Five years after the healthcare debate that lead to the passing of the Affordable Care Act, a majority of Americans still want a single-payer health insurance system according to a poll from the Progressive Change Institute that was first
reported to The Hill. Since the passage of the ACA, single-payer has essentially vanished from the debate, at least amongst lawmakers. The question I have is how much longer are we going to have to wait?
We all know the president would have delivered on single-payer if it would have been at all feasible. This Tea Party conspiracy video sums up his positions on that very well:
Unfortunately, Obama had to grapple with those within the Democratic ranks who had been heavily influenced by big insurance companies. We couldn't even get a public option.
Now, I won't go as far as to suggest that the ACA is terrible or that Obama and the Democrats in 2009-2010 were sellouts - hopefully you all can share in my pragmatism on this. In fact, we all know that the ACA is working. The number of Americans without health insurance has dropped by nearly 25% according to the New York Times.
Still, in that same New York Times article, you'll notice the final point, which is that healthcare costs have not gone down, nor did ACA really have the teeth to bring them down. A single-payer system would not only provide true universal coverage, but it would also deliver the cost effective system we really need to provide quality healthcare for everyone.
The Modern Medicine Network notes several reasons for the slower rise in healthcare costs in Canada:
Since 1980, Canadian spending per elderly Medicare enrollee rose an inflation-adjusted 73%, compared with nearly 200% in the U.S. Physician spending per enrollee grew 101% in Canada versus 274% in the United States.
...
• Single payer: Canada’s government-based, single-payer system has simplified administration, holding administrative costs to 17% of overall spending versus 31% in the United States.
• Global budgets: Canadian hospitals receive prospectively determined global operating budgets, removing incentives to provide unnecessary care while simplifying billing and administration.
• An emphasis on primary care: About 51% of Canada’s physicians are primary care practitioners compared with 32% in the United States. Primary care–centered health systems are “generally thriftier,” the authors note.
• Pooled purchasing power: Canada’s provincial plans have used their concentrated purchasing power to limit drug and medical device prices.
But we needn't look only to Canada for an example of administrative efficiencies. The Centers for Medicare and Medicaid services has 4100 employees. Medicare covers about 48 million people and Medicaid about 46 million. Compare that with the massive health insurance company United Healthcare Group that covers 70 million people - they have 165,000 employees.
There is no question we are losing out. However, the pessimistic part of me suspects we won't see a single-payer system until we have Democratic supermajorities in both chambers of congress with a Democratic president. Oh yeah, and none of them are tainted by big health insurance lobbying and campaign contributions. Hopefully we are heading that direction. It's definitely worth the fight for millions of Americans.