By Dr. Ida Hellander for Health Over Profit. Above photo: Canadian Medical Association. Under Premier Tommy Douglas (“the father of Canadian medicare”), Saskatchewan establishes an insurance plan guaranteeing publicly funded hospital care for most residents of the province.

Liberals have created a new single payer bogeyman to justify their renewed pursuit of failed incremental policies for health reform (“Medicare for All Isn’t the Solution for Universal Health Care” by Joshua Holland, The Nation, August 2).  It used to be that single payer was not “politically feasible”.  Now, according to the likes of Joshua Holland, Harold Pollack, and Dean Baker, it’s that single payer advocates haven’t worked out a plan to “implement” single payer, or the “brass tacks.”

In fact, implementation is the easy part of health reform.  The Canada Health Act is less than 14 pages long, and is only that long because it is also printed in French. Taiwan, which had a whopping 40 percent of its population uninsured in 1994, installed a universal, single payer system ahead of schedule in less than a year.  The ease of adoption of the U.S.Medicare program, as Holland admits, also refutes the myth that a lack of policy detail will sink the single payer movement.  Nearly every implementation issue Holland raises is already addressed in the Physicians Proposal for Single Payer National Health Insurance (2015) and Conyers’ bill, HR 676, which is the “gold standard” for single payer legislation.

The “single payer” envisioned in these proposals is not today’s Medicare, of course, but an improved version of Medicare, with more comprehensive benefits, and greater ability to control costs.  HR 676 may not specify an exact financing plan, but gives specific enough parameters so that whatever financing plan is adopted (one possible version I worked on is below) will shift the burden from the sick and poor to the healthy and wealthy, and make care free at the point of delivery.  Private employers only pay a paltry 20 percent of the current health care tab, which can be recouped with a small payroll tax or tax on corporate revenues (as recently proposed by Robert Pollin for California). Taxes already fund over 65 percent of health care in the U.S., so moving to a publicly-funded plan is a shift, not a radical change.

For one example of what the “brass tacks” of this shift might entail, Gerald Friedman, an economist at U. of Mass. at Amherst proposed this plan for the additional funding:  a tax of 0.5 percent on stock trades and 0.01 percent tax per year to maturity on transactions in bonds, swaps, and trades (the so-called Tobin tax), a 6 percent high-income surtax (on households with incomes > $225,000), a 6 percent tax on unearned income from capital gains, dividends, interest, profits, and rents, a 6 percent payroll tax on the top 60 percent of income earners (with incomes over $53,000) and a 3 percent payroll tax on the bottom 40 percent of income earners. It could use a few tweaks, such as exempting people earning less than poverty from the payroll tax, but it’s otherwise a solid example of the kind of policy detail that advocates of incremental reform insist is missing.

Holland also wrongly asserts that physicians will have to be paid less under a single payer, which is false.  There are many advantages to a single payer system, not least of which is the saving of $500 billion annually currently wasted on insurance overhead and excess provider bureaucracy – more than enough money to cover the extra costs of clinical care for the uninsured and under-insured, and to eliminate co-pays and deductibles for everyone, without cutting physician pay.  Having said that, the single payer will have the ability to shift more funding towards primary care over time, which would help with both access and costs down the road.

Bizarrely, Holland tries to revive Jacob Hacker’s discredited proposal for a “public option” that would compete with private insurers. The premise for Hacker’s proposal is that Americans are “stubbornly attached” to employer-based insurance and don’t want to give it up.  Far from wanting to keep their rapidly shrinking employer-based coverage, polls show that about 2/3 of Americans consistently favor Medicare for All.  Adding one more insurance company to our fragmented and failing health system will not cover everyone or control costs.

Proposals for incremental reform to “fix” the ACA are on the Congressional agenda, but much more fundamental reform is needed.  As Nina Turner, the new head of Sanders’ group Our Revolution, recently said, “If we can go to the moon we can have Medicare for all.” If Congress passed single payer today, we could implement it within a year and save tens of thousands of lives.”  Time to get to work.

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