|ObamaCare: “A Good First Step Toward Single Payer”?|
By Ashton Ellis
Wednesday, October 02 2013
With the ObamaCare insurance exchanges up and glitching, at least one high-profile supporter sees "better" days ahead.
In an op-ed entitled, “A Good First Step Toward Single Payer,” Bernie Sanders, a United States Senator from Vermont and avowed socialist, argues plainly for using ObamaCare as a launching pad to expand Medicare into a single payer system for all Americans’ health care.
But before turning to Sanders’ argument, it’s relevant to point out where he published his missive – in the British newspaper The Guardian.
Britain is home to the National Health Service, a worldwide symbol for socialized medicine. Anyone following British politics since NHS was born after World War II knows that it constantly suffers from high costs and long waiting times to see a doctor. To compensate, NHS rations care.
Yet the British public remains supportive of NHS because the institution represents a decades-old, government-brokered social contract. So entrenched, reformers like Prime Minister David Cameron are left to tinker at the margins by giving doctors more control over their budgets and letting private health providers compete with the government – both of which a majority of Britons opposed when introduced last year.
The resistance to market competition makes the British public a receptive audience for what Sanders is selling. But of course the same isn’t true of Americans. By the time ObamaCare’s insurance exchanges launched October 1, disapproval of the law tied an all-time high of 52 percent. Reasons vary, but it’s safe to say that no one in the oppose camp – and few that support the law – think the fix is to mandate less options for consumers.
Despite all this, Sanders’ op-ed is worth reading and considering. No other liberal national political figure provides a clearer roadmap for seeing ObamaCare as opening a pathway toward a single payer system.
Sanders begins with two core premises. First, health care is a right, not a privilege. Second, this right creates a responsibility to “create a national health care system that provides quality health care for all in the most cost-effective way possible.” For Sanders, this means expanding Medicare’s single payer system for Americans aged 65 and older into a nationwide program that covers everyone.
ObamaCare is the precedent. It requires that every person participate in the system. It mandates the content of insurance plans. And it pays for a portion of the premiums. But the law won’t fix the main problems as Sanders sees them. It will only cover 20 million uninsured, less than half of the 50 million without insurance. It won’t address the enormous administrative costs driving increases in health spending. Most importantly for Sanders, it won’t eliminate the profit motive in health care delivery.
That’s where Sanders’ bill, the American Health Security Act, comes in. Introduced with Rep. Jim McDermott (D-WA) back in March, the bill promises a complete government takeover of American health care. It does this by requiring each state to establish a “health security program” with access to health care coverage and services like dental, mental health and low-cost prescription drugs. It then requires each state health security program “to prohibit the sale of health insurance in that state that duplicates benefits provided under the program.”
Bye-bye private sector. In its place, the bill creates “a single federal payer of state-administered health plans.” A new federal agency will be tasked with “develop[ing] national policies and guidelines, as well as minimum national criteria, while giving each state the flexibility to adapt the program as needed.”
It is difficult to tell how much flexibility would be available to states since, under Sanders’ scheme, the federal government decides all the rules, including when and how much to pay. And, since the whole point of his program is to vest the Feds as the exclusive source of funding, it is impossible to imagine that states will be anything other than glorified middlemen.
Moreover, the costs associated with Sanders’ move to an all-encompassing single payer system would be enormous. Already there are fears that ObamaCare will cost much more than originally estimated because many employers are cutting employee hours and moving retirees onto the exchanges. Both moves are likely to trigger subsidies not previously contemplated by the law’s drafters. This explosion in entitlement spending will hit taxpayers hard.
Now imagine something like Sanders’ proposed system where all health spending runs through the federal government. Taxes will rise to try and keep pace with spending, but when that gets prohibitive the Feds can borrow a page from Britain’s NHS and start rationing care. Health care reform in America will at that point resemble the British model – endless tinkering with a faulty institution that is too entrenched to eliminate.
Or put another way, it will look and sound just like Medicare reform does today.
Not so long ago, few could conceive of a government intervention into the health care system on the scale of ObamaCare. Maybe Bernie Sanders is giving us a glimpse of what could be next, unless a serious conservative alternative intervenes.
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