The renewed push for universal health care
Americans are once again looking for a better deal
Martin Luther King, Jr. once said that “the arc of the moral universe is long, but it bends toward justice.” In a different context, I would tell you that the arc of the health care universe is long, but it bends toward universal health coverage. Ultimately, each country should ensure that it’s citizens are guaranteed health coverage that they can afford. It is simply the most equitable way to provide health care, to say nothing of the most efficient and cost-effective. For the first time in decades, a majority of voters also think this way.
Americans have been proposing, and walking away from, universal coverage policies since the New Deal. The 2008 presidential campaign and President Obama’s health reforms serve as the high-water mark for the idea. The Affordable Care Act (ACA) pushed the United States the closest it has come to providing universal health coverage. However, it still left several million Americans without health insurance, and the question of what to do to protect this population has put UHC back onto the agenda. Bernie Sanders moved the issue into the spotlight by including a single-payer system as a plank in his 2016 campaign platform. Now, Republican efforts to repeal the Affordable Care Act may be pushing the country closer to universal health care, even as they work to take coverage away from millions of their own constituents.
The problems Republicans have faced in trying to come to a consensus on repeal illustrate this shift in thinking. The ACA can trace its roots back to a market-based, consumer-driven vision for health care from the Heritage Foundation. There is little else in the way of health policy anchored deeper in conservative values. The question they are unable to answer is, if Republicans are dead-set against a market and consumer-focused health care solution, what do they support? Voters have expressed their distaste with rock-bottom support of both Senate and House health plans. The opposition to cutting and restructuring Medicaid in the Senate and, to a lesser degree, the House suggests that voters and their representatives aren’t as uncomfortable with government health programs as campaign rhetoric suggests. Against this backdrop of uncertainty, states are once again starting to explore creating their own single-payer systems and national politicians stump for a public option to stabilize insurance markets.
It should be noted that while “single-payer” is often used synonymously with universal health care, single-payer is just one means to this ends. For over a hundred years, Germany has provided a universal health coverage system based on non-profit sickness funds that looks like the American system distorted in a funhouse mirror, while Singapore provides universal coverage through a savings and subsidies based system. However, Americans seem particularly drawn to a single-payer approach, often based on allowing people to buy into coverage offered by Medicare and Medicaid (already the nation’s largest insurers), or simply expanding one of these programs to provide for the nation’s care by default. In fact, “Medicare-for-all” polls slightly better than referring to “single-payer.” I myself would prefer a Medicaid-for-all, as it would likely offer stronger benefits, fewer gaps in coverage, and less out-of-pocket spending. However, that in turn would make it much more expensive, which speaks to the problem that single-payer systems have run into in the US.
As California has seen, the costs of such a generous plan are tremendous, and the numbers often scare away support. Proponents argue that this merely changes where consumers pay for health care, not how much. Instead of paying a separate insurance premium each month, the money is drawn from taxes. Additionally, they suggest that if your employer is no longer paying to subsidize your health care, wages will go up commensurate to the tax increase. The rising cost of health care to employers may in fact be one of the primary drivers of stagnant wages in the country (economists would caution that this is very tricky to prove). Whether single-payer supporters find a way to move beyond sticker shock and convince reluctant voters of the benefits remains to be seen.
Part of the issue may be the focus on “savings”: single-payer systems are not cheap, but they are much more cost-effective than the current Rube Goldberg machine that Americans rely on. The government is inherently spending more to cover the lives of every individual within, but the per-person cost of health care drops precipitously as a streamlined, more efficient system takes over for the fragmented system we currently live in. Universal health coverage is not easy, but making sure everyone has access to coverage is ultimately the only just way to provide care.
