Tag: single payer

Will single-payer go mainstream in 2019?

January 9th, 2019 by
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The Democrats are braying

I have long predicted (Goodbye Obamacare? More like hello single payer) that if the GOP succeeds in undermining the Affordable Care Act it could hasten the move toward single-payer. Well, the undermining has been reasonably successful. And I think 2019 will shape up as the year that formerly taboo proposals like single payer health insurance go mainstream.

Despite what opponents say now, the Affordable Care Act was a moderate bill that sought to work within the existing system and incorporate bipartisan elements, including 188 Republican amendments. Before the individual mandate was pilloried as a threat to freedom, it was upheld as a virtuous plan of personal responsibility by the Heritage Foundation and American Enterprise Institute. Democrats tried to get Republican votes for the ACA. It was a GOP strategy to refuse.

When Republicans tried Repeal and Replace, they didn’t even pretend to include Democrats in their solutions. And of course, Candidate Trump’s promise to replace Obamacare with “something great” was a lot of nonsense.

With all this history, mainstream Democrats are feeling freer to jump to more radical and comprehensive proposals. After all, the ACA was complicated, messy, and full of compromises largely because of its attempt to be bipartisan and incrementally change the existing system. Why not jump to something purer and simpler that doesn’t need GOP input?

As the race for President gets underway, Democrats will start to feel their way on healthcare. Defense of the ACA is a pretty modest, minimum requirement. You can expect to hear calls for Medicare for All, which is a way to offer a popular benefit to more people without creating a whole new system.

But I’m also on the lookout for more radical approaches and it looks like we won’t even need to wait for the Presidential campaign to heat up in order to hear about them. Newly installed California Governor Gavin Newsom is ready to take on Donald Trump directly, calling for a single-payer system, mandatory coverage, expanding access for undocumented immigrants, and regulating drug prices. California is holding an early primary this cycle, so the ideas Newsom is setting out now will influence the debate.

I’d like to see serious discussion of Medicaid for All (rather than Medicare for All). Medicaid pays providers and drugmakers less and is also more comprehensive than Medicaid and better suited for younger adults and children. It’s a more affordable way to provide coverage, provides discretion to the states, and would drive down overall costs by driving down reimbursement rates. Medicaid for All would be a mixed bag for providers and pharma, so would unleash a very passionate debate.

A likely compromise is to offer Medicaid to everyone as a fallback, while retaining commercial and Medicare coverage for those who are eligible and want it.


By healthcare business consultant David E. Williams, president of Health Business Group.

What does GOP think will come after they sabotage (or repeal) Obamacare?

July 20th, 2017 by
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Comrade Trump, are you listening?

Just after the election I wrote (Goodbye Obamacare? More like hello single payer!) to lay out my vision of where Republican dysfunction and ideology could ultimately lead. At the time I said:

Trump himself has been at least a liberal and frankly more of a socialist when it comes to health care policy, at least based on his earlier writings. Once he learns that the ideas of the conservatives in Congress won’t produce universal coverage, he may well go back to improving –instead of replacing– Obamacare, moving to a Canadian style single payer system, or opening up Medicare for all, just like Bernie and much more radical than Hillary.

The last six months of Republican flailing on healthcare makes it even more likely that socialism will ultimately come to the US healthcare system. Here’s why:

Americans –and that includes Republicans– now expect insurance to be available without restriction or penalty to those with so-called pre-existing conditions. Everyone wants lower premiums and out-of-pocket costs, and Obamacare opponents are beating up on the ACA for failing to deliver. But nothing the GOP is doing is helping advance these goals. Most of GOP proposals actually undermine these objectives.

Meanwhile, Trump and Congress are creating uncertainty about the exchanges and actively undermining them, e.g., by refusing to enforce the mandate, talking about exchanges failing, and using public money meant for promotion of Obamacare to undermine it.

The Affordable Care Act is a moderate piece of legislations, with free-market concepts like health insurance exchanges that conservatives would like if they looked at them objectively, and which were included in order to generate support from some in the GOP.

But with all the chaos, ill will, and sabotage of Obamacare by the Administration, liberals and centrists are now talking about more radical ideas. In particular, the concept of a single payer health system is now being discussed openly and seriously, something that would not have happened if Congress had done the sensible thing and made improvements to Obamacare.

What happens next? If, for example, repeal without replace goes through, then I think we’ll see single payer come up as a mainstream topic in the 2020 presidential election (assuming we are still holding elections in this country by then).

I also expect that rather than move to a Medicare for all model we may see more talk about Medicaid for all. It’s cheaper, because it pays providers less, and coverage is far more comprehensive. It  could serve as a baseline for universal coverage.

The healthcare morass is keeping Republicans from tackling other legislative priorities that supposedly would be easier to accomplish, such as tax reform –or more likely, straight tax cuts. If you’re an opponent of the GOP agenda, then the extended fight over healthcare is not such a bad thing.

I do worry, though, that as the administration continues to flail from the Russia investigations and lack of legislative success, they will resort to desperate tactics that could have dire consequences. In particular I’m worried that the GOP won’t take seriously the necessity to raise (or better yet, eliminate) the debt ceiling. They may try to tie a lot of unrelated issues, including Obamacare repeal, to this must-pass bill. Once the US is in default, all bets are off.


By healthcare business consultant David E. Williams, president of Health Business Group.