Could the passage of federal health reform hasten America’s march toward a single payer, Medicare for All, system? Many think so, including some conservatives. According to this recent blog post, written by Dr. Don McCanne of Physicians for a National Health Program, these conservatives believe that as private insurance continues to become unaffordable for many Americans, there will be a popular push for single payer.
The majority of progressives predict that a single payer system is inevitable because the nation will no longer tolerate the increasing costs of health care. On the other side, many conservatives and libertarians predict that a single payer system may be inevitable because health plans will no longer be affordable in a regulated insurance market. Senator Tom Coburn and Professor Paul Feldstein represent the latter view.
Apparently some government bureaucrats are also seeing the writing on the wall, according to an article posted on AlterNet. The author, a healthcare activist, recounts a conference she attended that featured a presentation by a representative from the Center for Medicaid and Medicare Services (CMS).
Yesterday, a high-ranking CMS official (the kind of guy who wouldn’t give a health coalition the time of day before 2008) described (with relish) the complete culture change his agency has undergone. He used mostly four number words too profane to repeat although many began with the number 3 (patient safety) or 6 (I forget). There were hundreds of them.
They were the new regs being rolled out that he promised would lay the foundation for what might one day become (I kid you not) “Medicare for All.”
Even a plurality of doctors in Massachusetts are rejecting that state’s reforms in favor of single payer. The Massachusetts system, which requires most residents to purchase private insurance, is the model on which the federal Patient Protection and Affordable Care Act (PPACA), signed into law by President Obama, is based.
A plurality of the physician respondents, 34 percent, picked single-payer health reform as their preferred model of reform, followed by 32 percent who favored a private-public insurance mix with a public option buy-in. Seventeen percent voted for the pre-reform status quo, including the permissibility of insurers offering low-premium, high-deductible health plans.
Remarkably, only 14 percent of Massachusetts doctors would recommend their own state’s model as a model for the nation. A small number of respondents, 3 percent, chose an unspecified “other.”
In other words, the doctors with the most on-the-ground experience with the Massachusetts plan, after which the Obama administration’s new health law is patterned, regard it as one of the least desirable alternatives for financing care.
And state officials in Maine are looking at alternatives to PPACA, including single payer, which could save the state $1 billion a year. A healthcare expert from Taiwan recently addressed a health committee in Maine, and spoke about the Taiwanese system.
In the early 1990s, when Taiwan wanted to tackle rising health care costs, it hired economist William Hsiao to come up with a solution. And it was a tall order, Hsiao told the Legislature’s Joint Select Committee on Health Care Reform Opportunites and Implementation.
“Taiwan decided that everyone should have access to basic health care. However, health care costs money, and regardless of how you pay for it — either out of your own pocket or though premiums paid partly by your employer or out of your own pocket — it’s going to be paid by somebody, through some avenue.”
With the goal of affordable universal coverage that is sustainable over time, Taiwan developed a single-payer system, adminstered by the government. Hsiao, a professor at Harvard, says the cost is much lower than in the United States health care system, and it is paid for by employers, employees and the federal government.
The fact is, our current for-profit healthcare system is unsustainable. As healthcare costs continue to spiral out of control to the point where not even government subsidies will be enough to help families afford insurance, PPACA’s inadequacies will become more and more apparent. Politicians will no longer be able to ignore an impending revolt against for-profit health care. The public will soon be clamoring for a universal expansion of the popular Medicare program.