Single payer health care on the rise

We see fresh indications that public and legislative support for a single payer health care system are on the rise. Bernie Sanders is one of a growing number in Congress who support the HR 676 “Medicare for All” bill this week. A long list of Democratic Congressional representatives co-sponsored the House bill. The president even took time out of his busy tweeting schedule to denounce the idea this week. I could make a snarky comment that anything the president opposes is likely to be eventually supported by the majority of voters nowadays simply because of his negative energy.

The concept of ‘single payer’ and ‘Medicare for all’ are not new, nor are they necessarily even the same approach to health care policy. The proposed legislation clearly states that multiple providers can be involved and that many of these (like Blue Cross and HMOs) are not commonly thought of primarily as Medicate providers. This blog post does not address the technical issues of the delivery system. The common connection, for purposes of this discussion, is that the proposals increase government’s role in providing health care and managing its cost.

Some Republicans say this proposed single payer legislation is not what they meant when the supported “repeal and replace” of the Affordable Care Act. They want less government involvement in health care, not more. Yet this is in fact the direction that Americans are leaning. 6 out of 10 now ay that it is government’s responsibility to provide health care for all. 4 out of 10 say that the way to do this is through a universal “medicare for all” health care system. Those number come from a Pew poll in June. My expectation is that majority support for the “Medicare for All” plan is not too far away as the Affordable Care Act shows its age and faults. Yet popular support alone will not b enough to effect such a dramatic change in health care finance policy. Such a change will likely need to be the keynote of the next Democratic president’s agenda.

Yesterday NPR covered the details of the proposal pointing out that the bill has no realistic chance of becoming law now but that this effort is “framing” for the future of health care finance policy. Meanwhile The Atlantic did a great job of explaining the problems with the bill and the issues that we have not yet addressed.

I was active in the academic side of this conversation back in graduate school in the 1980s. My conclusion then remains the same today: The United States will eventually adopt a single payer health care system after we have suffered through and failed at every other option. 

Our basic health care will eventually be provided under a government program while supplemental and more advanced care will be privately financed. I hold this forecast to be among the most basic of the future of the United States. But no matter what happens next, we still have years of struggle ahead with our health care finance.

In summary, we should know that single payer health care is coming but not soon enough to have any impact on our current financial planning.


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