When the Senate and House were in contentious debates over how, exactly, to reform the country’s healthcare system back in 2010, liberal firebrand Sen. Bernie Sanders (I-VT) made his objections to the nascent Affordable Care Act known. Complications might arise, he argued, from having people compare the health care costs of different private insurance plans online.
“Well, what it is going to mean,” Sanders told CNN’s Rick Sanchez on February 23, 2010, “is that people will have, looking a website, different private plans and know what the coverage is and the cost is in a way that is not available today. Now, that is not my preferred option. As I said, I would prefer a Medicare-for-all system so you don’t have to go through all of that complicated stuff. But that is what they are pushing.”
Sanders’s description — that health care is more difficult to navigate when people have “to go through all of that complicated stuff” — has proved exceedingly accurate since one of the main tenets of Obamacare took effect. The rollout of the federal health care marketplace website, where Americans are supposed to shop around for different private insurance plans and figure out their possible subsidies, has been an utter screw-up. People can’t even get their online account set up. Or, when they can, they’re given the wrong information about their options.
Conservatives have used the discovery of these glitches to argue that the government shouldn’t be in charge of health care.
“If they can’t set up a website, what if they control the health care of million of Americans?” Rep. Joe Pitts (R-PA), who sits on the committee hearing testimony over the failed website debut, asked CNN on Thursday.
But there is an argument, on the left, that what’s happening here isn’t a failure of government administration. It is more broadly a failure of a convoluted health care system that relies on a mix of private insurers and several different government-administered options to provide Americans with care.
Like snowflakes, the health care qualifications of every American are unique: The government runs Medicaid and CHIP, COBRA, the Indian Health Service, Medicare, TRICARE and the Veterans’ Health Administration. There are college-run health care plans and government funding under programs like Refugee Medical Assistance. And then there are the dozens of major medical insurers and supplemental plans.
A website that needs to understand even a quarter of these things bears a heavy burden. And so do the people currently navigating the health exchanges established by Obamacare, who first need to figure out where they stand with each of these programs. Then they log onto the site and, when it finally loads, they try to figure out whether they qualify for a government subsidy, and if so how much. After that comes the “shop around” phase of private plans that President Obama likens to a Kayak.com for health care.
None of these steps would be necessary if the United States had single-payer healthcare, à la Medicare for all, as Senator Sanders pushed for in an opinion piece in the Guardian last month. While he didn’t yet know about the glitches (he now tells ThinkProgress that “the rollout has not been good” but that “the program will get its act together”), he did make a compelling case for how a single government system that administers care would streamline and simplify what’s become a complex and uber-capitalist process:
Despite this unimpressive record, the US spends almost twice as much per person on healthcare as any other nation. As a result of an incredibly wasteful, bureaucratic, profit-making and complicated system, the US spends 17% of its gross domestic product – approximately $2.7tn annually– on healthcare. While insurance companies, drug companies, private hospitals and medical equipment suppliers make huge profits, Americans spend more and get less for their healthcare dollars [...]
Such a single-payer system would address one of the major deficiencies in the current system: the huge amount of money wasted on billing and administration. Hospitals and independent medical practices routinely employ more billing specialists than doctors – and that’s not the end of it. Patients and their families spend an enormous amount of time and effort arguing with insurance companies and bill collectors over what is covered and what they owe. Drug companies and hospitals spend billions advertising their products and services.
A reported $200 million went into the malfunctioning exchange site. And while a fully implemented Obamacare is undeniably a step up from the state of healthcare today — it will cover more people and save the government $190 billion over 10 years — it still puts life-saving medical treatment in the hands of companies who mark up procedures and medication by a staggering 400 percent. The prospect of a Kayak.com for your health starts to sound less appealing.
Obamacare also gives state governors control of the expansion of public insurance to the poor through Medicaid. For both political and policy reasons, some Republican governors have turned down the expansion and left 5.2 million people without coverage, all because of this nod to federalists. In fact, the entire Affordable Care Act template was originally a brainchild of the Right — a free market solution to what Sanders calls “a right, not a privilege.”
Single payer, on the other hand, is a progressive health care solution. Two loudly progressive elected representatives, Sanders and House Democrat Jim McDermott (D-WA), are the ones calling for it. They have introduced a bill in their respective chambers, the American Health Security Act, that aims to make a Medicare-for-all system “to provide every U.S. resident who is a U.S. citizen, national, or lawful resident alien with health care services.” It includes everything from dental care to hospice. They see it not so much as a replacement to Obamacare but as a next step.
There’s no hiding that the technical rollout of a single payer system could potentially be complicated, too: Sanders and McDermott’s act requires every U.S. resident to have a national health card known as a “smart card,” “for purposes of identification and processing of claims for benefits under the program.”
But (with the obvious caveat that it depends how it’s crafted) a single payer health care system would be a one-shot deal, tied to a social security number or, for non-citizens, a Tax ID. Since it wouldn’t need to change based on who employs you or where you live, the system lasts forever. And it could be significantly more cost-effective too. While Sanders rightly points out that health care costs make up 17 percent of the U.S.’s GDP, the cost of the National Health Service in England is about half that.
Of course, the idea of passing single payer in the US is more of a thought experiment than anything. It is politically unfeasible at this point. There’s no room for a renewed debate around health care right now. Or, even, for an editing phase to the existing law, since Republicans would undoubtedly use that as an opening for repeal. But it’s not totally politically dead. Since 2011, Vermont, Sanders’ home state, has been in the process of rolling out its own single-payer system, Green Mountain Care. The implementation of that law has been put on hold, though, until the implementation of Obamacare hits its final stage and the state can get a waiver.