Progressive Democrats in Congress and on the presidential campaign trail have rallied around “Medicare-for-all,” a so-called single-payer health plan popularized by Sen. Bernie Sanders (I-Vt.).
As the media and budget experts attempt to add a new framework around what it might look like, voters who are beginning to seriously consider their options in 2020 would be wise to study recent attempts to implement similar approaches to health care. These examples, launched in the bluest of states and most progressive of foreign countries, highlight the risks of how difficult that shift might be.
A five-year attempt at implementing single-payer in Vermont ran aground in 2014, when the Democratic governor concluded the health care overhaul would have required an additional $2.6 billion in tax revenue: a 151 percent increase over current state tax income. The solution offered by leaders in Burlington came in the form of an 11.5 percent payroll assessments on businesses and premium increases equating to 10 percent of individuals’ income.
If one considered Medicare-for-all to be on life support in Vermont, it was dead on arrival only a few years later in another blue state.
In 2017, the California Nurses Association waged an intense lobbying and public relations campaign in support of Senate Bill 562. The bill would have created a government-run system in California to effectively replace private insurance adopt single-payer. One legislative analysis found that California’s single-payer plan would cost $400 billion to implement, $200 billion of which would come in the form of new spending. Critics were quick to point out that this price tag represented twice the state budget. Assembly Democrats panicked and the bill was shelved.
Looking abroad, inside countries with the longest experience of single-payer government insurance, further research indicates massive waiting lists and delays that patients rarely encounter in the United States.
In the U.K., 4.3 million patients were waiting for an operation in 2018 according to the NHS, the highest total in more than a decade. Hundreds of thousands are also having to wait more than the supposed maximum of 18 weeks for surgery.
Despite what Democratic Presidential candidates may suppose about the likely strength of a government-centralized system, the fact also remains that single-payer systems also fail to outperform the U.S. in more routine yet equally as important procedures, such as screening tests.
Prior to the Affordable Care Act’s screening requirements earlier this decade, the United States had screening rates that exceeded European countries with nationalized systems for all cancers. In Canada, their single-payer system fails to deliver screening tests for even common cancers, including PAP smears and colonoscopies. The average American today is more likely to be screened at a younger age for cancer than their European peers. Not surprisingly, American patients continue to have had less advanced disease at the time of diagnosis than in Europe for almost all cancers.
Single-payer cheerleaders argue that the United States, which spends a greater percentage of its economy on health care than any other country in the world, should be able to finance a universal system. It’s a sympathetic argument to be sure. Is there wasteful spending in health care? Yes. Would the U.S. be wise to pursue reform and increased oversight? Of course. Yet, that’s not what proponents of Medicare-for-all are effectively preaching. One study last year from the Mercatus Center at George Mason University estimated that Sanders' legislation could cost the federal government more than $32 trillion dollars over 10 years; a cost burden that would fall most heavily on the middle class.
There are some Democrats and Republicans who have outlined thoughtfully substantive and pragmatic solutions to addressing failures in our domestic healthcare system. Florida Congresswoman Donna Shalala, a former Secretary of Health and Human Services has expressed her desire to move towards integrated care and closing the doughnut hole. Republicans in Congress have also called for more investments in community driven health care administration through clinics and federally authorized healing systems. The lesson here is we do not need an all-or-nothing approach. It’s not politically feasible and it doesn’t work in practice.
The increasing cost of health care in the United States sure makes Medicare-for-all sound like a winning proposal. However, when voters take the time to study the proposals and run the numbers alongside similar systems, candidates supporting the end of private insurance system might have a tough time winning over voters on this issue.
Nancy Brinker, founder of Susan G. Komen, the world's largest breast cancer charity, has served as U.S. ambassador to Hungary, U.S. chief of protocol, and as a Goodwill Ambassador for Cancer Control to the U.N.'s World Health Organization. She is continuing her work in efforts to end death from cancer. The opinions expressed here belong solely to the author. To read more of her reports — Click Here Now.
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