Will Single Payer save U.S. healthcare?

Sen. Kamala Harris

Health care was the definitive issue that propelled the Democrats to leadership in the U.S. House of Representatives, during the recent midterm elections, and it’s bound to be on the agenda for the party as it moves progressively to the left; and after not being even remotely possible during the Obama administration, polls now show that it is the number one issue that most Americans care about.

In fact, a recent Reuters survey found that 70 percent of Americans now back universal healthcare.

The move to “Single Payer”, or what some are calling “Medicare for All”, has also become part of the litmus test for aspiring Democratic presidential hopefuls, and was on the platform for recently announced 2020 presidential candidate, Sen. Kamala Harris of California.

Not having comprehensive  healthcare for all of America, can also be seen, by some, as a moral issue; and, taking this stance is John Marty, who writing for Commonweal Magazine, noted, “The United States, the wealthiest nation on the planet, remains the only industrialized country that fails to provide health care for everyone. Our dysfunctional health-care system is bankrupting families and killing people by failing to provide needed care.”

Some history of how we got here

Helping us to take a look back on past efforts  is Investopedia, who stated, “Advocacy for a single-payer system in the U.S. is nothing new. In the fall of 1945, just after the end of World War II, recently inaugurated President Harry Truman addressed Congress with a plea for a national healthcare system. The American Medical Association opposed the idea, and it eventually faded away.”

Filling the void, were incremental steps: ”Medicare and Medicaid were established in 1965, essentially becoming a de facto single-payer system for certain groups of the population – senior citizens, and young children and the poor, respectively.

In modern times, the strongest push to nationalize healthcare in the world’s largest economy happened in 1993. When her husband’s administration was months old, then-First Lady Hillary Clinton spearheaded the Health Security Act . . .the bill required all citizens to enroll in a government-approved health plan and forbade them from ever exiting that plan.”

In the space of less than ten years, when President Obama saw no possibility of a single payer bill  passing Congress, there is now the additional  push for a bill proposed by Sen. Bernie Sanders, to build on the foundation of the Affordable Care Act, known as “Obamacare”, which has helped 17 million Americans gain health coverage.

A new beginning?

“Imagine how much less stressful our lives would be without co-pays, deductibles, billing for services, lifetime limits or huge insurance premiums,” says University of Massachusetts Economics Professor Gerald Friedman.

Sanders proposes a 6.2 percentage fee paid by employers and for  families, 2.2 percent, resulting in total savings of $5800; and others are saying that there will be savings of $6 million over the current system.

Sen. Sanders

Giving a public push to the proposal that, “95 percent of U.S. households would save money under a single-payer plan,” says Mark Dimondstein, president of the American Postal Workers Union, in an Op-Ed piece last year for Cleveland.com.

Arguments for the single-payer option, are plentiful, but others are taking the tack that since the ACA was a “failure”, and is cost prohibitive, among them Friedman, a new effort should be made from whole cloth.

Part of the problem, he sees, for a GOP issued plan is it “would drive 22 million people from health insurance rolls, according to the Congressional Budget Office; incentivize employers to eliminate health coverage; limit coverage for pre-existing conditions; and drastically raise medical costs for seniors - all while giving billions in tax breaks to the wealthiest.”

What next?

Where are we now, say many? Is this an either or choice, or do we continue the struggle to harness healthcare, an effort almost as old as the nation, or do we give up, and go back to the dark days, where there was no coverage for preexisting conditions and where preventive care was not an option, except for those lucky enough to have a generous employer based plan.

Among those who are making single-payer, or Medicare for All, as the cornerstone of the new progressives, are  Rep. Alexandria Cortez-Ocasio, whose promotion of the plan, helped her unseat a seasoned New York incumbent,  and who publicized that she paid more, as a waitress, in the city, for health coverage, than she does as a member of Congress.

Joining in the opposition, are those who are “conservatives who simply abhor "big government." Some have perfectly valid reasons to question the merits of single payer in general or [Bernie] Sanders' methods in particular. Yet others claim they support universal healthcare in theory (one day, perhaps) but cannot do so now because of a "concern." They are "concern trolls" — broadly defined as "a person who disingenuously expresses concern about an issue with the intention of undermining or derailing genuine discussion," in a 2017 editorial in the LA Times.

With the single payer option, there is one source - the government - that would pay all health care providers and also negotiate with the pharmaceutical companies ro better drug prices.

Costs v. benefits

Nevertheless, some conservative concerns are valid: ”The Mercatus Center bakes in some assumptions that could vary the actual cost quite a bit. For example, its scholars assume (as the Sanders bill dictates) that hospitals and doctors would be paid at Medicare rates, a cut from private insurance rates but an increase from Medicaid rates. If the real payment rate were different, it could affect the price tag significantly.”

$32 trillion, to be exact, is the cost set by Sanders, and yet some supporters, while acknowledging this, also state, “Single-payer supporters are going to have to come up with a persuasive case that, yes, the federal government is going to spend more, but overall spending won’t go up. Taxes are going to rise for somebody, but many or even most Americans could end up saving money on their premiums or on out-of-pocket costs.”

Of course, as we have seen, partisan politics could bring the whole effort to a dead stop.

Circling back

Circling back, to those employer based plans, let’s take a look at how, and why, there were developed, and who benefits from them.

“Half of all Americans get health insurance through their jobs. That’s by design. Doctors and hospitals in the mid-20th century saw a rash of government-run systems being set up in Europe and they lobbied hard to avoid one of their own, vastly preferring private coverage. Employee benefits were exempted from wartime price controls during World War II, giving employers an incentive to offer them at a time when it was nearly impossible to offer raises. Labor unions got on board too, sensing an opportunity to expand the safety net for workers without needing to pass another massive piece of social reform so soon after the New Deal,” explained Vox in their continuing coverage.

“But the work-based system, for all its flaws, could also be the biggest barrier to enacting single-payer. Shifting 160 million people from the coverage they currently get through their jobs to a new government plan is a lot of disruption — and disruption, especially in health care, makes a lot of Americans nervous.”

“It's a real barrier to doing anything big,” says John Holahan at the Urban Institute, who helped create a proposal explicitly designed not to disrupt work-based insurance. “Most people with employer plans are reasonably happy with them.

When Vox conducted focus groups on single-payer, led by opinion researcher Michael Perry, one recurring concern we heard was from people who mostly like the insurance they have and were worried about losing it under Medicare-for-all.”

There is still a need . . .

The sad part is that “More than 30 million people still lack health coverage. Premiums and out-of-pocket costs for employer-sponsored plans have been rising steadily.

“Right now if you look at a lot of the labor disputes that go on, very often they have to do with health care. They have to do with employers saying, hey, you know what, we’re raising deductibles, raise your copayments.”

Sanders told Vox in 2017. “What we can say to those workers is they will be better off financially and that their business that they work for will be better off financially.”

With rising prices of the cost of healthcare, it is the one area that many employers cut back on the most, and is at the heart of many strikes, especially those by teachers.

There seems to be no simple solution in sight, and it is necessary, say some, to realize that “Employer health insurance does do a few things quite well. It covers a lot of people, of course. It helps pool risk — companies, particularly larger ones, are almost by default a useful mix of healthy and sick people, helping to spread costs around, because they were not formed for the purpose of providing health insurance.”

Prices are generally lower than the individual marketplace, and the insurance industry is trying to cover a menu of options and at a lower cost to meet need, while providing value to employees, say its defenders.

Sen. Merkley

“Sen. Jeff Merkley, an Oregon progressive with stated presidential interests, co-sponsors Sanders Medicare-for-all bill — but he has also introduced his own narrower proposal with Sen. Chris Murphy of Connecticut to give people the option to buy a government plan.”

“You have folks who will say, ‘Wait a minute, I don’t have a choice,’ and they will provide resistance,” Merkley said, “And, of course, the private insurance companies, which would be replaced, will put up massive resistance.”

Insurance heroes? True or False?

There are those that countering the argument that insurance companies are working hard at improving coverage..

“They haven’t proven that successful at improving health or managing costs,” Caroline Pearson, a senior fellow at NORC-University of Chicago, says. “What they’re investing in hasn’t shown any return yet. Behavior change is really hard. Frankly, we have no idea how to do it well.”

Employer based insurance also favors high earners at large corporations, and not people in the lower income levels, with many left wondering should an employer decide what health coverage that you can get?

Single-payer supporters state that, "Medicare is a very popular program, so the idea of expanding it to everyone is popular as well," Larry Levitt, senior vice president for health reform at the KFF, told CNBC Make It  last  August. "The advantage of 'Medicare for all,' which is much closer to how the rest of the world provides health care to their residents, is that you can achieve universal coverage at a lower cost."

It does all come back to cost, and there are wide price disparities, for simple surgeries, and, ”a national comparison of hospitals, from The New York Times, showed pricing for the simplest form of knee replacement ranged from about $3,400 to about $55,800. Hospitals charging the low-end prices are not undercharging; they set prices sufficient to cover their costs. Those radical price disparities—unrelated to costs or benefits—show that some purchasers of health care are being charged as much as ten to fifteen times what is reasonable. A logical single-payer system negotiates prices, resulting in rational costs,” say advocates.

Opposition

Opposing is Scott Atlas, who in 2017, in an Op-Ed piece for CNN, saw the single payer option as being the worst option for the nation, and citing our neighbors to the North, said, “in Canada's single-payer system, the 2016 median wait for a referral from a general practitioner appointment to the specialist appointment was 9.4 weeks; when added to the median wait of 10.6 weeks from specialist to first treatment, the median wait after seeing a doctor to start treatment was 20 weeks, or about 4.5 months.”

In contradiction, one Canadian replied that these were mostly false statements, and emphasized “we wait, if it’s not urgent, but then we are more of a communal society than the States.”

Another Canadian expat, said in return, that was an example of  ‘Canadian conceit.”

“Increases in per capita healthcare spending in Canada have kept pace with those in the U.S., expenditures in the former having almost tripled since the mid-70s, going from $39.7 billion to $137.3 billion. The Canadian government not only acknowledges that many of its citizens have to wait a long time for care, but recently spent an additional billion dollars to examine the issue. In the meantime, watching the months pass is an unavoidable component of Canadian healthcare. If you want a new hip or knee, prepare to live with your old one for at least half a year,” say those in opposition among them, financial analyst, Greg McFarland.

Joining the naysayers are those who feel that control is lost and fear the bugaboo of government control.

This just in

Not to be outdone in the political climate, where winning is still winning and losing is well, still, losing is a report from Politico, released on Tuesday,  noting that “Several likely 2020 Democratic presidential candidates are pushing plans for something short of universal health care, a move already creating friction within the party's empowered left wing, which has panned any attempt to water down the progressive dream of a single-payer system.”

In a nod to political reality, “One idea gaining support is allowing some demographic groups to buy into Medicare earlier than age 65, while still incrementally building on Obamacare coverage gains.

“It’s easy to say ‘Medicare for All’ and make a good speech, but see no action,” said Sen. Sherrod Brown (D-Ohio), a potential 2020 candidate whose own bill would give retiring police and firefighters access to Medicare before 65. “I want to see action.”

It's a pathway Brown and many in the party establishment have gravitated toward in recent months — one that balances the desire to make a Trump-era lurch leftward with memories of the political blowback Democrats endured for a decade after their last revamp of the nation’s health system.”

“If we could make the leap straight to Medicare for All, I would love for us to do that,” Merkley said. “But it’s important to lay out a route about how we get to that vision. If you tell people the only choice they have is Medicare, that could produce a lot of folks being concerned about, ‘Wait a minute, I like my health care and you’re telling me I have to leave it.” - giving credence to the earlier arguments for retaining employer based insurance.

Chances are slim for Democratic hopes “of enacting any coverage expansion bill while Republicans control the Senate . . . rather, the party establishment is urging progressives to bide their time and use the next two years to perfect a plan the entire party can get behind come 2020.”