Approaching single­payer health care

Now that primary contests are concluded, mention of health care reform doubtless evokes a glazed reaction from many. It’s an old story and a critical one, yet without resolution in the United States. But if one surveys health programs around the world, one kind repeatedly rates among the best: “single­payer,” a single­system like Medicare, which covers an entire population. After this season’s primary wrangle, what is different is that younger voters are more than dimly familiar with the substance and cost of various health care plans, are aware of the staggering cost increases of pharmaceuticals, and grasp that health care is a right to wellbeing, productivity and fulfilling living. They also realize that comprehensive health and wellness programs are a prized right of citizenship in democracies as diverse as Denmark, Taiwan, Norway and Canada. Moreover, younger Americans recognize that others’ single­payer plans are a truly enviable benefit that we can learn from and determine to make a reality here. This wasn’t true in 1994 when Hillary Clinton bulled her way into congressional chambers, a First Lady with rolled­up sleeves determined to deliver a universal health­care plan through competitive programs and employer mandates along with spending controls. Fear of government takeover extinguished the program’s bid for favor and it crashed. Largely forgotten was a Democrat­sponsored bill by Washington state’s Representative Jim McDermott, which passed out of committee in 1993 and had more congressional backing than any other health care plan put forth at the time. His was a single­payer program supported by public financing, privately delivered and modeled after the Canadian system.

Still fresh in many minds is the 2008 presidential race and the clash between candidate Obama’s plan and Hillary Clinton’s. Obama proposed that the federal government offer health care plans to compete with the more costly private policies that many moderate and low­income persons could not afford. He declared that his plan would end the exclusion of persons from coverage because of one’s prior medical history. Subsequently this happened. The imposition of an insensitive federal bureaucracy forecast by opponents did not. “Death panels” did not seize the fate of the public. Instead, the Patient Protection and Affordable Care Act (ACA) became law on March 23, 2010, hailed as the most important legislation of its kind since Medicare and Medicaid in 1965. A Supreme Court Review upheld its legitimacy on June 28, 2012. Nevertheless, every Republican candidate for the presidency has pledged to repeal Obamacare, as the ACA came to be known, even as it continues to gain adherents.

Granted Obamacare has not been a panacea, especially in states that resisted Medicaid expansion; yet surveys indicate that more and better health care is experienced by an increasing number of Americans. As reported in the online newsletter Healthline (“Scoring Obamacare After Two Years,” by Cameron Scott), some 16 million more people now have health coverage than when Obamacare became available in 2010. Medicaid benefits to low­income persons have risen to 72 million. According to a Commonwealth Fund survey, the number of persons reporting difficulty in meeting medical expenses dropped from 75 million in 2012 to 64 million in 2014. In its July 28, 2015 issue, the Journal of the American Medical Association reported on a research team’s analysis of data from a national telephone survey of over 500,000 adults, conducted by Gallup­Healthways Well­Being Index. Among the results, they found that from 2012 to 2015, the number of persons reporting they were unable to afford healthcare coverage had dropped by 5.5 percent.

Progress to be sure, but not enough. Although more of us are covered, the cost of care has risen, especially for pharmaceuticals. Many complain that after using their basic medical coverage they haven’t enough dollars left to afford the cost of prescribed medication. Meanwhile the salaries and related income of pharmaceutical executives have reached indecently exorbitant levels as shock and awe stories continue to expose the vast dollars health industry leaders have stashed beyond our borders in tax shelters protected from IRS acquisition and potential usefulness to the public’s welfare.

Bernie Sanders’ alarm bell campaign has alerted many to how since the Reagan era our economy has been molded according to the predilections of the very wealthy. Those between ages 21 and 45 are now realizing that the solid middle­income lifestyle that brought respectability, financial well­being and satisfaction to parents and grandparents is no longer a “given.” Our economy is now tilted to those anchored to investments and eternal profiteering at the expense of mid­to­low income Americans. This is also true of our healthcare system, yet others, like Hillary Clinton, hold that a tweaking of Obamacare will heal its shortcomings, overlooking that it is planted in soil primed for profit rather than the greater good of all in need of medical treatment. We have been trying to get health care right since the Truman years, and we have made progress. But every election cycle reminds us how far we are from where we ought to be. Nevertheless, encouraging are the concern and spirit of younger voters who not only see what needs to be done, but show a willingness to stay the long course to make it happen.

Thus far Sanders and other single­payer activists have not offered detailed, step­by­step accounts of the many economic, medical, accounting, organizational and personal adjustments that would accompany the transition to single­payer health care. Rather they have focused on glowing outcomes. Even with a good strategic plan, it is likely that deadlocks will occur and modification will be needed. The transition will happen incrementally, state­by­state, as allowed by the ACA. We should regard the turnabout in the context of years, not months. But it has been done elsewhere, and it can be done here. Consider the still greater adjustments confronting us in the next hundred years as we experience declining air quality, insufficient water for crops and food, ecological breakdown, the global upheaval of those dispossessed from their native soil, and widespread governmental collapse. Yet nationally and internationally we have shown that health care is something we can get right as we combat widespread suffering and disease. Surely we can put our common good ahead of uncommon profiteering and develop an American single­payer health program we can regard with pride.

Canada’s evolution to a universal single­payer system is instructive. It began with introduction of medical insurance in Saskatchewan in 1947. By 1966 each province was allowed to establish its own universal health care plan, and in 1984 the Canada Health Act provided hospital and physician services to all residents without charge. Along the way was plenty of turmoil in what Steven Lewis described as “the public­policy equivalent of a Civil War” (New England Journal of Medicine, May 2015). But today Canada has a flourishing system that ranks better than our own in most quality assessments. And according to Olga Khazan, (The Atlantic, October 21, 2014), Canada spends $1,483 per person, whereas we spend $2,051 per person in our administratively burdensome system.

Today Colorado, Oregon, New York and Minnesota are among the states in which single­payer programs are in the works for legislative action. Pennsylvania too has a well­conceived plan worthy of earnest consideration. Given the sluggishness that attaches itself to progressive programs in the Commonwealth, however, we are unlikely to be at the forefront of the nation’s evolution to universal health care. If you do not know about it, I encourage you to check out Commonwealth of Pennsylvania House Bill 1688 online, or read about it on the web site for healthcare4allpa.

Joseph Carter is a retired English professor with 35 years of classroom experience in liberal arts colleges in Pennsylvania, Florida and Virginia. He also served fifteen years as a chief academic administrator. He is a member of Gettysburg Area Democracy for America’s healthcare task force