Published on Thursday, December 31, 2009 by The Nation

Single-Payer’s Last Stand?

by Greg Kaufmann

The Progressive Caucus (CPC) is the largest caucus in Congress with 82 members--it dwarfs the often-hyped Blue Dog Democrats with its 52 yapping pups.

Lynn Woolsey and Raúl Grijalva, Co-Chairs of the House Progressive Caucus, sandwich President Obama. The question, however, is whether or not the 82 member caucus can exert any influence as the health bill goes to conference. One point of particular interest is waiver language that would permit states to implement alternatives to insurance market exchanges, including single-payer systems. (Newscom collage h/t TPM)

Yet the CPC has struggled to get the respect and attention it has strived for--prior to this Congress, it seemed like the mainstream media wouldn't even refer to it by name, instead using vague descriptions like "the liberal wing of the party."

That's because getting the talented but diverse Caucus to unite and show its legislative muscle has often been described--even by its own members--as herding cats.

This might be the moment for the Caucus to change all that in dramatic fashion.

The House healthcare bill passed by just five votes--220 to 215. Surely the CPC's 81 House votes (the 82nd member is a Senator, CPC founder Bernie Sanders) should be viewed as just as powerful as the votes of Ben Nelson or Joe Lieberman in the Senate.

But will a strong majority of the CPC unite around a single provision and insist that it be included in the final bill exchange for their support?

One item worth rallying around--and it hasn't received a lot of attention--is waiver language that would permit states to implement alternatives to insurance market exchanges, including single-payer systems.

The Senate bill allows states to apply for such waivers in 2017, but that's arguably too late. States would be required to establish (and invest in) the insurance market exchanges in 2014, making it difficult to develop and provide resources for any alternative model. The House bill doesn't have any waiver language at all, though CPC members--including CPC co-chairs Raúl Grijalva and Lynn Woolsey, and Congressman Dennis Kucinich--fought successfully for similar language in the House Committee on Education and Labor version.

Canada's healthcare system evolved from a program first established in Saskatchewan. Will states in the US have a similar opportunity to serve as incubators and prove that single-payer can provide comprehensive coverage and reduce costs? The CPC has the power to insist on it--if it chooses to do so.

© 2009 The Nation