Single Payer isn’t the only progressive healthcare policy
Single Payer and Universal Healthcare aren’t interchangeable
Recently, Senator Bernie Sanders (I-VT) introduced his “Medicare-For-All” Act in congress. Surprisingly, the bill has received a lot of support from congressional democrats with about a third of the senate caucus signing on and pledging their support. With co sponsorships and support from potential 2020 contenders Kamala Harris, Elizabeth Warren, and Cory Booker; this signals a dramatic shift in center-left discourse on health care. The recent republican attempts to repeal the Affordable Care act, or Obamacare has shifted the discourse into viewing healthcare as a human right that the government should play a larger role in guaranteeing to the public.
The bill goes has a very extensive benefit package covering all health care and requiring no cost sharing by the end user whatsoever. It would be even more generous than the existing single payer systems like that of Canada with its coverage of vision and dental care. However there is very little information available about how it will be paid for but released a set of options that potentially could be used.
For now the measure seems to be a matter of virtue signaling to insulate potential candidates from left wing critics. Support for single payer is quickly appearing to be a litmus test for democrats serious about running for higher office. Estimates for the program’s price tag range from $1.4 to $2.4 trillion per year. What no one seems to want to talk about is what the herculean task of implementing such a system would entail. We are talking about switching 300 plus millions people off of their current plans (many of whom are satisfied with private insurance) to a new system, Raising taxes substantially on a broad majority of americans, Putting an industry that employs hundreds of thousands of people out of work, and asking another industry to take a substantial pay cut.
This would be a set up to an extreme disappointment if democrats managed to retake the white house and congress in 2020 and were unable to pass such a bill because the logistics haven’t been worked out.
Many people make the mistake of believing that single payer and universal healthcare are synonymous and can be used interchangeably, however they are not. “Single Payer” describes a monopsony in a political economy in which one entity (usually the government) is the sole purchaser of healthcare. The phrase “Universal Healthcare” describes a condition in which all citizens in a country have access to healthcare coverage, be it through government programs or private insurance, or a mix of both. However single payer is not the only progressive route to universal healthcare and progressives shouldn’t limit to themselves to one specific policy that may not be the best option.
Not all western european nations have single payer. France and Germany have excellent healthcare systems using a combination of both private and public coverage. The US could easily replicate it by revisiting the idea of a public option that was originally mulled during lead up to the passage of the Affordable Care Act. Senator Brian Schatz (D-HI) proposed a bill that gives people the option to buy into the medicaid program. Medicaid expansion could be revisited in the states that initially rejected it.
With the Affordable care act, America has reached close to 90% coverage. In the context of 100 years of progressive activism, the law is a pretty big deal. Teddy Roosevelt tried to get national healthcare but failed. FDR wanted it as a part of the New Deal, and failed. Truman attempted to push for it and failed. LBJ managed to get a limited expansion with medicare and medicaid. Carter promised national healthcare reform on the campaign trail but couldn’t manage to pass it even with a democratic majority. Bill and Hillary Clinton famously failed in the 90’s to push for health reform. However the Obama administration managed to get it done.
With multiple bills being put forth to repeal the ACA, progressives should focus their energy on preserving what gains they have made and expanding on them eventually. Applying purity tests for a lofty ideal is counterproductive and short-sighted. Incremental policy changes aren’t as exciting and appealing as big pie-in-the-sky ideas, but they are more feasible. Policymakers should not be swayed by ideas that sound good on paper but don’t add up in reality. Someone has to ask the tough questions of how it will work out, how it will be paid for and how it will be implemented. Sound policy most definitely trumps sexy slogans.
