Single-Payer Health Insurance Gaining Support

David Leonhardt/NYT Bernie Sanders plans to introduce his Medicare for all bill this week, and it’s already winning support from some Democrats. Even Max Baucus, the powerful former Montana senator who long opposed single-payer, now supports it. With Republicans controlling every branch of government, single-payer health care has no chance of becoming law anytime soon. But the attention to it still matters. The odds are rising that Democrats will make a push toward single-payer when they next are in charge. So here are five questions to consider as you follow the story: 1. What is single-payer, anyway?  Good question! People are too often afraid of asking basic questions about complicated policy debates. Single-payer health care describes a system in which only one entity — the government — pays basic medical bills. If all Americans had Medicare rather than insurance through their jobs, it would be a single-payer system. But single-payer doesn’t necessarily involve the elimination of private insurance, as Larry Levitt points out. In Medicare, for example, private insurers sometimes act as a middleman between the government and hospitals or doctors. The key difference is that taxes, rather than payroll deductions or disposable income, pay the bills. 2. Does single-payer work well in the countries that have it? Generally, yes, it works very well. Costs are lower across Europe, Canada and Australia, where government plays a bigger role in medical care than here, and citizens in many of those places live longer than Americans. This is the single best argument for single-payer. “In America, we should join every industrialized country and guarantee health care to all Americans as a right,” Sanders told Stephen Colbert last week 3. Could the United States keep its distinctive advantages under single-payer? The American system is expensive and inefficient. It also produces many of the world’s most important medical innovations — new drugs, devices, treatments and the like — and is home to many of the best hospitals and researchers. That’s why wealthy people from other countries often come here for treatment. It’s certainly conceivable that a single-payer system could retain these advantages while making American health care less wasteful. But I’d like to hear a fuller explanation from advocates about how it all would work. 4. How will single-payer overcome its political obstacles? Even if single-payer reduces costs and lifts quality, the transition would be very tricky. Many people would be forced to change insurance plans even if they liked their current coverage. (Ask Barack Obama how popular that would be.) And money that Americans are now spending on private health care would instead have to be funneled into higher taxes Sanders deserves credit for both the passion and detail he is bringing to the subject. Yet his plan from the 2016 campaign was not realistic about the necessary tax increase, as an analysis by the Urban Institute, a left-leaning think tank, showed. The recent failure of single-payer in left-leaning Vermont, which helped end the governor’s political career, shows how brutal the politics are 5. Is this a yes-or-no subject, or is there a middle ground? Ah, my favorite question. There is indeed a middle ground It’s entirely possible for the country to move toward single-payer without going all the way. This approach would involve expanding Medicare and Medicaid over time. The Republican Party’s radicalism on health care over the past decade has made this sort of transition all the more likely. The conservative alternative to creeping single-payer is an expansion of the private markets. But the Trump administration and many (though not all) Republican governors have been actively undermining Obamacare’s private markets Ron Pollack, a longtime advocate for expanding health coverage, has a nice breakdown of the gradualist approach in Vox I recommend reading Paul Krugman’s argument that progressives should now focus their energies on issues other than health care, and The Times’s Editorial Board on why single-payer may yet be a bridge too far. Clio Chang of The New Republic has written a piece asking why more progressive wonks don’t favor a single-payer push And anyone interested in this issue should go to the source and read Sanders’s proposals here. It’s also worth watching the more gradual approach of Senator Chris Murphy, which Elana Schor of Politico explains.