One Thing That Could Kill Single Payer

Most of the concerns about the single-payer plans offered by Sen. Sanders and Rep. Conyers have to do with the financing of such a massive change to our health care system. That is a very legitimate issue and one that I’ve been addressing for a while now. But there is another problem that could pose just as big of a barrier to their proposals. It just isn’t likely to surface until it becomes obvious that these are serious bills under consideration. In the meantime, Democrats need to think about it and face the issue head-on.

Currently 153 million Americans (47 percent) get their insurance via a plan offered by their employer. Under both the Conyers and Sanders plan, they would all be forced to give up their current insurance in exchange for the government plan. While Sanders and other supporters of single payer are probably right that they would eventually be satisfied with their coverage, that comes later. But the initial reaction would be huge. We’ve never even come close to attempting anything like that in this country.

While Medicare is pretty much the universal provider of health insurance for the elderly, there is no mandate for seniors to sign up, and there are other options for them to consider. I know that because I have relatives who opted out of Medicare and purchased their own private insurance for years based on their political principles. Doing so has always been an option, although almost no one takes advantage of it. Even my relatives eventually signed up when the costs became overwhelming.

But the Conyers bill specifically makes it illegal for insurers to sell coverage that is deemed to be duplicative—and that goes into effect immediately. The Sanders bill bars employers from offering separate plans that compete with the government-run program. So neither of them allows for an alternative. People will have to either sign up for the single payer plan or go without insurance.

In a country that has what I would deem to be an over-fixation on individual freedom and very little appreciation for communal responsibilities, that is guaranteed to trigger a massive backlash. I’d be willing to suggest that the pushback would be so strong that it could hamper any further reforms for a very long time.

This is why the alternative plans being proposed by Democrats make so much sense—they preserve the ability to chose. If, as many of us believe, programs like Medicare and Medicaid are superior options, then more and more people will chose them.

That is not simply a theory. Recently Dylan Matthews wrote about another very interesting option called “AmeriCare.” It was proposed back in 2006 by Rep. Pete Stark (D-CA) and would do the following:

You can think of the AmeriCare approach as a public option on steroids. It would create a new single-payer program called AmeriCare that would take on everyone ensured by Medicaid and SCHIP, and would automatically enroll all children at birth. It would pay the same rates to providers as Medicare, meaning it’d be considerably less generous to doctors and hospitals than private insurers…

Here’s the kicker: Employers could buy into the plan. They’d have to pay 80 percent of the premium, leaving 20 percent to employees, but it’d be an alternative every company got to their existing private plan.

In 2009, the nonprofit Commonwealth Fund hired the Lewin Group, a widely respected health care policy research group, to look at the AmeriCare proposal. They found that over time, 85 percent of Americans would be insured by AmeriCare, with only 1 percent remaining in private plans (the remainder would be in Medicare and other government programs). That is primarily because employers would find that AmeriCare was cheaper than private insurance plans. Here is how Matthews summed it up:

AmeriCare doesn’t eliminate the private insurance system, but it does make it small enough to drown in a bathtub.

The critical distinction between a plan like this and the ones proposed by Sanders and Conyers is that individuals and employers would be provided with an incentive to move in the direction of single-payer, rather than simply have their options taken away by politicians. I suspect that would make all the difference in the world.

Nancy LeTourneau

Nancy LeTourneau is a contributing writer for the Washington Monthly.