September 23rd, 2017

Single-payer health care: America’s left gains soldiers in its lonely march


By Alexander Panetta, The Canadian Press on September 13, 2017.

WASHINGTON – A lonely march to bring Canadian-style, single-payer health care to the United States is a little less lonely these days, with a sudden stampede on the left to get behind Bernie Sanders’ so-called medicare-for-all bill.

The socialist senator is unveiling a bill today that has the support of more than half the Democrats on Capitol Hill. It now has about 15 co-sponsors attaching their name to the legislation, including the party’s reputed presidential aspirants.

“The last time I introduced this bill, it lacked a single co-sponsor,” Sanders said in a letter to supporters.

It’s the latest step in the winding path to health reform in the United States – which has taken a decidedly different route from Canada, whose single-payer experiment began in Saskatchewan with a heated debate and doctors’ strike in 1962.

The U.S.’s patchwork system is mostly private, partly public and covers the vast majority of Americans. When Barack Obama took office, about 84 per cent of Americans had health coverage; the number rose to about 89 per cent under his reform; now the parties are debating next steps.

Some Republicans are still working to pare back Obamacare. Some Democrats want to focus their fight on saving what exists. But others, like Sanders, want to expand the battle to new terrain: single-payer.

Republicans are preparing for that fight.

A GOP senator raised the issue at a news conference Tuesday, without being asked. Wyoming Sen. John Barrasso pointed out that Sanders’ home state of Vermont made a serious push for single-payer a few years ago – and dropped it because it would require a big tax increase.

“It seems that this complete government takeover of health care is becoming the litmus test for the liberal left,” Barrasso said.

“While Bernie Sanders’ slogan may be very popular, it’s really the nuts-and-bolts and the details that matter the most. What’s it going to cost the American people, in terms of money, in terms of (waiting) time and in terms of their freedom of choice?”

Polling on the issue makes it obvious why Republicans focus on the fiscal effects.

A Kaiser Foundation survey finds strong U.S. support for single-payer when you call it “Medicare For All” – at 57 per cent. To Americans’ ears, Medicare is the popular public program that provides health coverage for seniors and it’s the closest thing the U.S. has to single-payer.

But mention taxes, and the support plummets. When respondents were told taxes would go up, Kaiser found that opposition grew from 40 per cent to more than 60 per cent.

A single-payer system would certainly require tax revenue.

A researcher at the University of Massachusetts calculated a tax plan that might fund a single-payer bill from another Democrat a few years ago. Gerald Friedman concluded that it would take a six-per-cent tax hike on top-earning households, a three-per-cent hike on lower-earning households and smaller taxes for different types of stock trades ranging from 0.1 per cent to 0.5 per cent.

But he concluded single-payer would save money in other ways. Compared with doctors in Ontario, he said, American physicians spend nearly four times as much on billing and insurance related activities – at US$83,000 per physician, versus $22,000 in Canada.

The health care issue is now too popular to avoid on the left.

Every lawmaker touted as a potential Democratic presidential nominee is following Sanders’ lead and supporting his bill: Elizabeth Warren, Kamala Harris, Kirsten Gillibrand and Cory Booker.

The slog ahead remains huge.

The support of barely half the Democratic caucus means single-payer still only wins the votes of about one-quarter of the Congress. Meanwhile, Democrats running in tough races in 2018 are less likely to get behind the idea.

“I support fixing what we’ve got,” said Sen. Jon Tester, who faces re-election next year in Montana.

“Because I think that’s more likely to happen.”

Another Democrat proposed a more flexible fix through the magic of federalism.

Ron Wyden of Oregon points out that he inserted a clause in Obamacare a few years ago that allows states to opt out of the law – provided they expand coverage. He suggests his state, California, and Washington could start their own single-payer system.

”There are a variety of approaches,” Wyden said.

”I’m attracted to the idea of using the existing law.”


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