Monday, January 23, 2017

Single-payer health insurance has an opening

President Trump declared before his inauguration that his promised replacement for Obamacare would have a goal of "insurance for everybody." While that doesn't sound much like what Republican members of Congress have been saying for the past eight years, it does sound quite a bit like "single-payer" health insurance, which is the model most western democracies have in place to cover "everybody" with insurance backed by the government with payments to providers by the government entity that oversees health care.

Canada has this plan. Great Britain has this plan. France, too. Generally speaking, the citizens of those countries support their national healthcare plans. It's simple. It's more efficient than the dozens of separate private insurance providers and the thousands of individual businesses that pay insurance premiums for their employees. But whenever a similar system is suggested for the United States, conservatives complain that it's "socialized medicine." Well, yes, but so what?

America's messed-up system, which has given the United States the dubious honor of spending the largest portion of its gross domestic product on health care of any western democracy, evolved from labor union contracts. When World War II wage freezes took pay hikes off the table, the unions targeted health insurance as a way to increase worker benefits. Soon, employer-paid health insurance became an expectation of job seekers.

The 2009 Affordable Care Act attempted to keep the private insurance and the employer payments in place while guaranteeing coverage to all or almost all Americans. It didn't work perfectly, but it did reduce the number of uninsured Americans.

With the dominant GOP promising the repeal the Affordable Care Act and replace it with ... something, it's time to give the single-payer option a chance. It won't be cheap, but what we have now isn't cheap, either. Add what employers pay to the employees' "share" of the premium and the co-pays and deductibles employees pay, and it comes to large number, which could be replaced by health care taxes on employers and workers that would be approximately equal to what they now pay.

Cost savings from having a single organization paying all the bills (like Medicare) would result in cost savings. Instead of thousands of health insurers taking a cut of the money flowing to health care, on entity would cover all health care bills. With the federal government paying the bills, pressure on pharmaceutical companies, hospitals and other providers to reduce costs would result in a decline in health care costs.

If Trump is for it and his party controls Congress, why shouldn't it happen?

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