Single-payer Is Still the Best Option to Repair American Healthcare

The fate of the Republicans' health-care bill is clear; it’s not looking good. The ultra-conservative House Freedom Caucus refused to vote for the American Health Care Act because it basically wasn't cruel enough, resulting in a sloppy rewrite the night before the scheduled vote and further negotiations between them and President Trump on voting day. But the changes alienated some more moderate Republicans and failed to appease the ultras anyway. At that point, the vote was delayed until Friday. It then ultimately died.

The AHCA was a monstrous bill that would have left at least 24 million more people uninsured by 2026. But regardless of the bill’s failure, Democrats shouldn't just sit by and let Republicans slowly bleed the ACA to death by other means. They need a counter-offer, one that's more compelling than the creaky status quo. They need a single-payer, Medicare for all plan. Here's why.

Single-payer is quite clearly the best universal health-care policy option for the United States. The U.S. model of multi-tiered health insurance has generated lousy and highly unequal outcomes, both here and in European countries with similar structures like the Netherlands. Complicated public-private hybrid systems mean much larger administrative costs, and the fact that markets are extraordinarily ill-suited to deliver health care means tons of difficult regulation. Millions of Americans remain uninsured. Massive, complicated programs such as Obamacare tend to allow people to fall through the cracks.

ObamaCare remains a complicated hybrid system that can be replaced by something much more efficient. Instead of being a relatively simple, straightforward program to hand out insurance coverage—such as medicare—Obamacare has complex regulations, fiddly quasi-market structures, and mandates everywhere you look. It should be no surprise that many of those regulations do not completely fix the problems they were intended to address—or they are effectively ignored. We need tools that are simpler, bigger, and more efficient. Single-payer fits that bill. description. Implementing single-payer would be seriously disruptive to the existing insurance arrangements in America. However, that’s no reason for inaction.

Just under half of Americans get their insurance through their employers. Expanding Medicare to that size in one stroke would be a huge administrative undertaking. If implemented, a single-payer program would also eliminate many large health insurance companies that employ tens of thousands of people. There are ways that this disruption could be handled, of course. For example, You could couple single-payer with a one-time surge of active labor market policy to shift people into new jobs, so that most of these people land on their feet. 

This brings me to the politics. As noted above, ObamaCare has only started the job of achieving universal health care, and this is a good chance to move the ball forward. The AHCA was extraordinarily unpopular largely because it took coverage and subsidies away from folks, and a majority of Americans believe that it should be the government's responsibility to make sure everyone is covered. Furthermore, government-funded health insurance programs such as Medicare are very popular. If Democrats had simply bulled ahead with a single-payer type plan in 2009 instead of the complicated and heavily means-tested ObamaCare, they may have done better in the 2010 midterm elections.

For people who are skeptical of going full-bore all at once on single-payer, it still makes an excellent opening bid. Start with single-payer for all and you could end up with a plan of combining Medicare and Medicaid, enrolling all people under 26 and over 55, or putting a Medicare buy-in on the ObamaCare exchanges. Even the original draft of ObamaCare was far more generous before it got badly beaten down by conservative Democrats.

Medicare for all is simple, easy to understand, and hard to argue against or distort. Most people know someone on Medicare who can testify to the generally good care—or someone who is counting the days until they can enroll and have the peace of mind that comes with quality coverage. Fabricated scares like the mythical ObamaCare "death panels" will be a much harder sell.

As Republicans do their level best to make sure as many poor people as possible go bankrupt from medical debt or die of preventable diseases, a single-payer counter-offer makes perfect policy and political sense. It's also the right thing to do. This is the time for progressives to stand up, be counted, and continue down the path to guaranteed health care.


Matthew Sporn is a Senior Editor at Sojourn Review. You can follow him on Twitter here.