The Real Obstacle to Single-Payer

[RandySF]

The barrier to single payer is that the American health-care system has been built, by accident, around employer-based insurance. The rhetoric of single payer concentrates its moral emphasis on people who lack insurance at all. (“Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right?” writes Sanders today.) But the barrier to single-payer health care is the people who already have coverage. Designing a single-payer system means not only covering the uninsured, but financing the cost of moving the 155 million Americans who have employer-based insurance onto Medicare.

That is not a detail to be worked out. It is the entire problem. The impossibility of this barrier is why Lyndon Johnson gave up on trying to pass a universal health-care bill and instead confined his legislation to the elderly (who mostly did not get insurance through employers), and why Barack Obama left the employer-based system intact and created alternate coverage for non-elderly people outside it.

In theory, the transition could be done without hurting anybody. The money workers and their employers pay to insurance companies would be converted into taxes. But this means solving two enormous political obstacles. First, most people who have employer-based coverage like it and don’t want to change. Second, higher taxes are unpopular. Yes, in an imaginary, rational world, people could be reassured that Medicare will be as good as what they have, and the taxes will merely replace the premiums they’re already paying. In reality, people are deeply loss-averse and distrustful of politicians.


http://nymag.com/daily/intelligencer/2017/09/sanderss-bill-gets-u-s-zero-percent-closer-to-single-payer.html

[RainCaster]

1. Uhh Yeah, he's got this right.

And here I sit, a Demo, and I haven't figured out a way to make this right.

[RandySF]

2. Because it's not easy.

[brush]

15. Except one small detail...many workers don't like their employers healthcare system.

Deductions have gone up exponentially in recent years.

Workers just don't have anything to compare it to.

Once it's explained to them that there won't be a $3000 deductible with Medicare they might come

around, especially if, the devil being in the details, paycheck deductions are worked out to be less under Medicare

There has to be funding from somewhere, whether it's more taxes or taxes shifted from somewhere else like as I mentioned above, payroll deductions.

Sanders is doing himself and us Dems a disservice by making it seem like universal care will be pie-in-the-sky free.

Not being up front about that fundamental fact that can't be gotten around and will come back to bite us in the you know where if it seems later that we weren't being transparent about where the funding is going to come from.

Now if it's proposed that a minor 3-5% cut in the military budget could do it, we might get some positive feedback. Even repugs know the military budget is extremely bloated and could stand a minor trim.

The ACA can be folded into it. It'll be complicated, as will the whole rest of Medicare for all will be, but it can be done if we keep the public educated about it. We have to be transparent because we know the repugs and FOX and Limpballs et all will be preaching just the opposite.

[Demsrule86]

16. Try to take it away and watch the demonization of single payer...and watch a repeat of

'Hillarycare'.

[ucrdem]

3. That captures it.

What it comes down to is that what's needed is what we've already got, surprise, thanks to a certain past president initials BHO. I can think of no legitimate reason for risking the ACA to reinvent that wheel. This give the whole business the air of a shakedown based on what was done to Clinton and does not bode well for the ACA or 2018. JMHO YMMV.

[RandySF]

4. i'm for universal medicare, but

I know we can't wish it or talk it into existence. It's a long, hard and bloody process.

[ucrdem]

6. Congress, the insurers, the current president and the GOP are all intent on breaking the ACA.

They may well succeed. They will not, however, no way no how, vote to tax themselves up the yinyang to pay for everybody's health care. The idea is absurd. This is the wrong fight at the wrong time.

[RandySF]

7. Exactly

We're in a defensive posture until at least 2020.

[Ninsianna]

10. Isn't medicaid the better model to use for Universal care?

Medicare has premium and doesn't cover everything.

[Demsrule86]

17. I agree...it is a fine plan...adding a public option and fixing some weaknesses is what any

Congress person should do ...not signing on to single payer which has no shot and is a distraction .

[pnwmom]

5. Yup. Good article. Thanks, RandySF.

The other obstacle is salaries. Doctors here make a lot more money than in most countries. How do we reduce costs significantly without reducing salaries?

[Demsrule86]

18. I have a friend who just finished medical school he is $500,000 in debt.

And unless you are a surgeon, you don't make as much as some think.

[SunSeeker]

8. Exactly. As Hillary said, "tell me something real." nt

[area51]

9. The biggest impediment to single-payer

is the demos & republinazis who don't want to give up their bribe money from the insurance agencies.

[Ninsianna]

11. This is a really simplistic take, that doesn't actually take into account

what the real issues are. If we can't identify what those are without the wild eyed, "it's both parties who are the same and bribes!1!1!" foam flecked silliness, how are we actually going to do what's needed to intelligently, honestly and effectively tackles the very real obstacles to achieving the best form of single payer that addresses the needs of our population without taxing everyone to literal death?

Calm down, take a deep breath and educate yourself on what the real issues are. Look at the history of medical care in the US, how other countries have handled single payer, the myriad of ways they achieved it, the pros and the cons and then come back so we can all have a rational, adult discussion.

Slogans and repeating silly nonsense isn't helping anyone, nor is it fixing anything.

[JI7]

12. you have to convince Voters to accept it . that's what it comes down to.

[Freddie]

13. 100% correct

Most people are happy with their employer-provided insurance and know that Medicare may not be as good in terms of out-of-pockets, etc. They hear the screams of "higher taxes" and perhaps the offset of no insurance premiums/higher taxes may not be a wash if their employer pays all or most of their premiums.
I work in payroll and benefits. I think one way to make this work is a flat payroll tax, say 6% of wage with an employer match. Adjust the tax codes so this is largely offset for lower incomes. We as a nation should decide what percent of our earnings (including capital gains) we should pay for health care and be done with it.

[stevepal]

14. I don't understand the thesis of this post.

The private insurance that so many people already have is PRIVATE. Why would a switchover to "Medicare for all" even affect this private side of the equation? If the employees want to continue their private insurance, let them continue doing so. It will probably cost them more in the long run but if it's what they want, let them go for it. If the employers want to continue handling all the paperwork of costly private insurance, let them continue doing so.

I don't see the problem. In other countries with single-payer, people can still purchase private insurance if they want to. Maybe the best way to ease into a single-payer system is by allowing individuals to buy into medicare. This would make the change smoother perhaps. But I can't see the problem here. Maybe I'm missing something.

[stevenleser]

19. Because the intent of single payer is to do away with the private system, thus if you are going to

do that, folks who already have good health coverage and healthcare through their employers better get the same or better through the single payer system or it will be an unpopular disaster that will be promptly repealed.