Time has come for single-payer healthcare

Recently, it has been reported that 7.5 million Americans have enrolled in Obamacare, many more than expected. Yes, it’s better than before: overall, Americans are insured, and insurance companies are no longer allowed to overcharge or deny coverage to the elderly and people with pre-existing conditions. Key issues persist, however: Some people still cannot afford adequate insurance or insurance at all. New issues have arisen as well: 14 million people are left scrambling after their plans were canceled, and others are ignored by the system all together. Going backward is not the answer. But clearly, the Affordable Care Act is not the answer either. So where do we go from here? According to prestigious organizations such as Physicians for a National Health Program, the American Medical Student Association and the California Nurses Association, the answer is clear: single-payer health care.

Single-payer health care is a system in which a single payer — in our case, the federal or state governments — fronts the cost for all health care. There is no insurance industry, and there are no insurance companies to deny people coverage. The system is funded by progressive taxes, so people pay exactly as much as they can afford and no more.

The ACA falls short of a single-payer system on several key points. First off, 29 million people still won’t have health care. Part of this is inherent in any system for which people must proactively sign themselves up — they won’t. Maybe they don’t know how to enroll, or as the Obamacare website demonstrates, enrollment will go awry. In addition, some people are lost in the gap between where their state’s Medicaid ends and Obamacare begins. For example, in states such as Virginia, where requirements for eligibility for Medicaid are notoriously strict, single men are not eligible for state-sponsored care under any circumstances. Obamacare has an income minimum, operating on the assumption that anybody below that minimum will be covered by their state. But as Virginia law demonstrates, this is not always the case. In a single-payer system in which every resident is automatically enrolled at birth, nobody will fall through the cracks.

In addition, Obamacare has proven enormously expensive, both for the federal government and for some citizens. Much of the federal government’s health care expenditures go to administrative costs, which are high for this very complex system. Because single-payer is simpler to administer, it costs less. The ACA is the longest and most intricate piece of legislation passed by Congress in 10 years, whereas the single-payer system is simple enough to be described in the 56 words that make up the second paragraph of this piece. Administering the ACA will cost the government $1.1 trillion over the next 10 years, while the single-payer system would save $400 billion.

Additionally, some citizens will find their health care costs rising under the ACA. These are people who purchased their own plans independent of insurance provided through a job or a government program like Medicare or Medicaid. Many of these people purchased very limited, cheap plans that don’t hold up under the stricter requirements the ACA has set for insurance plans. These people are left with two options: purchase a new plan or pay a hefty fine. In many cases, new plans are much more expensive. There are two reasons for this: Because new plans are required to provide more coverage than before under the new requirements for insurance plans, they are of higher quality and therefore cost more. In addition, since insurance companies are no longer allowed to deny coverage to “high-risk” clients (those with pre-existing conditions who are likely to require a lot of health care), they must charge everyone more to make up for taking on costly clients. Many people find they cannot afford the new insurance options on the market and also cannot pay the fine imposed on them should they choose to forgo health insurance. Because single-payer is a universally imposed progressive tax, everyone will pay as much as he or she can afford and will receive equal coverage. In fact, 95 percent of Americans will pay less than they currently do for equal or greater benefits.

Lastly, the Affordable Care Act does not provide coverage for undocumented immigrants. These people pay much more in taxes than they receive in benefits, so it’s only fair to provide them with basic health care. While some may argue that because these people are not American citizens the American government is not responsible for their health, the health of these undocumented immigrants affects the health of American citizens, which should be the responsibility of the American government. There are currently about 11.7 million undocumented immigrants in the United States, and sometimes they get sick. Sometimes they cannot afford treatment. Sometimes they ride BART, go to the supermarket or attend school or work even though they are ill, and sometimes they spread illness to others. Not only would single-payer give these undocumented immigrants access to a human right they do not currently possess, but it would also improve public health conditions overall.

The health insurance industry is, always has been and always will be broken. Any attempt to reform the health care system that provides for a health insurance industry may help some, but it will also perpetuate the problems inherent in private sector control of a human right. The answer is clear: do away with the health care insurance industry all together. It’s time for single-payer health care.

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  • KeithEns

    I agree with most of the opinion, but there are a couple ways single payer systems work, one of which is the Bismarck system used in France, Germany, and Japan. It’s basically like Medicare Advantage but much more regulated to serve society. Many people including the author think illegal residents are a uniquely American problem. Spain has more illegal residents per capita than the US. I called at least 7 consulates from single payer nations including Spain and none of them offer illegal residents health insurance. The Belgium or Canadian rep actually laughed at the idea. Anyway, a single payer whether traditional Medicare or Medicare Advantage like I described will be a tremendous economic and social shot in the arm.

  • John Kelley

    As a single male in Virginia… I’m just floored, numbed and speechless by this article.

  • Mel Content

    Recently, it has been reported that 7.5 million Americans have enrolled in Obamacare, many more than expected.

    Talk about spin. Supposedly there were 44 million uninsured people in this country who supposedly were jumping at the bit to sign up for for this. Yet less than 20% did, and half of them only did so because their previous policies were made illegal by the ACA. it would be nice if for once in your lives some of you journalist wanna-bes had the intellectual curiosity to research things for yourself instead of believing whatever propaganda is shoved your way by the Obama administration…

    Lastly, the Affordable Care Act does not provide coverage for undocumented immigrants. These people pay much more in taxes than they receive in benefits

    Show me your sources. You LIE.

    • Close to or more than 1/2 of the uninsured are not eligible for ACA coverage because they are excluded as undocumented immigrants. Millions more do not have access to the new coverage because their states are not allowing for MediCare expansion.

      But your inference is correct. Dump ACA and institute Single Payer and every resident is automatically insured– with no money wasted on excess profit, salaries, or promotion.

  • paradocs21

    This editorial lays out the rational for a “single payer” health financing system very well. There are many economic, financial and efficiency benefits to be had. However, for all of us, the most important aspect of this reform would be that It embodies a public policy commitment to an inclusive community support system, to social justice and to the moral virtues of universal health care.

  • JakeNewMexico

    A well-written piece without the complicated policy wonk—just like single-payer. Health care reform doesn’t need to be complicated. In fact, providing care is simpler (and cheaper) than denying it. Thanks, Sally!

  • KeithEns

    WHEREAS, demographic data from Catholic Healthcare West and Healthy Communities Access
    Program reveal about 70% of Merced County must remain destitute for Medicaid or
    limit their income for insurance subsidies under the Affordable Care Act further
    diminishing the economic potential of Merced County.

    WHEREAS, every child in a family that qualifies for subsidies under the Affordable Care Act is required
    to participate in Medicaid and will not be covered under the parent’s insurance

    NOW, THEREFORE, BE IT RESOLVED that the Merced County Democratic Central Committee
    by unanimous consent at the June 9, 2014 meeting:

    Support Universal, Publicly Funded Health Insurance that will affordably cover every
    Californian with comprehensive benefits that include but are not limited
    to medical, dental, vision and prescription drug coverage, as well as hospitalization,
    emergency room care and transportation, laboratory work, skilled nursing
    care, mental health care, drug addiction rehabilitation, chiropractic care, etc.

    Support Universal, Publicly Funded Health Insurance because patients and doctors should determine appropriate medical care within a well regulated health insurance system where
    insurance pays for services performed by any licensed doctor or medical
    facility as guaranteed in Article 25, Section 1 of the United Nations
    Universal Declaration of Human Rights.

    Approved and adopted June 9, 2014. I, the undersigned, hereby certify that the foregoing Resolution was duly adopted by the Merced County Democratic Central Committee.