The Stranger Single Payer Healthcare

Washington can have a Single Payer Healthcare System

As I’ve mentioned several times in the past: we can have a single-payer health care system in Washington state by 2020 if we want it. The plan requires Democrats to increase their majority in Washington’s legislature this November and to retake control of Congress and the Presidency at the federal level.

This will be tremendously difficult! But it’s possible. The only way we’re going to get there is if we vote for Democrats who will champion bills like David Frockt’s SB 5701 (or the House’s version, HB 1026), which would help establish a framework for implementing single-payer in the state. And the only way Democrats are going to champion single-payer in Washington state is if you call them up and tell them you need it in order to survive and still buy a can of beans every now and then.

According to answers from a questionnaire conducted by local single-payer advocates, the following candidates running for U.S. Senate, U.S. House, and the Washington Legislature said they’d vote YES on state-based universal health care legislation similar to HB 1026, and/or would co-sponsor state-based universal health care legislation.

But saying they “support” state-based single payer and actually running on state-based single-payer are two different things. So I called up a few candidates to see how that message is playing out in the field. Spoiler: constituents are into it.

SECB-endorsed candidate Joe Nguyen, who’s running to represent southwest Seattle in the Washington State Senate, was out door-belling when I called him earlier this week. He says state-based single-payer is “absolutely, 100 percent” a winning issue in the 34th Legislative District.

Nguyen says he’s talked to “tens of thousands” of people on the campaign trail this year, and at the doors he claims “Medicare for All comes up more often than not. The passion for it is very clear.” Nguyen says some people are even moved to tears when he talks at health care forums about Washington state starting its own Medicare for All program.

“I had multiple folks come up to me and say, ‘We get you’re for it, but is it possible?'” Nguyen says. “I tell them about Jayapal’s bill in the House, and about the Senate and House bills going through the state legislature. I tell them there’s a path, a clear path, and that it’s a matter of us as a society getting behind it. And one person teared up as I was saying this.”

“I’m not bullshitting you,” Nguyen added. “Health care is not one of those times to play games. There’s no compromise here. We need health care for all. Period. We can compromise on other things.” Woo! Joe gets it.

Joe Nguyen

Joe Nguyen COURTESY OF JOE NGUYEN

Rep. Noel Frame, who has represented northwest Seattle in the House since 2016, agrees with Nguyen. She says her constituents talk about Washington developing its own single-payer health care system “all the time.”

“In my district, people feel like they’re getting hit from every side because the cost of living is raising so much and wages aren’t keeping up. Access to health care is one more contributor to that affordability issue,” Frame says. “But this isn’t just a pocketbook issue, it’s a life or death issue,” Frame adds, offering a story of a mother whose daughter suffers from Crohn’s disease. “If they didn’t have access to quality health care, they would at minimum be bankrupted as a family.”

Since Frame doesn’t face much of a challenge at the ballot this year, she’s spent a lot of time knocking on doors outside of her district. Recently she’s been out in eastern Washington on behalf of Jessa Lewis, who’s running for Senate in the 6th LD. “I definitely think [single-payer] is a winning issue across the state,” Frame says.

When she tells people in eastern Washington that Lewis is running to create “universal access to health care,” Frame says she gets a positive response: “I don’t hear people saying ‘rawr, Socialism’ when you mention universal health care. To the contrary, they say universal health care would be pretty great right now.”

“Especially when you talk to the health care professionals,” Frame continues. “I first heard about health care for all from the physicians in my district. They’re the ones seeing people dying because they can’t get access to care. They’re the ones telling me, ‘We need this. We need this yesterday.'”

Dave Wilson says he’s knocked on 9,000 doors in the 6th District during his campaign to win an open House seat. He says single-payer comes up when he’s knocking in blue areas, but not so much in red areas. “People are concerned about their health care, but I don’t know that the average voter is tuned into the details until it directly affects them,” Wilson says.

Whenever health care does come up, though, Wilson finds that the following line is well-received no matter who he’s talking to: “We pay twice as much for health care as any other developed country. Something is wrong. We need to fix this. Congress should fix it, but unless Congress flips, nothing’s going to happen. I’m hoping as a state we can start working on it.”

When asked about single-payer specifically, Wilson says he’s open-minded to any solutions: “My goal is coverage for all. How we skin that cat doesn’t matter to me as much as skinning the cat.”

Rep. Nicole Macri, vice chair of the health care committee in the House, says she hears more people in Downtown Seattle asking how Washington can lead on the issue of universal health care in general. They’re not specifically asking about a state-based system.

“I think we still put out an aspirational policy, something that shows what a state-based single-payer system would look like,” Macri says, “But we’re also looking at the values of single-payer: a publicly financed system that leverages the state’s buying power, multi-state drug purchasing, looking at adding people to the public employees benefit program, that sort of stuff.”

Rep. Macri points to her bill to expand Apple Health (Medicaid) coverage to DACA recipients through the age of 26 as an example of ways we can piece together a universal system by expanding the number of people the state can cover.

“I’m not sure if we can pass single-payer in the 2019 session, but I think we can pass the bills that expand health care coverage and make it more likely that we can move towards publicly financed programs where everyone is covered,” Macri added, though she admits that people are more feverous about health care now than when she was running in 2016.

Rep. Eileen Cody, chair of the health care committee, is even less enthusiastic about the single-payer bills in the House and Senate. She’s represented the 34th LD since 1994, which is the same district Nguyen hopes to represent in the Senate. But she says she hasn’t heard the level of enthusiasm from her constituents that Nguyen has. She admits, however, that she hasn’t been door-belling the district lately.

“I’ve been a single-payer advocate for 24 years, but I’m also a realist,” she says as she articulates the fears of moderate Democrats in the House. “I’ve never sponsored the Washington Health Security Trust bill (HB 1026). I hold hearings on it so we can make sure to keep it alive, but one of the reasons I’ve never sponsored is because the right would go crazy. There are not the votes in the House or the Senate for it at this stage in the game.”

That may be so, but just because Republicans don’t like state-based universal health care plans doesn’t mean the constituents they represent don’t like them either. Recent polling suggests that a majority of people in swing districts (including WA-08) support Medicare for All. The Washington Post claims the idea has majority support in 42 states, including Washington. Moreover, polling from the National Progressive Institute shows that 64 percent of Washingtonians support Medicare for All, and a majority “strongly” support it.

“I’m just very cynical because I’ve lived through too many rounds of health care reform,” Cody says. “The drug companies, the hospitals, the doctors—you go through who will be lobbying against something and I don’t think it’s going to happen.”

She’s not sure how Washington state will pay for single-payer, either. But we’ll have a better idea about real cost once a new study from the Washington State Institute for Public Policy is complete at the end of this year.

Cody also says she can’t in good conscience support a bill that will only work if certain conditions are right at the federal level, despite the fact that Republican politicians at the state level are happy to do just that for the issues they care about, especially regarding abortion.

“The problem is that it’s hard for me to support something I know we can’t do without the federal waivers,” Cody says. “I support the idea, but is it worth wasting my time to support legislation that can’t go into effect for years? I prefer doing stuff we can actually implement, not focus on stuff that is years in the future.”

Instead of trying to advocate whole-heartedly for single-payer, Cody says she’s tried to “be more practical and do the things we can do,” like put more of the Affordable Care Act language in the state statue just in case Republicans repeal it at the federal level.

For perfectly understandable reasons, Cody and other moderate Democrats in the legislature are scared of lobbyists, scared to take on the challenge of enacting massive but necessary change, too cynical to advocate for an idea they believe in, or just too worn down by the work of legislating to really push for a big idea.

Here’s a list of candidates who aren’t too scared to do any of that. Support them. Vote for them (but only if they’re a Democrat, and only the ones the SECB tells you to vote for, obviously). And if you don’t see your representative or a Democratic candidate running in your district on this list, call them up and tell them you want them to start screaming their heads off about securing single-payer health care for Washington state.

(All candidates on the list are Democrats, unless otherwise noted.)

Washington State Legislature

Legislative District 1 
Colin McMahon Pos. 1 (No party preference)
Shelley Kloba Pos. 2
Matt Seymour Pos. 2 (Libertarian)

Legislative District 2
Anneliese Feld Pos. 1

Legislative District 3 
Timm Ormsby Pos. 2

Legislative District 4
Ted Cummings Pos. 1
Mary May Pos. 2

Legislative District 6
Jessa Lewis (State Senate)
Kay Murano Pos. 1
Dave Wilson Pos. 2
John Aiken Pos. 2 (Republican)

Legislative District 7
Crystal Oliver Pos. 2

Legislative District 9 
Jenn Goulet Pos. 1
Matthew Sutherland Pos. 2

Legislative District 10
Scott McMullen Pos. 1

Legislative District 12
Alan Fahnestock Pos. 2 (No party preference)

Legislative District 14
Sasha Bently Pos. 1
Liz Hallock Pos. 2

Legislative District 16
Rebecca Francik Pos. 2

Legislative District 17
Damion E Jiles, Sr.Pos. 2

Legislative District 18
Kathy Gillespie Pos. 2

Legislative District 21
Lillian Ortiz-Self Pos. 2

Legislative District 25
Jamie Smith Pos. 1

Legislative District 27
Jake Fey Pos. 2

Legislative District 31
Immaculate Ferreria (State Senate)
Victoria Mena Pos. 1

Legislative District 32
Jesse Salomon (State Senate, SECB Endorsed)
Maralyn Chase (State Senate)
Keith Smith Pos. 1 (Centrist Party)
Lauren Davis Pos. 2 (SECB Endorsed)
Chris Roberts Pos. 2

Legislative District 33
Mia Su-Ling Gregerson Pos. 2

Legislative District 34
Joe Nguyen (SECB-Endorsed, State Senate)
Shannon Braddock (State Senate)
Lemuel W. Charleston (State Senate)

Legislative District 35
Irene Bowling (State Senate)
James Thomas Pos. 1
David Daggett Pos. 2

Legislative District 36
Noel Frame Pos. 1

Legislative District 37
Rebecca Saldaña (State Senate)

Legislative District 38
John McCoy (State Senate)
Bruce Overstreet (State Senate)
Mike Sells Pos. 2

Legislative District 39
Ivan Lewis Pos. 1

Legislative District 42
Tim Ballew II (State Senate)

Legislative District 43
Nicole Macri Pos. 1 (She’s introducing HB 1026 this year.)

Legislative District 45
Manka Dhingra (State Senate)

Legislative District 46
David Frockt (State Senate)

Legislative District 47
Mona Das (State Senate)

Legislative District 48
Amy Walen Pos. 2

U.S. House

Reps. Pramila Jayapal (WA-7) and Adam Smith (WA-9) are both champions of single-payer health care at the state level. In June, Rep. Jayapal introduced the bill that will make it possible in Washington State, and Smith signed on.

SECB-endorsed candidates Sarah Smith (running in the 9th Congressional District) and Jason Rittereiser (running in the 8th Congressional District) have come out loud and proud for Medicare for All and state-based single-payer efforts. Shannon Hader (also running in the 8th CD) wouldn’t vote for Medicare for All in its current form, but she would support state-based single payer efforts. Kim Schrier (leading fundraiser in the 8th) would back a bill allowing states to apply for federal waivers to set up their own program, but she more or less supports a public option at the national level.

U.S. Senate

Sen. Maria Cantwell and Patty Murray haven’t signed on to Medicare for All. Whenever you bring up the issue with Cantwell’s people, they will say the wordsBasic Health Program until you go away. The BHP is a plan in the Affordable Care Act that states can implement to cover “people who are too poor to buy insurance on the market but too ‘rich’ to qualify for Medicaid.”

Sen. Murray, who sits on the Senate’s HELP committee, also refuses to embrace Medicare for All. But she’s sympathetic to the cause at the state level. “Senator Murray believes strongly that affordable, quality health care should be a right, not a privilege in our country and she has supported legislation that would allow states more flexibility to reach this goal, including by establishing single-payer systems at the state level if that is the option they choose to pursue,” says her spokesperson.