Single-payer health care should be funded by the federal government

Here is my Wednesday news blog post which ends as usual with some music – today some consummate guitar playing. Today, I discuss the dispute about M4A in the US and clear up some misconceptions. Many think that Medicare for All is defunct in the US because the ruling party – the Democrats have essentially rejected the lobbying attempts. Some people who have associated themselves with Modern Monetary Theory have, it seems, been advocating a state-based campaign to get single-payer schemes installed at that level. Is this a violation of MMT principles? Some think so. I do not. It might reflect ignorance of the nature of the sector but it doesn’t amount to a rejection of MMT. Anyway, I am a federalist and I explain why. I also bring attention to some anti-colonial struggles in the Caribbean.

Medicare for All – US

I have received several E-mails about a dispute in the US between activists who are agitating for Medicare for All (M4A) and those who want a single-payer health system installed.

The two pursuits are differentiated, it seems, because the former situates the struggle at the Federal level, correctly observing that the Federal government issues the US dollar and has the financial wherewithal to resource such a system should there be adequate productive resources available or could be diverted from other less desirable activities.

The latter believe, it seems, that there is no hope of securing an M4A system in the US, given the power of big privatised medical lobbies and interests, big pharma and whatever else that is ripping the American consumer off in this area, and so they are pitching their activism at the state level, hoping to pick off a few governors and get a limited system running up at that level.

They believe it is better have one state with a single-payer system than none, which reflects their lack of confidence in the M4A prospect.

Modern Monetary Theory (MMT) has, it seems, become embroiled in the debate.

The state-siders have quoted prominent MMT proponents saying the struggle has to be a state-based struggle.

The federalists have then considered that statement to be a breach of MMT consistency and the dispute between the two camps is very bitter.

Here is what I think.

First, this dispute has very little to do with MMT. It is not a ‘test case’ for MMT. A person can understand MMT and still advocate a state-level, single payer system.

Second, to advance a solution to these progressive activists eating each other up and getting nowhere fast in the process (why does the Left always do that?) there needs to be a study of health economics conducted.


Because the issue is really only to be advanced by understanding where the most effective scale for delivering broad-based, single-payer health care is located.

A cursory blush at what would be found if such a study was conducted would point one in the direction of a federally-funded, built, and organised system or a federally-funded system and built system, where ALL the states sign up to a single standard operational code.

I doubt that an effective scale can be achieved by having 50 different state-based single-payer health systems. Given the federal tax code links all citizens at that level, the administrative transfer to a single-payer system would be best performed at that level.

Further, the states are unlikely to have the muscle to resist the lobbying against a single-payer system from the private vested interests. The opportunity for corruption and captivity is higher at that level I suspect.

Also, progressives should be about equity as well. If all the citizens in California or Washington get a single payer system but the folks in Nevada or Idaho do not, then the idea that all Americans are equal against the law fades into irrelevance.

I know the idea of equity is a dream in a divided, corrupt America. But progressives should at least propose solutions that do not violate that principle.

Third, the matter will only be solved politically. MMT tells us that the federal government can buy all the medical resources available if it chooses whereas a state-level administration cannot. Small states will have worse care than larger states.

But it seems that the current Democrat administration has absolved itself of interest and responsibility at the federal level (that abominable Pelosi woman told the activists to forget any federal action).

Which means the activists think they have more chance getting at least one state over the line.

Is that a better outcome than none, when the activists have essentially given up trying at the (correct) federal level to achieve their aspirations?

I don’t think so.

Once the progressive side of politics bows to the conservative, neoliberals (which includes the Democrats in the US) and surrenders their ambitions such that they pursue something inferior but possible gettable, the battle is lost.

We have seen that surrender over and over again and that is why the Left doesn’t make much progress.

Australian Labor Party – more own goals

The news today is that the ALP, which is in the box seat to win the upcoming federal election in Australia (in May), is once again thumbing its nose to the citizens they are duchessing for votes.

I recently wrote this blog post – The last thing we need is a return to fiscal surpluses and rising household debt (February 21, 2022).

I discussed an Op Ed from a former senior advisor to a previous ALP Prime Minister who was demanding the Labor Party adopt the macroeconomic policies that the conservatives deployed between 1996 and 2007.

Those policies created fiscal surpluses that were only possible because the household sector’s debt went up to 180 odd per cent (from below 100 per cent) as the financial markets loaded up credit on anything that moved.

Those policies saw real wages fall and a massive redistribution of national income to profits.

It was a disastrous period in macroeconomic policy making but the needs of capital were met.

This morning we read that the author of that Op Ed is now going to be parachuted into a Western Sydney seat by central office to contest the next election against the wishes of the branch members of the party.

He is a ‘white, millionaire’ who works in the corporate world, doesn’t live in the electorate – instead lives in a multi-million dollar mansion in one of Sydney’s most salubrious (and expensive) suburbs and is on the extreme Right of the Party.

He doesn’t resemble any of the characteristics of a ‘Labour’ candidate.

And the seat he is being parachuted into is a relatively low-income suburban locality which is heavily multicultural and has several excellent candidates vying for nomination who live and understand the complexity of such an electorate.

The current Labor MP is retiring and comes from the Left of the Party.

It is amazing that the NSW Labor Party (State office) thinks this is a good idea.

I hope they lose the seat and the election as a result of their arrogance and shift to the Right.

The Party is in my view unelectable – which means no-one should vote for them.

Pay the reparations

The British royalty is doing what they often do – swan around the place pretending to love everyone.

At present, Prince William and his wife are on their way to Jamaica. They are not admitting this but they want to head off a growing distaste for the royalty in the Caribbean, which has seen Barbados finally kick the Queen of England out as the head of state and end the last formal vestage of the brutal colonial past.

On November 30, 2021, the island nation became a republic and swore in its first president (Sandra Mason) and the union jack was lowered for the last time – 55 years after first gaining independence from Britain.

Last September, the 300,000 Barbadians elected the new president and end the Queen of England’s tenure.

There are several former British colonies in the region that have now kicked her out as head of state and became fully-fledged republics – Guyana (1970), Trinidad and Tobago (1976), and Dominica (1978).

Jamaica retains the Queen as head of state.

Clearly the Royals are worried that they will be next to declare their republican status.

But the proposed visit is actually setting off new fires that the Royalty would not want to deal with.

A group of prominent Jamaicans (politicians, business leaders, doctors and musicians) have sent an open letter to the monarchy in Britain demand that they pay slavery reparations and apologise for the colonial impacts on the people in Jamaica.

The transcript of the – Open Letter – says among other things that:

We note with great concern your visit to our country Jamaica, during a period when we are still in the throes of a global pandemic and bracing for the full impact of another global crisis associated with the Russian/Ukraine war. Many Jamaicans are unaware of your visit as they struggle to cope with the horrendous fallout of the COVID-19 pandemic, exacerbated by pre-existing social and economic hardships inherited from our colonial past …

We see no reason to celebrate 70 years of the ascension of your grandmother to the British throne because her leadership, and that of her predecessors, have perpetuated the greatest human rights tragedy in the history of humankind. Her ascension to the throne, in February 1952, took place 14 years after the 1938 labour uprisings against inhumane working/living conditions and treatment of workers; painful legacies of plantation slavery, which persist today. During her 70 years on the throne, your grandmother has done nothing to redress and atone for the suffering of our ancestors that took place during her reign and/or during the entire period of British trafficking of Africans, enslavement, indentureship and colonialization.


Read the rest of it and get a sense of despair and anger that exists in these impoverished former British colonies.

Music – Round Midnight

This is what I have been listening to while working this morning.

This is another of my favourite records, which was released in 1959 and always delivers.

The actual track is – Round Midnight – which was recorded and published on the 1959 album – The Wes Montgomery Trio – by the band of the same name.

The players are:

1. Wes Montgomery – guitar.

2. Melvin Rhyne – organ.

3. Paul Parker – drums.

This album really marked the beginning of Wes Montgomery’s career who started out playing in a bar in Indianapolis before moving to New York City.

This bio – Wes Montgomery: The Softer Side of Genius (March 5, 2020) – will fill you in on the life of this great guitarist, especially his struggles with producers who thought they knew better than him about his sound.

Suffice to say, he restyled the concept of playing jazz guitar and has had many imitators since (include me at times).

That is enough for today!

(c) Copyright 2022 William Mitchell. All Rights Reserved.

This Post Has 15 Comments

  1. Bill,

    This is moving so fast now. The doors on information control are being slammed and bolted shut all around the world as fast as they can get away with it. Australia is on the front line of this war against “mental ” sovereignty.

    Governments to decide what is the truth.

    As reported in the Australian newspaper.

    How easy it was for the liberal left to cross that Rubicon. Never even put up a fight. In the one party nation state of Australia. Happening All over the world.

  2. The liberal left that suffer from Stockholm syndrome after years of of battered wife syndrome from the mainstream media.

    They will actually call this move from Morrison progressive.

  3. Our experience in Canada, was that universal healthcare did begin with a single province, Saskatchewan, shepherded along by premier Tommy Douglas, who would be considered a left wing radical by today’s standards, and later became a founder of the then socialist New Democratic Party, which still exists today but having shed socialism from it’s mission.

    Other provinces began to take up this popular cause, one by one, and only then did the federal government begin to contribute 50% to the costs. At that time the federal government had the power to tax and borrow in order to fund efforts that were not conflicting with those of the provinces.

    The health results/cost ratio of universal health in Canada and most other countries with similar systems is huge when measured against purely private funding and delivery, such as is the experience in the US.
    The only criticism of this, worthy of consideration, to come out of the right in the US, is wait times for elective surgeries, a non sequitur because those wait times are well managed to ensure that everyone receives the treatments they need long before the wait results in adverse consequences.
    By contrast, those who are under insured in a private health system often perish or face debilitating sequelae after developing a perfectly treatable health issue.

    Yesterday, the New Democratic Party of Canada entered a deal to keep the minority Liberal Party of Canada in power for another three years provided extending single payer health care to dental care and a some other things are brought to the table.

  4. As a witness to this very divisive dispute, I very much appreciate your comments regarding a National Improved Medicare For All.
    I, also, appreciated your link to The Wes Montgomery Trio. While not my favorite musical genre (I’m a 72-year-old Metalhead), listening to that cut took me back to my childhood and a local musician who was my neighbor, and all Pittsburgh kid’s “neighbor” as a member of Mr. Rogers Neighborhood, Joe Negri.
    Joe has had an interesting career. I thought you might enjoy his story and music.

  5. “He doesn’t resemble any of the characteristics of a ‘Labour’ candidate.”

    Can someone please point me to any left politician anywhere in the world (and even a right politician) who actually walks in the shoes of those they claim they represent?

  6. “The latter believe, it seems, that there is no hope of securing an M4A system in the US, given the power of big privatised medical lobbies and interests, big pharma and whatever else that is ripping the American consumer off in this area,”

    This part confuses me. Why would Big Pharma and their interests give a rats ass who pays for their products, whether it is predominantly govt or predominantly the private citizens? At the end of the day, they still profit and as long as they keep people convinced they have no immune system and need Big Pharma to keep them alive, there will always be huge demand for them. The fact that here in Australia we have Medicare does not stop people feeling sick and rushing to a doctor for a script as soon as they get a sniffle. In fact, if I had to pay my doctor $120 (as opposed to a simple medicare levy every tax year) just to go ask for a script every time my nose is runny, and then another $80 or whatever it is for the actual medicine, I aint doing it and I’ll let my body deal with it like it is designed to do. The fact we have medicare means more people are likely to rush to the doctor for a runny nose rather than not. So many contradictions in the way healthcare is debated.

  7. I am a U.S. Medicare recipient and someone who has attended an (online) Medicare-for-All (M4A) conference. I would not characterize myself as an “M4A activist” in the sense that it’s not the main focus of my political activity. But I have to say that this is the first time I’ve heard of people arguing for state-level single-payer versus federal single-payer and attempting to invoke MMT is support of one side or the other. When I attended that M4A conference last year, most people were simply unfamiliar with MMT but eager to learn more.

    I agree with Bill that federal-level M4A would be much more consistent with MMT than state-level. That being said, I also respect reader J Christensen’s observation that Canadian universal health care began in a single province. Where we currently have large Democratic majorities in state legislatures (e.g., California and New York), we have little to lose by making vigorous pushes at that level. Right-wing Democrats like Joe Manchin have less power to block our path forward in those cases. If we were to win single-payer in a big state, that would enable us to work out the institutional kinks in the program, which would be advantageous for when federal-level opportunities are more in our favor.

  8. “to advance a solution to these progressive activists eating each other up and getting nowhere fast in the process (why does the Left always do that?)”
    “The Party is in my view unelectable – which means no-one should vote for them.”
    Of course Bill dose not consider the labour party as part of the left so from that view point there is no contradiction in these statements. Outside this world view, one might vote for the compromised labour party to avoid a worse alternative.

    as to medical systems, as someone who has worked in Canada, UK and Australia the Canadian structure is imo far superior. This has more to do with the how and why of payments than who the single payer is (state vs fed). The debate about federal and state payment is far less important that the overall design of the system. In the US there is no prospect at all of a federal single payer so it would seem very reasonable to start with a progressive state. In Canada, which also has a better way of collecting state income tax, the provinces have different standards of health care and this seems to be largely accepted and amenable to the usual political process.

  9. Thanks for the excellent tunes. Enjoyed that especially. New to my ears and perfect for this rainy evening.
    As to the previous comment about Canada going province by province to gain healthcare, that country was nowhere near the neoliberal hellscape the US is right now – the national government there at the time was already looking at the NHS as a favorable example of what to do.

  10. @James Keenan

    Canada is a much smaller population than the States and doesn’t have the same divisions. In the US, the federal government can starve the states of money, as we saw with GFC. So it might protect from Manchin but it would open the states to set up single payer for failure under a republican president. But it’s true I hadn’t heard of state vs federal debate in M4A until now.

  11. My comment is divided into two parts. First a comment on Bill’s position that the political fight for M4A should be at the federal level rather than at the state level in the US.
    While in principle I agree with Bill, in Canada publicly funded doctor care got its start in the province of Saskatchewan (more on that below) and then spread to the rest of the country following action by the federal government (as J Christensen correctly notes above). In effect in Canada one province provided the spark and the rest eventually followed, led by the federal government. However a counterexample is provided by the ongoing efforts to get prescription drugs included in our medicare. That fight has focused on the federal government (I have been involved in this for 16 years) and it looks like the federal government will finally begin implementing a plan.
    With respect to the US today it is difficult to know what to do. For one thing healthcare in that country is so overwhelmingly expensive that MMT is largely irrelevant. The main issue is reeling in the costs of a health system that have been spiralling out of control for decades. Say a public system were implemented overnight with cost controls that brought the US to the spending level of other wealthy countries. The savings would be so huge (at least 7 percent of GDP) that domestic spending would plummet and the country would be plunged into a depression. Given the magnitude of the savings implementation on a state level would be possible with no federal money at all. However the political fightback by the putative losers would be enormous. Big Insurance, Big Hospital, Big Pharma, Big Doctor, Big Supplier, would combine to mount huge political opposition. This happened in California some 20 years ago and I believe only Big Insurance was involved then. A public healthcare referendum was easily defeated.
    Another problem is corruption. At the federal level every member of the US Senate and House of Representatives is corrupt with only a handful of exceptions. I don’t mean morally corrupt or co-opted somehow. I mean directly paid off by various business interests. They are in effect employees of some lobby or other. How do you deal with that? Is the state level the solution? How corrupt is the state? Could the state level program be easily reversed? Could political mobilisation overcome the combined power of the health lobbies? Would the state provide the spark for M4A or would the state be devastated by the ensuing fightback ensuring no other state would dare follow its example?
    I have no idea how the US could achieve public healthcare. Whatever level, federal or state, it would require overwhelming political mobilisaton.

    The second part of my comment involves a very very brief sketch of what happened in Canada to get doctors under a public system. A program first came into effect in Saskatchewan in 1962 after a fight with the doctors of the province who violently opposed it. Most doctors went on strike. The labour movement strongly supported the government’s program and led the mobilisation in favour of it. The government brought in NHS supporting British doctors , and others, to treat patients. The doctors’ strike was defeated after 23 days and the program was successfully implemented. It set the stage for the implementation of publicly funded doctor services across Canada beginning in 1969, funded 50% by the federal government. This was done by a Liberal minority government supported by the NDP that held the balance of power at the time.
    In subsequent years the system came under pressure as doctors began extra billing, i.e. they received payment for their services from the government PLUS additional payments they demanded from patients. This threat to the system was countered very cleverly by the Canada Health Act (adopted by the federal government in 1984) which empowered the federal government to claw back transfers to the provinces equal to the total amount of doctor extra billing to patients. One of the consequences is that Canada has been spared the British experience of a doctor being able to have both public and private patients, with private patients getting priority treatment. In practice the Canada Health Act has meant that doctors are either entirely in or entirely out of the public system. Since few people are able to pay private doctors out of pocket there are very few doctors who opt for private practice although some do, especially in cosmetic surgery. The integrity of the system has been maintained now for over 50 years.

  12. @Carol
    The distinction between “private” and “public” is more nuanced than it might appear from the labels.
    In Canada, the docs and public embrace the current system making it sustainable. Thats possibly owing to the fee for service structure – essentially its like a private service funded by a single insurance fund (the government). The only people outside that service in my experience were the menonites who didnt pay taxes and self insured and visitors. In the UK the poor heath care provided and the the dissatisfaction of the health care workers has allowed growth of private medicine increasing inequity. The single payer in the UK has chronically underfunded the service and has a command structure and payment system that compounds its underpayment.

  13. @Jim, I think it has been proven that the NHS model, non-insurance based, is the most cost effective health system in the world and reached a peak of patient satisfaction in 2011 after 13 years of investment by the Labour government. Of course, it was Labour which ramped up exploitation by the private sector – because they were ‘running out of ££’.

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