As the debate surrounding health care in this country heats up, advocates of a single-payer system are pushing hard for a national system that would provide coverage to everyone.
On the national level, congressional representatives in both the House and Senate have introduced legislation to push the issue forward. In the Senate, Sen. Bernie Sanders (D-Vermont) introduced the Medicare for All Act last September and Washington state Rep. Pramila Jayapal (D-Washington) introduced a bill in the house designed to let states enact their own single-payer systems while she helps build a House caucus for federal single-payer health care. Jayapal said a single-payer system would help the average American.
“The biggest issue is affordability and quality, you know, you have the situation of the exorbitant cost of pharmaceutical drugs that is hurting everybody,” she said. “Insurers are making a lot of money with their premiums.”
The bill in the House, Jayapal’s HR 6097 would allow states to form their own single-payer systems and negotiate for lower prescription drug prices though regulations as well as ensuring everyone has health care. Sanders’ bill, S. 1804 would create a federal single-payer system. A recent report by the Mercatus Center found it would increase federal health care costs by $32.6 million. However, a Business Insider article said this would be around $303 billion less than is already projected to be spent in the United States on health care over the same period of time, even with universal coverage.
Savings would likely come from many places, including the government’s ability to leverage bargaining power to lower prescription costs and ensure health care providers take a the lower offered payment rates, similar to health care systems found in most other developed nations. Instead of paying a private insurance company, the system would be funded by tax dollars and by using savings from services that would be cheaper once redundancies and profit margins were removed from the system.
Single-payer health care has received support from some national doctors organizations, including Physicians for a National Health Program (PNHP).
Mercer Island resident Sarah Weinberg is a retired pediatrician and a member of of PNHP. She said Medicare could be expanded into a single-payer system with some modifications, resulting in a system similar to Canada’s, where health care is seen as a human right instead of a privilege like in the United States. Providers would remain separate from the government, but would send bills to the government instead of using private insurance companies.
“Privatizing essential services is overly expensive and full of holes and it doesn’t work very well. That there is a reason why we need a community that we all tax ourselves to pay for essential services,” Weinberg said.
Despite gains made by the Affordable Care Act, in 2016, there were still more than 27 million Americans left without insurance. Advocates of single-payer health care say a national model would provide care and financial relief to everyone in the country.
While the national Democratic party has largely shied away from single-payer health care as a platform, the emerging Democratic Socialists of America (DSA) movement has been vocal in its support of an overhaul. Andrej Markovčič is an organizer with the Washington state DSA Medicare for All campaign and said they supported both the House and Senate bills.
“Both of them would get us to that point but if some other legislation came along that was better and fulfilled those requirements, we would be in favor of them,” he said.
LOOKING TO OTHERS
The DSA has five requirements for any single-payer system. These include provisions that any single-payer system be one program that offers comprehensive coverage, a single health program, no charge at the point of service, universal coverage for everyone in the United States — including non-citizens — and a transition plan and severance pay for people who would lose their jobs when insurance companies are shut down.
Unlike PNHP — which supports a Canadian-style system where medical providers are not government employees as opposed to a United Kingdom-style system where they are — Markovčič said the DSA will support any system that adheres to its five guiding principals.
Given the proliferation of single-payer systems across the rest of the post-industrial western world, Markovčič said implementing a new health care system relied more on finding the political will to push it through rather than whether it is possible. According to the DSA website, a working family currently pays more than $6,000 a year in premiums in the United States, a figure that could drop to less than $500 in only taxes under a single-payer system.
“Other countries do it and they do it well,” Markovčič said. “It’s not a mystery how to run a state single-payer health care system.”
A SYSTEM THAT FAVORS THE RICH
On top of financial savings, Markovčič said it is a moral imperative to transition to a system that doesn’t leave millions of people in debt or one emergency away from bankruptcy. This would need to come from a single system instead of offering dual-systems as proposed under public option insurance where the government offers insurance plans in addition to private plans. This would allow wealthy individuals who can pay more for expedited service.
“Any time that the wealthy get to have their own separate program, that’s what’s going to happen,” Markovčič said. “They’re going to take care of themselves and their own…and the bulk of people who have to go to work every day will be left to their own, basically, luck.”
A common criticism of single-payer is a trend of some Canadians hopping the border to the United States to receive faster care. CTV News reported that in 2016, some 63,000 Canadians who could afford to came to the United States to receive faster treatment. While waiting queues for non-emergency procedures can be longer, critical emergencies are taken care of immediately. This has led to the claim that health care will be rationed in the United States under a single-payer system, but Weinberg said health care is rationed under every system. In this country, it is rationed by one’s ability to pay for and afford service while many go without necessary procedures.
“We blame the poor for being poor,” she said. “We say, ‘Well, they’re just lazy.’ ‘They should just go get a job.’ etc., The rest of the world, you walk down the street and see a person begging you don’t say, ‘Oh, just go get a job,’ you say, ‘There go I but for the grace of God.’”
On top of this, eliminating private health care would free up workers to pursue better jobs if their insurance isn’t tied to their employers, Markovčič said. It could also strengthen unions by taking health care off the table as a bargaining chip for employers, he said.
A POLITICAL FIGHT
Jayapal, Weinberg and Markovčič all agreed that the push for single-payer health care would boil down to a political fight, and one that would hinge on pushing legislation through Congress as well as clearing inevitable judicial challenges in the Supreme Court.
Jayapal said she hoped Congressional Democrats would be able to stop the appointment of Brett Kavanaugh, the second Supreme Court nominee the Trump administration could appoint to the court, which would effectively cement a conservative court for a generation.
“Everything is about people in the streets and people voting and who you put into office, and really continuing to push the momentum for a single-payer system,” Jayapal said.
Others like Markovčič have suggested going even further and threatening to stack the Supreme Court once in power. This would mean increasing the number of justices on the court, which would be appointed by a left-leaning administration. It is the same tactic that was used by President Franklin D. Roosevelt to get the court to pass the New Deal and one that Markovčič said Democrats should consider to overpower both private and right-wing interests.
“They’re not going to just roll over. They’re not going to be convinced by moral pleading,” he said. “We have to have a coherent understanding of what we have and how to get the system we want.”