I have paid very little attention to Ron Wyden until now. But he is now my favorite senator, thanks to the quote you cited about his reaction to the Dr. Oz idea that telemedicine and AI or whatever can provide adequate staffing for nursing homes. I will be long dead by the time Dr. Oz is frail and in geriatric care, experiencing himself how it goes when he vainly pushes his call button with no one but an algorithm to help him get to the bathroom in the middle of the night, so I will just have to take my satisfaction at the future possibility now.
The best path for Democrats is to restore the good that has been broken—Medicaid, the Consumer Protection Bureau, the Department of Education and Title I, fully funding the National Park Service, USAID—and forge paths to make all those programs and others better. Something on my mind is transition programs for prisoners when they get out of jail, clean slate laws, voting rights restored, a national holiday for voting, and all the other ways we can say we want these programs to work for you Americans.
My recollection of the Clinton healthcare proposal blowback was that Hillary led a wonky group to develop an alternative without a public process to involve those whose ox would be gored by the reforms.
The providers, options, and lived experiences have changed radically since then. And several generations have come of age.
Beware of killer phrases like “we tried that 30 YEARS AGO and it didn’t fly”…
Money in politics and corruption are the reasons healthcare access keeps getting worse in our country. Healthcare has been commodified to serve the shareholder first and the patient last, with healthcare companies making money hand over fist by denying care that is purchased and paid for in premiums, copays, and any other scheme they can dream up. I think this is becoming less partsan as an issue, especially as folks recognize the breadth and ease of healthcare access available to folks in much less wealthy countries.
Like every problem - detention, child hunger, warring, corruption, a POTUS that hates, a POTUS that tries to hurt blue states, a POTUS that tries to buy votes, a spineless Congress, an unethical DOJ and FBI, a Vought and Miller that are hell bent on Project 2025, a political fraternity that hides the pedophiles and insurrectionists - the answer is getting the GOP and corrupt Dems out of Congress and local office. We need to vote. And maybe Texas and Florida need to make a special effort to keep their cheating governors and AG's lawful for a change. Paxton and Abbott are terrible - and Cruz sees it and does nothing in his position as Senate Judicial Committee member. We have a lot of corruption to beat before the middle and lower class get a better deal on health and everything else. DYK - Israel has free health and we pay for it.
As a retired physician and owner of a medical practice, while not touching employer provided insurance might have been a 3rd rail years ago, it is not now. Premiums were rising 15% a year for my company and copayments and deductibles were increasing. Insurance is becoming unaffordable for employers. Medicare for all is the only way and insurance companies need to be eliminated. They increase costs and decrease care. Anything else is just adding another layer to Rube Goldberg healthcare in the US. Also, if Democrats get the trifecta, eliminate the filibuster if they want to get anything done. First thing to do, make DC a state. The Republicans will scream, which would be music to my ears.
When Clinton was first pushing universal (government funded) healthcare, some friends and I did a “follow the money” exercise. As a nation, we were spending far more overall than we could identify as getting to healthcare providers. We didn’t find the answer, but about a month later, I was reading an article in Fortune about “recession-resistant” investments. Two of the five listed were health insurance providers and drug makers. Right then, I decided that any solution to the healthcare cost crisis that included any form of insurance was not a solution. It just wouldn’t work. When Kamala Harris campaigned on universal healthcare, the numbers bandied around ran $3-4 trillion. What the right didn’t say was that was about half what we all pay now. That’s still true. There really is no alternative to a single payer system. We’re the only first world nation that doesn’t have one already, and some of those are handled through private insurance carriers. We just need to have the guts to talk about it.
1) It seems obvious that a single-payer system will lead to some rationing of care and longer wait times. The question is why that would be. If it’s because more people are legitimately using the medical system for their needed care, then the problem is one of capacity. If people are “gaming” the system, then the problem is one of fraud. These two issues require different solutions.
Of course, we have rationing now. It’s just that it’s based on one’s ability to pay. And the people who squawk the loudest today when single-payer systems are discussed are the ones who have the ability to buy their way to the front of the line.
2) Here is an honest question that struck me while reading this article: when the BBB was passed, lots of people claimed that there would practically be a rebellion once the higher premiums hit at the first of the year (people either dropping coverage or complaining about the higher costs). Mr. Google says this: “Current estimates and data for 2026 indicate that between 2.2 million and 4.8 million people are expected to become uninsured following the expiration of enhanced federal tax credits at the end of 2025. Recent data from early 2026 already shows a decline in Affordable Care Act (ACA) marketplace sign-ups by approximately 1.2 to 1.5 million people compared to the previous year”. My question is this: if these numbers paint an accurate picture, why hasn’t this been a bigger story? Has this story been pushed aside by other events (like a war in Iran)? Where’s all the bitching that had been predicted? I can hardly remember reading any stories about it.
I'm glad the twenty year healthcare debate cycle hits when Dems may be in some positions of power. Hopefully In the House, if we are blessed to have unassailable wins this fall that will overpower the kinds of elections shenanigans some will be trying. If so, let the games begin. And it's great that some are preparing to tackle healthcare. The details are critical, but the real crux is the consensus: is healthcare a right, or a commercial commodity? If a right, some folks will then be contributing to others' healthcare. That's the eternal breakdown along which lines get drawn.
Jonathan, Thanks for the extensive reporting and background. Fundamentally, as with all things with our government as it evolves, money interests are the great impeder of progress for the ordinary folks, the poor and the vulnerable. Obamacare's mission was to get more people health care coverage who did not have it. Despite total Republican resistance, it achieved a modicum of success. Imagine what could have developed with their support instead. The Dems looking forward for another shot at this is compelling. It seems some iteration of Bernie's vision is desirable. The formation of this plan must be incredibly sound and appeal to a super majority of the electorate. The hardest part of the endeavor will be to get a super majority in the House and Senate to get it through. As with other things in our history, if Americans have the will and demand it, it can happen.
Obamacare only passed because it was an insurance company give away - government (tax) money passed along to insurance companies in exchange for covering more people who would otherwise have been rejected, and letting kids stay on their parents' plans until they're 26. Literally everybody won. Nobody really notices the tax increases required to partially fund the program, while more people got covered, providers got compensated, and insurance companies went to the bank.
No system of single payer will be adopted in this country until someone figures out how to do it without creating any losers. People with employer coverage can't end up with worse coverage at a higher price (higher taxes), unless they get the benefit money from their employers (good luck getting businesses to adjust salaries by what they spend on HC). Businesses can't be made to pick up the tab, or they'll pass the cost along and/or hire fewer people. This will also be tough because a lot of companies (my wife's for example) provide Cadillac coverage that far exceeds Medicare - and we don't pay any contribution toward it. This is similar to a lot of public employee union plans, as well. What happens to people like us?
If the insurance companies stand to lose money, or worse, face the threat of being put out of business, they'll spend their last dollar making sure the politicians threatening them are defeated, and the GOP could end up with 60 Senators.
Lower provider compensation to pay for this universal care (as they do in Europe) will result in the rationed substandard care they see over there - something Americans would be loathe to tolerate. I had a very sick friend who lived for a while in Denmark for business, and he said staying here long term would have killed him (and he was rich). He saw firsthand how inferior their kind of treatment and access was, compared to the treatment he received here.
Alas, it seems that single payer universal HC is a unicorn we may not see in the foreseeable future, no matter how much Bernie and Dems dream about and plan for it.
I had to close my small business in 2018 because my husband got laid off and we lost his insurance and the cheapest ACA plan that covered nothing until hitting a deductible was $2600/month with a $14,000 deductible. One with copays was $3500/month. I made too much to qualify for a subsidy which wasn't that much. We couldn't afford that so I had to go back to a shitty corporate job just for affordable insurance. A friend got laid off early in covid then was diagnosed with cancer. He wasn't eligible for a subsidy because he had no income. He didn't qualify for medicaid because he owned a house. He couldn't afford a $700/month ACA policy or cancer treatment and he died. The ACA has been great for people in the middle who qualified for a generous subsidy but nobody else. I agree with the previous comment that the ACA is basically a lovefest with insurance companies. It needs major reform to be affordable and accessible for everyone. I'm personally in favor of ditching the ACA and allowing people to buy into Medicare and keeping access to private workplace based insurance for those who want it.
I'd love to tear down the whole healthcare system and start from the ground floor. The system we have now was essentially all non-profit (we had Blue Cross Blue Shield) and grew from employers offering healthcare as a perk, then into something larger when unions got involved. I can't remember at what point healthcare became a for-profit business, but there have been so many hospitals and insurers who have been gobbled up that any expanded options began to narrow under predatory corporations. I can't imagine picking the pieces apart to build something better. Yeah, I'm feeling a bit pessimistic at the moment. I'd say the first thing that has to be done is reversing the humongous cuts to Medicaid, and reversing the despicable tax cuts the wealthy received.
Raising taxes creates wave elections that get (a lot of) people voted out of office. In my adult lifetime, there have been three major federal tax increases passed.
In 1993, Bill Clinton raised marginal tax rates, after promising during his campaign to cut them. In 1994, the GOP picked up 54 seats in the House and 9 seats in the Senate, and that lead to the rightward shift from the Clintons that embraced Reaganomics and permanently locked in the Reagan Revolution, as well as setting the stage for the great recession.
In 2008, Barrack Obama passed Obamacare, and the spending (taxes) required to fund it. In 2010 the Tea Party rose up, the GOP picked up 63 House seats and 6 Senate seats, as well as massive gains down ballot. That lead to the gerrymandering after the 2010 census that we are still dealing with today.
In 2012, Barrack Obama codified almost 80% of the 2001 Bush tax cuts into permanent law, but allowed some marginal rates and other taxes to go up. In 2014, the GOP won a net 9 Senate seats, and held that majority through Trump's first term, allowing him to appoint three SCOTUS Justices.
Trump's BBB has a real populist features (like no tax on tips/OT, and the senior bonus), and only made then-current 2017 tax provisions permanent. It was not a "despicable tax cut for the rich". Go ahead and repeal it, and then make sure to duck in 2030 and beyond. One constant in modern American politics - Americans HATE tax increases.
I thought that the MMA prohibition on Medicare negotiating drug prices was a capitulation to drug companies in order to get the legislation passed - not necessarily a stance of the Republican Party. I’m sure there were many Dems that accepted contributions by drug manufacturers, as well as Republicans.
I have paid very little attention to Ron Wyden until now. But he is now my favorite senator, thanks to the quote you cited about his reaction to the Dr. Oz idea that telemedicine and AI or whatever can provide adequate staffing for nursing homes. I will be long dead by the time Dr. Oz is frail and in geriatric care, experiencing himself how it goes when he vainly pushes his call button with no one but an algorithm to help him get to the bathroom in the middle of the night, so I will just have to take my satisfaction at the future possibility now.
The one question I have is whether the Democrats will have 2030 on their minds when they push anything.
The best path for Democrats is to restore the good that has been broken—Medicaid, the Consumer Protection Bureau, the Department of Education and Title I, fully funding the National Park Service, USAID—and forge paths to make all those programs and others better. Something on my mind is transition programs for prisoners when they get out of jail, clean slate laws, voting rights restored, a national holiday for voting, and all the other ways we can say we want these programs to work for you Americans.
My recollection of the Clinton healthcare proposal blowback was that Hillary led a wonky group to develop an alternative without a public process to involve those whose ox would be gored by the reforms.
The providers, options, and lived experiences have changed radically since then. And several generations have come of age.
Beware of killer phrases like “we tried that 30 YEARS AGO and it didn’t fly”…
Money in politics and corruption are the reasons healthcare access keeps getting worse in our country. Healthcare has been commodified to serve the shareholder first and the patient last, with healthcare companies making money hand over fist by denying care that is purchased and paid for in premiums, copays, and any other scheme they can dream up. I think this is becoming less partsan as an issue, especially as folks recognize the breadth and ease of healthcare access available to folks in much less wealthy countries.
So much work to be done before existing MAGA /GOP and Trump.takeover. TG for our Dem fighters...
Ron Wyden certainly is earning his keep, between this, and following the money in the Epstein criminal case. Real leadership and doggedness.
Thank you to the good people of Oregon for electing him!
Like every problem - detention, child hunger, warring, corruption, a POTUS that hates, a POTUS that tries to hurt blue states, a POTUS that tries to buy votes, a spineless Congress, an unethical DOJ and FBI, a Vought and Miller that are hell bent on Project 2025, a political fraternity that hides the pedophiles and insurrectionists - the answer is getting the GOP and corrupt Dems out of Congress and local office. We need to vote. And maybe Texas and Florida need to make a special effort to keep their cheating governors and AG's lawful for a change. Paxton and Abbott are terrible - and Cruz sees it and does nothing in his position as Senate Judicial Committee member. We have a lot of corruption to beat before the middle and lower class get a better deal on health and everything else. DYK - Israel has free health and we pay for it.
As a retired physician and owner of a medical practice, while not touching employer provided insurance might have been a 3rd rail years ago, it is not now. Premiums were rising 15% a year for my company and copayments and deductibles were increasing. Insurance is becoming unaffordable for employers. Medicare for all is the only way and insurance companies need to be eliminated. They increase costs and decrease care. Anything else is just adding another layer to Rube Goldberg healthcare in the US. Also, if Democrats get the trifecta, eliminate the filibuster if they want to get anything done. First thing to do, make DC a state. The Republicans will scream, which would be music to my ears.
When Clinton was first pushing universal (government funded) healthcare, some friends and I did a “follow the money” exercise. As a nation, we were spending far more overall than we could identify as getting to healthcare providers. We didn’t find the answer, but about a month later, I was reading an article in Fortune about “recession-resistant” investments. Two of the five listed were health insurance providers and drug makers. Right then, I decided that any solution to the healthcare cost crisis that included any form of insurance was not a solution. It just wouldn’t work. When Kamala Harris campaigned on universal healthcare, the numbers bandied around ran $3-4 trillion. What the right didn’t say was that was about half what we all pay now. That’s still true. There really is no alternative to a single payer system. We’re the only first world nation that doesn’t have one already, and some of those are handled through private insurance carriers. We just need to have the guts to talk about it.
A few comments...
1) It seems obvious that a single-payer system will lead to some rationing of care and longer wait times. The question is why that would be. If it’s because more people are legitimately using the medical system for their needed care, then the problem is one of capacity. If people are “gaming” the system, then the problem is one of fraud. These two issues require different solutions.
Of course, we have rationing now. It’s just that it’s based on one’s ability to pay. And the people who squawk the loudest today when single-payer systems are discussed are the ones who have the ability to buy their way to the front of the line.
2) Here is an honest question that struck me while reading this article: when the BBB was passed, lots of people claimed that there would practically be a rebellion once the higher premiums hit at the first of the year (people either dropping coverage or complaining about the higher costs). Mr. Google says this: “Current estimates and data for 2026 indicate that between 2.2 million and 4.8 million people are expected to become uninsured following the expiration of enhanced federal tax credits at the end of 2025. Recent data from early 2026 already shows a decline in Affordable Care Act (ACA) marketplace sign-ups by approximately 1.2 to 1.5 million people compared to the previous year”. My question is this: if these numbers paint an accurate picture, why hasn’t this been a bigger story? Has this story been pushed aside by other events (like a war in Iran)? Where’s all the bitching that had been predicted? I can hardly remember reading any stories about it.
I'm glad the twenty year healthcare debate cycle hits when Dems may be in some positions of power. Hopefully In the House, if we are blessed to have unassailable wins this fall that will overpower the kinds of elections shenanigans some will be trying. If so, let the games begin. And it's great that some are preparing to tackle healthcare. The details are critical, but the real crux is the consensus: is healthcare a right, or a commercial commodity? If a right, some folks will then be contributing to others' healthcare. That's the eternal breakdown along which lines get drawn.
Jonathan, Thanks for the extensive reporting and background. Fundamentally, as with all things with our government as it evolves, money interests are the great impeder of progress for the ordinary folks, the poor and the vulnerable. Obamacare's mission was to get more people health care coverage who did not have it. Despite total Republican resistance, it achieved a modicum of success. Imagine what could have developed with their support instead. The Dems looking forward for another shot at this is compelling. It seems some iteration of Bernie's vision is desirable. The formation of this plan must be incredibly sound and appeal to a super majority of the electorate. The hardest part of the endeavor will be to get a super majority in the House and Senate to get it through. As with other things in our history, if Americans have the will and demand it, it can happen.
Obamacare only passed because it was an insurance company give away - government (tax) money passed along to insurance companies in exchange for covering more people who would otherwise have been rejected, and letting kids stay on their parents' plans until they're 26. Literally everybody won. Nobody really notices the tax increases required to partially fund the program, while more people got covered, providers got compensated, and insurance companies went to the bank.
No system of single payer will be adopted in this country until someone figures out how to do it without creating any losers. People with employer coverage can't end up with worse coverage at a higher price (higher taxes), unless they get the benefit money from their employers (good luck getting businesses to adjust salaries by what they spend on HC). Businesses can't be made to pick up the tab, or they'll pass the cost along and/or hire fewer people. This will also be tough because a lot of companies (my wife's for example) provide Cadillac coverage that far exceeds Medicare - and we don't pay any contribution toward it. This is similar to a lot of public employee union plans, as well. What happens to people like us?
If the insurance companies stand to lose money, or worse, face the threat of being put out of business, they'll spend their last dollar making sure the politicians threatening them are defeated, and the GOP could end up with 60 Senators.
Lower provider compensation to pay for this universal care (as they do in Europe) will result in the rationed substandard care they see over there - something Americans would be loathe to tolerate. I had a very sick friend who lived for a while in Denmark for business, and he said staying here long term would have killed him (and he was rich). He saw firsthand how inferior their kind of treatment and access was, compared to the treatment he received here.
Alas, it seems that single payer universal HC is a unicorn we may not see in the foreseeable future, no matter how much Bernie and Dems dream about and plan for it.
Prior to the passage of the Affordable Care Act- I was denied insurance because of a broken ankle (non-surgical) totally healed. Crazy? Right?
The net positive of the Affordable Care Act is unquantifiable because everyone requires healthcare (some routine, some acute, some chronic.)
For the first time in my voting life- I can say am a one issue voter and it’s preserving and improving upon the Affordable Care Act.
Oh- and the war in Iran is stupid.
I had to close my small business in 2018 because my husband got laid off and we lost his insurance and the cheapest ACA plan that covered nothing until hitting a deductible was $2600/month with a $14,000 deductible. One with copays was $3500/month. I made too much to qualify for a subsidy which wasn't that much. We couldn't afford that so I had to go back to a shitty corporate job just for affordable insurance. A friend got laid off early in covid then was diagnosed with cancer. He wasn't eligible for a subsidy because he had no income. He didn't qualify for medicaid because he owned a house. He couldn't afford a $700/month ACA policy or cancer treatment and he died. The ACA has been great for people in the middle who qualified for a generous subsidy but nobody else. I agree with the previous comment that the ACA is basically a lovefest with insurance companies. It needs major reform to be affordable and accessible for everyone. I'm personally in favor of ditching the ACA and allowing people to buy into Medicare and keeping access to private workplace based insurance for those who want it.
I'd love to tear down the whole healthcare system and start from the ground floor. The system we have now was essentially all non-profit (we had Blue Cross Blue Shield) and grew from employers offering healthcare as a perk, then into something larger when unions got involved. I can't remember at what point healthcare became a for-profit business, but there have been so many hospitals and insurers who have been gobbled up that any expanded options began to narrow under predatory corporations. I can't imagine picking the pieces apart to build something better. Yeah, I'm feeling a bit pessimistic at the moment. I'd say the first thing that has to be done is reversing the humongous cuts to Medicaid, and reversing the despicable tax cuts the wealthy received.
Raising taxes creates wave elections that get (a lot of) people voted out of office. In my adult lifetime, there have been three major federal tax increases passed.
In 1993, Bill Clinton raised marginal tax rates, after promising during his campaign to cut them. In 1994, the GOP picked up 54 seats in the House and 9 seats in the Senate, and that lead to the rightward shift from the Clintons that embraced Reaganomics and permanently locked in the Reagan Revolution, as well as setting the stage for the great recession.
In 2008, Barrack Obama passed Obamacare, and the spending (taxes) required to fund it. In 2010 the Tea Party rose up, the GOP picked up 63 House seats and 6 Senate seats, as well as massive gains down ballot. That lead to the gerrymandering after the 2010 census that we are still dealing with today.
In 2012, Barrack Obama codified almost 80% of the 2001 Bush tax cuts into permanent law, but allowed some marginal rates and other taxes to go up. In 2014, the GOP won a net 9 Senate seats, and held that majority through Trump's first term, allowing him to appoint three SCOTUS Justices.
Trump's BBB has a real populist features (like no tax on tips/OT, and the senior bonus), and only made then-current 2017 tax provisions permanent. It was not a "despicable tax cut for the rich". Go ahead and repeal it, and then make sure to duck in 2030 and beyond. One constant in modern American politics - Americans HATE tax increases.
I thought that the MMA prohibition on Medicare negotiating drug prices was a capitulation to drug companies in order to get the legislation passed - not necessarily a stance of the Republican Party. I’m sure there were many Dems that accepted contributions by drug manufacturers, as well as Republicans.