Senator Bernie Sanders
June 28, 2012

In my view, while the Affordable Care Act is an important step in the right direction and I am glad that the Supreme Court upheld it, we ultimately need to do better.  If we are serious about providing high-quality, affordable healthcare as a right, not a privilege, the real solution to America’s health care crisis is a Medicare-for-all, single-payer system. Until then, we will remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship.


By Don McCanne, MD

The responses to the Supreme Court decision to uphold the basics of the Affordable Care Act were quite predictable. Through all of the cacophony, two predominant views settle out: 1) After a period of celebration, the proponents want to move forward with implementation, and 2) The opponents want to change control of the government so that they can repeal the Act (though maybe proceed with reintroducing limited elements of it).

Yet there is another view simmering under the surface. There is a grave concern that too many people will be left out of the system, that those who have insurance will find that the subsidies are inadequate to provide financial security in the face of medical need, and that the Medicaid program will remain chronically underfunded, resulting in health care access limitations. It will become obvious that these are not acceptable outcomes.

People who understand the single payer model realize that it is the only feasible option, but just as it was buried during the reform process, it will now be buried under the fervor in implementing the Affordable Care Act. We will continue to speak out, but the supporters of the Act will refuse to listen because they are too busy with implementation.

By about 2015 or 2016, those dedicated ACA supporters will see that the numbers really aren’t working, in spite of their efforts – still too many uninsured, costs too high, personal financial hardship rampant, and inability to adequately fund Medicaid because of the stigma of being a welfare program. By then, the celebration of the Supreme Court victory will have long worn off, and our friends will understand that decisions will have to be made as to how to alter course.

Those currently in charge are tinkering incrementalists. They will be looking for solutions such as enhancing consumer empowerment (i.e., keeping insurance premiums down by shifting costs to patients), structural reform of delivery systems (after the failure of accountable care organizations), capping malpractice awards (wrong solution to tort problem), and opening insurance markets across state lines to make insurance affordable (even if health care isn’t). After all, since the ACA provisions aren’t working, it’s time to try the conservatives’ favorite approaches, they’ll reason.

Come on. The solution is staring them in the face – single payer! Yet the resistance will continue. We’ll have ever more of “let’s try this first.”

It will take us until about 2015-2016 to have an impact, only because we’ll have to wade though the muck of ACA reform before our well-meaning friends see that there is only more muck ahead. At that time they will be looking for better solutions, but we cannot wait until then to recharge our campaign. The need is now! We have to establish single payer as a meme. It has to be an automated mentation process.

This means that we have to gear up immediately with an unrelenting campaign to get our friends to understand that single payer is not only the logical solution, but it is the only feasible alternative since it is the only approach that will work. It is long past time for us to replace the concept of political feasibility with the concept of social feasibility.

Re-posted with permission from