With both Democrats and Republicans universally suggesting that The Affordable Care Act (Obamacare) requires fixing, a renewed push for a “Medicare for All” Single Payer Healthcare System is afoot. This may be a lofty goal but it is full of arguments that must be addressed and consequences thought out. The fate of the world may hang in the balance.
Amidst the rhetoric and the debate over healthcare which has ravaged the better half of this century there is a concept, once thought unimaginable and now thought of as plausible called Single Payer Healthcare…American style. Being that it is next to impossible to address the issues without addressing political bias, populism and electoral popularity, this paper is going to address some of the core issues that must be thought through in order for the success of a Single Payer System or a return to relatively private health insurance is implemented. Rhetoric needs to be called as such, but here are the issues.
With the election of President Bill Clinton in 1992, the idea that America may be ready for a Single Payer healthcare system came to the forefront. President Clinton put his wife, Hilary, in charge of the effort and the talk immediately turned to a socialized system similar to the European model. The effort became known as Hilarycare in the media and, in the years to follow, the idea of a single payer system went down in flames. Healthcare in America, was given little more than lip service, until the election of President Barak Obama in 2008, more than 15 years after Hilarycare was resigned to the dustbin of history. With a supermajority in the Senate and a majority in the House, President Obama seemed poised to pass a version of healthcare reform similar to the one implemented by Republican Governor Mitt Romney in Massachusetts, and originally proposed by the conservative Heritage Foundation. There was some talk of a government backed option for the healthcare reform bill, The Affordable Care Act, dubbed Obamacare by its detractors, but little action to make it happen. The Democrats had a 60 vote filibuster proof majority, but they would need every one of those votes in order to pass Obamacare. The death of Massachusetts Senator Edward Kennedy, and his replacement by Republican Scott Brown , complicated the effort, as the base of the bill had been passed but the Republican Party could now filibuster any changes to the House bill, which left a Government Run Insurance option out of the bill. The Democrats were confident, that even if Obamacare completely turned the individual market on its head, its positive effects would be irreversible, which to this day has turned out to be true. The bill was passed and signed into law. Despite numerous court challenges, overturn votes in the House and Senate, and a Republican sweep in 2017, there does not seem to be a viable replacement for Obamacare.
With the talk of Single Payer returning to the public sphere with the candidacy of Vermont Socialist Independent Senator, Bernie Sanders, the talk of Single Payer has been mentioned every time reforming Obamacare is raised. The argument for Single Payer seems to be resonating more and more.
What is Single Payer?
A Single Payer system is one where the government, either State or Federal is the primary dispenser of health insurance in the country. It requires that all citizens of the country be given healthcare, on demand, and the government is responsible to provide it. The cost is borne through taxes as a way of funding the effort, and it covers every man, woman and child in the country from birth to death. It description is almost to seductive to ignore. It has had some success in other countries, and could possibly have success here, the issue is that both parties will be required to address certain special interests, lobbyists, opposition parties and the courts. Below is a list of some of the potential issues and consequences that will need to be addressed by the side of the debate that will need to confront it.
Trial Lawyers (The Democratic Party)
The cost of Medical Malpractice Insurance costs up to $34,000 per year for a starting surgeon. It rises whenever a doctor gets sued, which in America is very very often. This not only effects the price of the actual services offered by the doctor, but forces the doctor to practice defensive medicine. This is not an entirely bad thing. Defensive medicine actually leads to better outcomes because it forces doctors to over test out of fear as opposed to under testing to conserve costs. This issue will have to be addressed before the issue of government involvement in healthcare can even be broached. When the defendant is the government though, and by the government it actually means the taxpayer, it gets to a point where lawsuits need to be regulated and trial lawyers will need to be brought to heel. This is also a Constitutional issue, which would unravel the whole system. The Constitution gives the right to any citizen to sue, in court, for any issue above $17 dollars. The solution to this would need to be addressed.
Deaths From Lack of Care (The Republican Party)
This is a core issue that the Republican Party never fails to fail on. A market based system will leave some people without medical care. This could be a completely acceptable outcome. There are plenty of market based, and also reality based, reasons why this is an acceptable loss. The issue the Republicans have is they are too gutless to say it. All healthcare systems involve some form of rationing, whether because the governmental budget cannot accommodate it or the people can’t afford to enter the market. This is an argument that needs to be explained. The Republican Party can explain it, they choose to hide from it. Their opinion will continue to be marginalized without being honest.
Efficiency (The Democratic Party)
The Democratic Party loves to float statistics about how administrative costs for Medicare and Medicaid (the governmental systems in America for the elderly and poor) are a fraction of what they are in the private market. This is a typical BS political stunt. The statistics do bear this out, and a very syllogistic way of looking at it is that it is due to the effects of profit motives. Truth is that the government is more efficient because they push the majority of their administrative costs onto health care providers. The very inefficiencies they tout are caused by the system they praise. Better doctors have no desire to support Medicare/Medicaid due to low reimbursement rates and the ridiculous amount of paperwork that is required to get paid. To make matters worse, mistakes on reimbursement forms could have the effect of criminal and professional sanctions. It also carries a fear of political retribution for complaining about the system publicly. This needs to be owned and addressed.
Equality in Access Effects Equality Of Service (Both Parties)
Very few people would say that equality of access to health care is a bad thing out of hand, but if you reframed the question to “what would you be willing to give up for others to have access to health care?” the answers would change dramatically. This is especially true about doctors. When doctor’s services are exposed to market forces and a good doctor will be able to charge more for their services and to be able to attract the clientele they desire. When doctors are basically paid the same, regardless of level of competence, the only way for a doctor to increase their income is to see more patients. Bad doctors will thrive in a system where they can increase their income by seeing more patients than they should. Good doctors will still provide the care they normally would, and suffer financially and possibly professionally for it. There are very few Americans who would be happy with a single payer system if it meant that they would lose, or fight for, the quality of care they are used to and demand.
Innovation (Both Parties)
Even countries that have already implemented Single Payer systems, benefit from America’s lack of one. Due to profit motivations, American innovation leads or funds the world’s research. If the provision of funding or the control of costs are decided by government committees and based on political forces, the ability to innovate could be stifled severely. This is not just a question for the United States but for the whole world. How many people would die from alack of new medicines, if the market forces were taken out of healthcare.
There Is No Partial Solution (Everyone)
In the 1980’s there was a law passed requiring the government to offer subsidized catastrophic insurance to the population. It lasted a year. To partial reform the system is a recipe for disaster. If you socialize primary care, everyone will get sent to a specialist, if you socialize catastrophic, you will see a huge rise in catastrophes. If there is going to be reform, it has to be done in a way where both parties own it and there is a commitment to reform that will not create gridlock. There has to be a commitment by both parties to fix what is broken and not squabble about blame. This is also the true failure of Socialism, it is not really possible. Politics is everything when allocating tax dollars.
In the end, the result of the current situation is probably going to be that Obamacare will stay in place and the Republican Party will just let it implode. This is smart politics, and there is no magic 8 ball to say it isn’t a good thing. I don’t think there is any plan the Democrats can accept that their voters will allow them to vote for. The future is going to be interesting, no matter what.
*Part 2 will be released soon with some solutions that both parties can get behind. Stay Tuned!