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With Obamacare Repeal Stalled, Single-Payer Health Care Now Mainstream

Here are some basics on what a single-payer, "Medicare for all" system is and how it's getting more attention in the American health care debate.

by Demetria Irwin
Aug 2 2017, 3:30pm

Image via Flickr user Michael Fleshman.

This is part of an ongoing series examining the politics and advocacy around America's health care future.

Three Republicans and 48 Democrats made sure the "skinny repeal' didn't have a fat chance making it out of the Senate last week, but Obamacare and Trumpcare are not the only options on the table for Americans.

What's next in the ongoing effort to address what many see as a broken system is an open book. But what is clear is that health care is a top issue for Americans, and will surely dominate headlines for the foreseeable future. More importantly: It'll be a big part of the 2018 election season.

So, what's on the table?

One path largely championed by "progressives" -- but is also getting increasingly more attention from across the political spectrum -- is a single -payer, "Medicare for all" system. Proponents of the system say it will prioritize patients over profits and ensure all Americans are insured. It has gradually made its way to the mainstream in political circles of influence, and several states have single-payer efforts in the works. Additionally, several political candidates are running on a single-payer platform

It sounds great, but what exactly is single-payer?


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Who is the single-payer? Me?

Nope. Under a single-payer system, a public or quasi-public agency would take the place of today's for-profit health insurance companies and ideally provide every American citizen with basic healthcare coverage.

Given the current political climate, doesn't this kinda sound like a pipe dream?

It already exists on a smaller scale for senior citizens. It's called Medicare. That's why the single-payer system also goes by Medicare for All, as the program is often applauded by both liberals and conservatives as a successful pillar of the American social safety net.

Under Obamacare, the number of uninsured Americans dramatically decreased, but there are still millions of uninsured people.

If the GOP's Obamacare repeal effort is an indicator, today's political climate is not business as usual and what's clear is that millions of Americans are expecting their government to take bold actions, which makes this a very real possibility. In addition, more state-level lawmakers from California to New York are expressing interest in the system, though it is yet to be successfully implemented just yet.

Doesn't Obamacare cover pretty much everybody already?

Under Obamacare (aka, the Affordable Care Act), the number of uninsured Americans dramatically decreased, but there are still millions of uninsured people. By 2026, an estimated 28 million people will still be uninsured under Obamacare. This handy chart from National Nurses United compares Obamacare, Medicare for All, and the GOP plan. With a single-payer system, everyone is insured.


Okay, but how would this program be funded?

Physicians for a National Health Program (an organization with a self-explanatory name) says the savings from nixing private insurance companies would be hundreds of billions of dollars per year and more than enough to cover the costs of insuring everyone. And it's not just progressively minded health care groups that see single-payer system as a viable path; billionaire investor Warren Buffett is a fan, describing it as a vehicle to bring down costs.

Still sounds uphill. The insurance companies can't possibly be on board with this and don't they have a pretty powerful lobby?

Advocates of the single-payer system are up against formidable opponents.

Some speculate that lobbying dollars from the insurance and pharmaceutical industries are what tanked the California legislature's recent inability to push through a single-payer bill. New York politicians are also currently attempting to get a single-payer healthcare system on the state level. But more and more elected officials, advocacy groups and medical officials are voicing support as the most viable option for America's health care future.

Is there support for this in the US Congress?

Yep. H.R. 676, the Expanded and Improved Medicare for All Act, was originally introduced in 2003. The current iteration is sponsored by Rep. John Conyers (D-MI) and co-sponsored by 115 other Congressional members. (Check here to see if your rep is a co-sponsor.) Senator Chuck Schumer (D-NY) recently said that creating a single-payer healthcare system is "on the table" for the Democrats. And America's most popular politician and youth galvanizer Senator Bernie Sanders (I-VT) has consistently supported the system throughout his legislative career, and plans to introduce legislation in the US Senate shortly.

Advocates of the single-payer system are up against formidable opponents.

The bill has not yet been brought to a vote in either chamber of Congress, but signs seem to point in that direction.

Will I have to wait in an hour-long line for basic care?


Some critics of a single-payer system believe that providing care for everyone would crush any system by sheer volume. But single-payer activists maintain that a well-designed and properly funded system can accommodate the numbers. They point to Canada, Greece, Italy, and other countries that have had single-payer healthcare systems in place for years.

Speaking of numbers, will I have to pay anything?

Under the single-payer health care model, there are no deductibles and non-covered medical costs such as cosmetic surgery could still be purchased with the patient's own means. A 2013 study about H.R. 676 concluded that 95 percent of Americans would see a decrease in medical costs.

Interesting. I want to learn more about single-payer. How can I stay in the loop?

For more of a deep dive on the economics and numbers informing health care reform in the US, the Congressional Budget Office is a great nonpartisan resource.

For more on the politics and advocacy regarding single-payer, you can sign up for updates and learn about opportunities to engage at the websites of National Nurses United and Physicians for a National Health Program. You can also look up your congressional representatives and see what their stance is on the issue. Hell, you can even give them a call and ask them.

Over the next few months, VICE Impact and Tonic will be covering the latest in advocacy and policy developments around health care reform in the United States, so please share your thoughts on what YOU think health care in the US should look like.