How we can bypass Mitch McConnell and the Republican-controlled Senate to get Medicare-for-All now

As far as Medicare-for-All is concerned, the question is: Do we really want it? If we do, we can have it right now

Published April 1, 2019 11:30AM (EDT)

Senate Majority Leader Sen. Mitch McConnell (R-KY) (Getty/Win McNamee)
Senate Majority Leader Sen. Mitch McConnell (R-KY) (Getty/Win McNamee)

It’s 2009. Barack Obama has just been elected president, and Democrats hold commanding majorities in both chambers of Congress.  The Academy Award-winning documentary "An Inconvenient Truth" recently prophesied a coming climate cataclysm and engendered a new surge in environmental activism. Former Republican Speaker of the House Newt Gingrich and current Democratic Speaker Nancy Pelosi even appear together in TV ads agreeing that "both sides" want action on global warming.

This consensus for climate action takes the form of the Waxman-Markey bill, the core element of which is "cap and trade." Cap and trade is a politically-moderate proposal, which would set a gradually-diminishing cap on greenhouse gas emissions for large energy users and establish a market to trade these newly-valuable emissions rights. Republican Senator John McCain had proposed cap and trade in his presidential campaign one year earlier, and 60 percent of Americans favor implementation. It has every reason to pass.

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However, that busted slaughterhouse of dreams known as the Senate engages in another filibuster nightmare – a clusterbuster – and the Waxman-Markey bill fails. Cap and trade is dead. Republicans take back the Peoples' House the following year, and in the intervening decade, Congress does nothing whatsoever to avert anthropogenic ecosystem collapse.

But here’s the twist: Cap and trade didn't actually die there. Behind the scenes, a gang of ten Northeastern states, from Maryland up the coast to Maine, had been devising a plan since 2003 called RGGI (pronounced “Reggie”) to practice cap and trade on their own, and just as the federal plan crashes and burns, theirs goes live.

In the decade since 2009, not only has cap and trade lived on in the RGGI states, which make up about 20 percent of the country’s GDP, but according to studies by Duke University, Analysis Group, and the Acadia Center, it has thrived. In RGGI states, emissions are down 51 percent, half of which is directly attributable to cap and trade. RGGI has saved its energy consumers $220 million, it has created 14,500 new full-time jobs and in just the two most recent years studied, it led to $1.4 billion in net economic benefits. Virginia just applied to join, and if other states get smart, there is no technical obstacle to its continued growth.

That brings us to the current battle over "Medicare-for-All." Medicare-for-All is the popular nickname for a national single-payer health insurance system, which would provide coverage to every single American as birthright and save trillions of dollars in total health spending. It has also been a raging battleground in American left-right politics since the end of the last World War. And right now it is having a moment: According to a recent Reuters poll, 70 percent of Americans – and even a majority of Republicans – now support it. Not to mention, most of the Democratic presidential candidates are running on it.

Yet here's the thing: Despite that popular support, it is absolutely, positively not poised to pass in Congress. The House of Representatives could maybe – possibly – pass legislation. However, in the Senate, you need 60 out of 100 votes to pass anything — a filibuster-proof majority — and there simply are not 60 votes for Medicare-for-All in that chamber. Even though a majority of Americans want Medicare-for-All, a majority of states do not, and senators represent states – and thus a busted slaughterhouse of dreams. To boot, only 15 Democratic senators have even signed onto the legislation.

And these numbers aren’t changing anytime soon: Democrats have long-shot odds of picking up three Senate seats in 2020. And in swing territory, they won’t be progressive ones. There absolutely, positively will remain at least 41 votes to block Medicare-for-All in the Senate for the foreseeable future. Plus, if Trump gets re-elected – and odds are he will, according to TrendMacrolytics – you would need a veto-proof majority of 67 Senators to back it, which is lightyears away from happening.

So why die at the altar of an "all or nothing" proposition that would surely result in "Nothing-for-Anyone?" Instead, we could end the decades of war now if we stop trying to win over and appease leery conservative states and simply doing what RGGI did: create a full on, single-payer, everyone-gets-healthcare-priced-into-their-citizenship, Medicare-for-All system across the states who want it.

Don't confuse this with various other “Medicare-for-More” plans pushed by battle-shy centrists. Those proposed watered-down solutions include allowing anyone to buy into Medicare or expanding coverage to more age or income brackets. One could perhaps argue the merits of those, but this approach isn’t that. This is about providing member states real deal, 100 percent Medicare-for-All.

How would it work? According to Article 1 Section 10 of the Constitution, states can enter into "interstate compacts," or agreements between two or more states, as long as they get the “consent of Congress.” And the courts have pretty much nullified that “consent of Congress” part: In the cases of Virginia v. Tennessee of 1893 and U.S. Steel Corporation v. Multistate Tax Commission of 1978, the Supreme Court held that if a member-state could theoretically execute the program in question by itself anyway – and if the compact does not threaten the supremacy of the federal government more broadly – then the U.S. Senate does not have to weigh in at all. In fact, despite it being a massive, multi-state program, RGGI itself fully bypassed Congressional consent.

In addition to RGGI, there are just shy of 200 active interstate compacts. You are probably affected by several interstate without even knowing about them. The Driver License Compact (DLC) is why, if you get pulled over in Montana, it affects your Maine license. A compact is why most states share the same state scratch-off lottery games. Connecticut, Massachusetts, New Jersey, New York and Pennsylvania even have a compact to provide each other with military aid in the case of an emergency, like a little NATO.

Interstate compacts do not make sense for everything. There is little benefit, say, in three sexy states getting together to declare that on Wednesdays they wear pink, rather than each declaring it individually. But when it comes to government programs, something where the sharing of resources would be of benefit, or where coordination makes the whole greater than the sum of the parts, then interstate compacts are sometimes the most powerful tool in America's arsenal.

In the case of Medicare-for-All, joining together could make possible what a state cannot do on its own. Vermont tried to create their own single-payer system, which famously sputtered out. The startup and administrative costs of such a system are too much for one single state to bear alone – especially one with a small tax base.

But the 16 bluest states represent almost half of the country’s GDP and 37 percent of its population. Their collective GDP is larger than every other country except for China, making them certainly large enough to support a single-payer program. That’s larger than Sweden, Bahrain, Canada, Cyprus, Finland, Iceland, Italy, Japan, Kuwait, Norway, Portugal, Slovenia, Spain, United Arab Emirates and the United Kingdom, all of which provide single-payer health coverage to their citizens.

Every kid knows that if Dad says, "You can’t have ice cream," you ask Mom instead. In this case, Daddy Senate is not just saying no ice cream – he’s basically unconscious. Each year brings another round of “Least Productive Congress” headlines, eulogizing our ineffectual Senate. That is, in part, because Majority Leader McConnell gets to single-handedly block any bill he doesn’t like from coming to a vote. And if he doesn’t, then another Senator will: The filibuster, a once-arcane procedure to block a vote by threatening to never shut up, is now deployed almost constantly. If something does make it through for a vote, the fact that every state gets two senators regardless of population size means 17 percent of Americans can impose “majority rule” over the other 83 percent. Yes, it’s time to ask Mommy inter-state compact for some ice cream.

Potential stakeholder states could start immediately in developing a system to fund and administer the program — just as RGGI states did for Cap and trade. And if the left’s claims about single-payer are true, then a Pennsylvania, say, seeing the success in its neighbors of Maryland and New York, would apply to join — as Virginia is doing right now in RGGI. Or if the right is correct that single-payer would bring about Soviet-style ruination for individuals and businesses, then surely states would leave it – or their citizens would leave them.

This means, as far as Medicare-for-All is concerned, the question is whether or not we really want it. Because, if we do, we can get it right now.

So, can someone tell Gavin Newsom to get Andrew Cuomo on the line?

By Daley Gruen

Daley Gruen is a former Democratic congressional staffer, and most recently helped run a midterm campaign in an upstate New York swing district. He writes about democratic reform and the new economy.

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