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Will Single-Payer Supporters Have A Voice? An Interview With Senator Bernie Sanders

berniesanders.jpgRecently, Vermont Sen. Bernie Sanders introduced a single-payer bill into the Senate. The bill hasn't attracted much in the way of co-sponsors, but it's become a rallying point for single-payer supporters who feel locked out of the process. A few days ago, Sanders brokered a meeting between Max Baucus and single-payer advocates. I spoke with him last night about the bill, the meeting and what legislation could be yet more radical than single-payer health care. A lightly edited transcript of our interview follows. -- Ezra

Let's start at the beginning: Give me, if you can, the elevator pitch for S.703, the American Health Security Act.

If the goal of health-care reform is to provide comprehensive, universal health care in a cost-effective way, the only honest approach is a single-payer approach. And in my view the single-payer program would be best administered at the state level.

I fear very much that much of the talk of health-care reform is not getting to the root cause of why we have 46 million uninsured and, at the same time, we pay more for health care per person than any industrialized country on earth. And the reason the discussion is not getting to the root cause of the problem is that the discussion is unwilling to take on the role of private insurance companies that are precisely the reason our system is so wasteful, inefficient and bureaucratic. And not to take on that fact is to ignore the reason we are where we are.

You've introduced the only single-payer bill in the Senate. As far as I know, you're the only sponsor. That's in contrast to the House, where the cousin to your legislation has dozens of co-sponsors. Why do you think the Senate is more resistant to this proposal?

Well we have two cousins in the House. Conyers and McDermott. And we're more related to McDermott.

Fair enough. Why do you think the Senate is more reluctant to embrace this?

I think in general the Senate is a more conservative institution. I was in the House 16 years and I founded the House Progressive Caucus. In the House, you'd have 30, 40, 50 strong progressives. Percentage wise, we don't have that in the Senate. The reason why is the topic for another long discussion, but that's just the way it is.

For all the talk of the Congressional Budget Office lately, I haven't seen the CBO taking on your legislation or Rep. Conyer's. Have you submitted it to be scored?

We have not submitted it to be scored. If we can we surely will. It's not clear they would score it.

Why wouldn't they?

These studies don't take five minutes. If I were the chairman of the HELP Committee they'd score it.

Tell me about yesterday's meeting with Max Baucus. How did it come about? How did it go?

Baucus, after the arrest of nurses in his committee hearings, indicated a willingness to sit down and talk to single-payer advocates. His office didn't follow up on that so I chattered with him and decided to be the intermediary. So we arranged for some of the leading single-payer proponents -- Dave Himmelstein at Harvard, Marcia Angell also at Harvard -- and we picked a time and a place. And the meeting was cordial.

Baucus began by talking about a trip to Canada and saying he left impressed by what he'd seen. People in Canada seemed to be doing a very good job. He also indicated that he regretted having said that single payer is off the table. But he felt that at this point the process was so advanced and the timetable so tight that he didn't think he could schedule anything.

And what do you think about that?

There was nothing surprising on that. On the other hand, you could have a hundred hearings and he wouldn't be supportive of single payer. I think we will try to get a hearing in the HELP Committee.

I think the importance of the hearing is not that it will change minds but that the American people -- and Congress -- should hear the facts about the enormous waste and bureaucracy and profiteering associated with private health insurance. Not to deal with that is mind-blowing.

You've implied here that single payer may be the long-term goal. In the shorter-term, what should single payer advocates be looking to get out of the health care process Baucus is running? Are there any concessions that could make that a win?

I am sure that there are some single payer advocates who think the only thing worth fighting for is single payer. What I have also introduced, which we will be fighting for, is a five-state option. That would mean five states would have the option of running pilot programs in universal health care but one would have to be single payer.

I think it's possible this will never happen in DC, but that this country will join the rest of the industrialized world when a state, maybe like Vermont, implements single payer and does it well. And then New Hampshire will be looking over our shoulders, and they will adopt that, and so on through the country. That's in fact how national health care came to Canada, it started in the Saskatchewan province.

The second area of less importance, but important nonetheless, is the fight for a strong public option. In my view, if you had a level playing field and a pubic program and a private insurance program providing the same level of benefits, people would come into the public program because the public program would be substantially more efficient. I think we can make that case, and I will advocate for it in the legislation.

Lastly, you're the author of one of my favorite pieces of legislation: The bill to create a prize process for pharmaceuticals. Want to say a word on that?

That makes single payer look like a conservative bill! [Laughs] All that that does is take on the entire pharmaceutical industry and say that everything they've been telling the world for many years is simply not true. They're not using their huge profits into new research for drugs. The best way to get the research we need to address the medical problems we face is to provide a prize to those companies willing to address the most serious problems in the world, and not worry about my baldness or cosmetic me-too drugs, which is what they do.

What we're saying is okay, you come up with a solution to these very serious health problems which are killing millions of people and you'll get financial renumeration for it. It changes the whole dynamic. Right now, billion and billions are going into medical research funded by taxpayers into this country. But when the drug is developed, the profits go to the pharmaceutical company. This may be the most radical legislation I've ever introduced because it would transform the worldwide pharmaceutical industry.

Just to draw you out on one element of that, the idea is that you replace patents with prizes so the developed drugs are cheaper, right?

Money is coming straight from governments into a fund. That money is used to develop drugs to treat serious problems around the world. And because government is doing it, those drugs are sold to people at the lowest possible price.

(Photo credit:

By Ezra Klein  |  June 5, 2009; 7:00 AM ET
Categories:  Health Reform , Interviews  
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Next: What We Are Debating When We Debate Late-Term Abortions


There is no question that if we had nothing today and wanted a healthcare system, single payor would be what we would adopt. In our wildest dreams we would not dream up a system that combines Medicare, Medicaid, self-pay, uninsured, employer provided and individual policies.

Single payor is simple, it works, and it is inexpensive.

It is also way to big of a political leap from the bizarre system we have today where there are so many fingers in the pie. The best we can hope for is a public option.

Posted by: scott1959 | June 5, 2009 9:56 AM | Report abuse

Nice interview, but double HOLLA to that pharmaceutical "prize" legislation. Is that modeled after legislation from another country? i.e, where'd he get the idea from?

Posted by: pbasso_khan | June 5, 2009 2:07 PM | Report abuse

I have had employer based insurance for most of my life and I hate it. Reams of paperwork for coverage, limited choice of doctors, and no portability. Give me a public option and I will gladly get out of my (relatively generous by US standards) insurance program. But I want the extra wages garnished from my paycheck to pay for my insurance to go toward the public option or (better yet) back to me. My employer should not get a windfall for me leaving their plan.

Posted by: srw3 | June 5, 2009 2:17 PM | Report abuse

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