The reality of single-payer healthcare in America

This piece from Joshua Holland in The Nation is so, so good.  If you want to understand the politics and policy of moving the US towards genuine universal health care, this is an absolute must-read.  So, just read it.  That said, a few very important points:

But from a policy standpoint, Medicare-for-All is probably the hardest way to get there. In fact, a number of experts who tout the benefits of single-payer systems say that the Medicare-for-All proposals currently on the table may be virtually impossible to enact. The timing alone would cause serious shocks to the system. Conyers’s House bill would move almost everyone in the country into Medicare within a single year. We don’t know exactly what Bernie Sanders will propose in the Senate, but his 2013 “American Health Security Act” had a two-year transition period. Radically restructuring a sixth of the economy in such short order would be like trying to stop a cruise ship on a dime…

Harold Pollack, a University of Chicago public-health researcher and liberal advocate for universal coverage, says, “There has not yet been a detailed single-payer bill that’s laid out the transitional issues about how to get from here to there. We’ve never actually seen that. Even if you believe everything people say about the cost savings that would result, there are still so many detailed questions about how we should finance this, how we can deal with the shock to the system, and so on.”

Achieving universal coverage—good coverage, not just “access” to emergency-room care—is a winnable fight if we sweat the details in a serious way. If we don’t, we’re just setting ourselves up for failure…

The most important takeaway from recent efforts to reshape our health-care system is that “loss aversion” is probably the central force in health-care politics. That’s the well-established tendency of people to value something they have far more than they might value whatever they might gain if they give it up. This is one big reason that Democrats were shellacked after passing the Affordable Care Act (ACA) in 2010, and Republicans are now learning the hard way that this fear of loss cuts both ways…

Under the current Medicare-for-All proposals, we would be forcing over 70 percent of the adult population—including tens of millions of people who have decent coverage from their employer or their union, or the Veteran’s Administration, or the Federal Employees Health Benefits Program—to give up their current insurance for Medicare. Many employer-provided policies cover more than Medicare does, so a lot of people would objectively lose out in the deal… [emphases mine]

There’s a common perception that because single-payer systems cost so much less than ours, passing such a scheme here would bring our spending in line with what the rest of the developed world shells out. But while there would be some savings on administrative costs, this gets the causal relationship wrong. Everyone else established their systems when they weren’t spending a lot on health care, and then kept prices down through aggressive cost-controls.

“Bringing costs down is a lot harder than starting low and keeping them from getting high,” says Baker. “We do waste money on [private] insurance, but we also pay basically twice as much for everything. We pay twice as much to doctors. Would single-payer get our doctors to accept half as much in wages? It could, but they won’t go there without a fight…

Rather than making Medicare-for-All a litmus test, we should start from the broader principle that comprehensive health care is a human right that should be guaranteed by the government—make that the litmus test—and then have an open debate about how best to get there. Maybe Medicaid is a better vehicle. Perhaps a long phase-in period to Medicare-for-All might help minimize the inevitable shocks. There are lots of ways to skin this cat.

Okay, that’s a lot of excerpts, but, seriously, read the whole thing– so many good and important points.

We can absolutely get to genuine, universal health care, but it will be hard work and just how we go about doing this is super-important.  Time to have serious conversations and debates about how we actually in the real political world move to a system of basic, affordable health care for all Americans.

About Steve Greene
Professor of Political Science at NC State

One Response to The reality of single-payer healthcare in America

  1. Mike in Chapel Hill says:

    The healthcare “costs” to taxpayers and employers are “revenue” to hospitals, medical device manufacturers, drug companies, and so on. Every effort to reduce costs will be met with aggressive, well-funded, and well-organized opposition from the stakeholders who will lose revenue. The cost-control efforts will be characterized as socialism, communism, big government, death panels, rationing, etc. That’s just the PR spin. The big money will be flowing to members of Congress who will buckle under the pressure.

    Furthermore, as long as money is pouring into the health care system the costs will not go down. It’s basic economics — if the provision of health care is defined as a right and costs will be paid by Uncle Sam in perpetuity then there is no pressure for suppliers to cut prices.

    There is some economic logic to the Republican plans to drastically curtail spending on health care. If the medical-industrial knows that the pool of money available for spending is x next year and only x + 3% every year after that, and if they want to continue to sell drugs and medical devices and surgery, then they will need to find a way to reduce their prices to meet the supply. This scheme works only if the expectation for the availability of money is firmly defined and enforced.

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