Why the United States Must Implement a Single-Payer Healthcare System
Republicans’ persistent efforts to repeal the Affordable Care Act since retaking the White House have brought the shortcomings of the United States’ healthcare system into sharp focus. Poignant stories illustrating the human cost of some 32,000,000 Americans losing their coverage have circulated widely online, betraying the weight of the ongoing struggle. And for every American who would lose health insurance if Republican efforts succeed, there are nearly as many who remain uninsured today — an estimated 28,000,000 — exposed to the uncertainties of everyday life without the proper safety net.
Democrats, for their part, have firmly challenged Republicans on the issue, emphasizing the considerable success of the Affordable Care Act and pressing for details about Republican plans for a replacement. Some Democrats, notably Senators Bernie Sanders (VT) and Elizabeth Warren (MA), have gone further, pushing for a single-payer healthcare system that would expand coverage to all Americans, and urging Democratic leaders to follow suit. Yet the reluctance of many Democrats, despite growing support for single-payer among party members, suggests that the path forward to universal healthcare remains undecided.
One understandable concern, most often expressed by antistatist critics of healthcare reform, is the cost of financing such a system. Estimates of the price tag on single-payer range from $1.38 trillion/year to upwards of $2.5 trillion/year, a burden to be met primarily by taxpayers. In a country racked with sharp income inequality and stagnant wages, such a burden warrants careful consideration from single-payer’s proponents.
Yet evidence shows that Americans already pay more for healthcare, per capita, than any other country in the world. By the 1990s, the “private health care system was already reaching new heights of bureaucratic complexity,” fragmentation that was compounded by the ACA’s “three-legged stool” structure. The current arrangement is plainly inefficient, particularly in light of the successes single-payer systems have enjoyed elsewhere. And there are plenty of models from which to base a system of our own. Representative John Conyers’ (D-MI) proposed Medicare-for-All bill, H.R. 676, aims to cover the costs of single-payer by raising income taxes on the top 5% of earners and implementing a “progressive excise tax on payroll and self-employment income.” H.R. 676 and other models demonstrate that much of the groundwork for financing single-payer has already been laid.
Perhaps the most serious roadblock to single-payer healthcare are stakeholders who benefit enormously from current healthcare arrangements. Sociologist Jill Quadagno concluded in her 2006 study of healthcare reform, “…each attempt to guarantee universal coverage has been resisted by powerful special interests who have used every weapon on hand to keep the financing of health services a private endeavor.” Quadagno argues persuasively that the only way to counteract these special interests is through popular mobilization. Here we must follow the lead of the courageous activists who have organized protests throughout the country, in senators’ offices and government buildings, with coordinated phone-banks, marches, and rallies. As their actions suggest, the more the public declares healthcare to be a social right provided by the federal government, the closer we are to achieving universal healthcare in the United States. Every wasted moment is one too many.
