lesson Democrats should take from the backlash to Ryan’s Medicare privatization scheme is that when faced with a choice between a market-based healthcare system and a government-run plan, voters overwhelmingly favor the latter. Nearly 80 percent oppose cutting Medicare benefits and two-thirds support raising taxes to continue to fund them. That’s because Medicare works—not perfectly, but compared with private health insurance, it’s far more efficient at keeping down costs while ensuring a baseline of coverage.

Contra Ryan, the problem with Medicare is that it’s not big enough; in countries like France and Canada as well as the United Kingdom, where government plays a much bigger role in financing healthcare and bargaining down prices, healthcare costs are about half what we currently spend, and they have comparable or better health outcomes.

Instead of just hoping that Republicans continue to play to their Tea Party base and implode in a general election, Democrats should be taking this moment to lead and to educate, not just on the practical virtues of Medicare for all but on the principle of social solidarity behind it.

They have the perfect opportunity now that Vermont Governor Peter Shumlin signed a single-payer healthcare plan on May 26. Vermont’s plan isn’t the single-payer system die-hard advocates want (there’s no funding for it yet, for example)—but it’s a start. If Vermont succeeds in providing its citizens with quality healthcare while keeping costs below market rates, other states may emulate its pioneering plan.

But in order to act as a national model, Vermont will need a federal waiver to bypass some of the requirements of the Affordable Care Act, passed in 2010. Obama has said he supports granting such waivers, but under current law he can’t do so until 2017. Vermont Senators Bernie Sanders and Patrick Leahy and Congressman Peter Welch have proposed legislation that would move the window up to 2014. That’s a bill worth going to the mat for.