With massive upheavals, reforms and health care policy changes still on the table in Congress, others are igniting support for a long since proposed health care system: single payer.
Several federal lawmakers, such as Sen. Bernie Sanders, I-Vt., and Sen. Elizabeth Warren, D-Mass., as well as several New Jersey lawmakers, have expressed their desire to reform the way Americans are covered for health care services and the government’s role in that delivery, in the face of heavy opposition.
“I think a state level approach only works if you have at least a minimum federal commitment (for support). If that’s a hostile situation, it becomes a tough sell,” said Michael Gusmano, associate professor at Rutgers University School of Public Health. “It’s a big philosophical debate about what good health insurance is and is it appropriate for the government to step in and help.”
A single payer health system, dubbed “Medicare for all,” is one in which a single government insurer provides coverage for basic health care costs for everyone, regardless of income, age or employment status, and is financed by taxes.
Hospitals, health care providers and doctors could remain private, and residents still could choose where they go for health care.
It may sound familiar — and that’s because the United States already has a single payer model in Medicare. Legislators have said they would use those policies as a foundation and create a nationwide system for everyone, not just those 65 and older.
Sanders reportedly will introduce a single-payer health care bill to Congress sometime this month and Warren has publicly announced her support for it.
When lawmakers introduce single-payer systems, they often refer to Canada’s health care system, Gusmano said, which is actually not a true single-payer model.
Gusmano said if individual states or the country as a whole were to adopt a proven system, it would most likely resemble the health care systems of several European countries, such as France, where government funds universal health care and most doctors remain in private practice.
People who are especially uninsured, underinsured or on Medicaid plans may benefit greatly in a single-payer system, he said.
“It you look at the U.S. as a whole, uninsured people or people on Medicaid don’t have as much access,” he said. “If you go to a system like in France, Germany, Canada or South Korea, you’ll find people have tremendous access. They may have some other limitations, more so than in the U.S., but not severe.”
Though nice in theory, opponents of a single-payer plan argue it would be too expensive. Insurance companies, for-profit hospitals, pharmaceutical companies and large nonprofit hospitals that rely heavily on private insurance could stand to lose the most, experts say.
Lt. Gov. Kim Guadagno, the Republican candidate for governor, has said in the past she opposes government-run health care because it would be too expensive for taxpayers and the state. Other experts agree it would be a heavy lift in New Jersey, and elsewhere.
“I think there is a lot misunderstanding about the ability to save money under single payer — like that you could eliminate ‘insurance companies’ and the allegedly unnecessary things they do. But someone needs to contract with providers and manage claims, or else there is no way to control costs,” said Katherine Hempstead, senior adviser at the Robert Wood Johnson Foundation in Princeton.
Hempstead also said many people with employer-based health insurance are unwilling to consider a single-payer system on the chance coverage would not be as good as their current plans.
Most recently, California lawmakers tried to pass a single-payer bill for state residents, but the motion was shelved.
Anthony Rendon, the state’s Assembly speaker, said in July that plans contained too many issues, including financing, delivery of care, cost controls and the realities of support from the federal government under President Donald Trump.
Despite general criticism and skepticism among many, Ron Caplan, a Stockton University associate professor of public health, said consideration of single-payer is much more serious today than several decades ago, when the late Sen. Ted Kennedy promoted the model.
“Most other countries spend less (on health care) than we do, and they are healthier,” he said. “Child mortality is down, life expectancy is more. There are certainly complaints, but they overall tend to be happy with their systems.”
Caplan said it would cost more up front to reform the U.S. health care system, but would be more beneficial in the long run and save people money as the government would be able to better spend heath care dollars.
“I really think this might be the time for single-payer to emerge,” he said.