Moving Forward on Healthcare Reform: Single payer?


It is frequently stated that the current Republican Congress is ineffective in getting anything done. That is not entirely true.  A big issue was decided this past summer.  The failure of Congress to repeal and/or replace the Affordable Care Act means that the goal of universal healthcare for all Americans is here to stay.

The question now is the best way to implement universal healthcare.  Senator Bernie Sanders (D, VT) has just introduced a single payer universal plan, “Medicare for All.”  Here are some of the problems associated with such a plan:

  • At least three states, Vermont, Colorado and California have recently rejected state-wide single-payer plans because of the huge costs involved.
  • The Urban Institute estimates that Medicare for All would increase federal spending by $32 trillion for the first ten years (compared to a very high current total national debt of $20 trillion).
  • Medicare is an inefficient hidebound system with over 140,000 procedure codes where private sector cost-saving measures, like competitive bidding for routine services, are rarely used.
  • There are now 155 million Americans who receive and like their employer provided health insurance and who will resist moving to a Medicare for All plan especially at the cost of a huge tax increase.

On the other hand the cost of healthcare in the U.S., public and private, now eats up 18% of GDP, almost twice as much as for any other developed country, and major changes need to be made to give individuals more direct responsibility for the cost of their own healthcare.
One attractive alternative is to limit the tax deduction for employer provided care to the cost of catastrophic coverage, at a cost of about $3000 per person per year.  It could be made progressive by tying deductibles to income.

Conclusion. Healthcare spending in the U.S. is way too high and something major needs to be done. Universal catastrophic care for all Americans not already covered by Medicare and Medicaid is an attractive alternative to single-payer Medicare for All.

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7 thoughts on “Moving Forward on Healthcare Reform: Single payer?

  1. The Power Law Distribution curve can be used as a concept to analyze Healthcare Spending. Now imagine that we could know the total spending for the healthcare of each citizen, annually. The up and down, aka y axis, would be a log scale for health spending (as in 1,10,100,1000,100000, etc). The x axis would be plotted with the cost of each citizen ranked highest to lowest from left to right. If the x axis was 3 inches long, the first 1/8″ would represent the citizens using 80% of our nation’s annual health spending, the next 1 3/8″ of the plotted citizens would represent 15% of our nation’s health spending, and the last 1 1/2″ of our nation’s citizens would represent 5% of our nation’s health spending. The citizens within each spending group tend to annually move up, down or finish a given spending level during their lifetime.
    Our Nation’s, current healthcare reform strategy is largely focused on reducing the health spending for the 10% (32 million) users. There is no accurate evidence that this strategy will reduce it to the level of health spending occurring for most of the other developed nations: 11-12% of their economy. By comparison (as noted above), we used 18% of our economy for health spending in 2016. Unless we have a strategy to focus on the Stable HEALTH of every citizen, there is absolutely no hope to prevent our health spending from eventually bankrupting our nation’s economy, without onerous rationing. Remember, our nation’s health spending as a portion of our GDP grew from 5% in 1960 to 18% in 2016, an increase of 2.33% compounded annually in addition to economic growth.
    Since agriculture is our most effective and efficient “basic need” industry, why not an Amendment to the Smith Lever Act of 1914? Promoting a “Community HEALTH Cooperative for each community of @400,000 citizens would not be that difficult. It would mobilize each community’s local STAKEHOLDERS to *) assure the equitable availability of Primary Healthcare for each citizen, *) assess the local “collective action” strategies to augment their community’s social capital for its COMMON GOOD and *) monitor the community’s disaster preparedness. The Cooperative Extension Service would only be a technical and training associate for each Community HEALTH Cooperative. With commitment and good will from the Governor’s association, it could be up and running in 6 months.
    Remember, among the world’s developed nations, our nation’s agriculture industry is the most effective and efficient. Sadly, our nation’s healthcare industry is the the least efficient and least effective among these developed nations. We need and deserve better. ( see “Mirror, Mirror…” report at )

    • Lots of lessons here. The best agricultural system in the developed world and the poorest healthcare system. The Mirror, Mirror article is outstanding. I’ll come back to it in my next post.

  2. Jack,
    I have for now but one question to ask: “What should be the relationship between forming children and adults’ minds in relation to caring for their physical health?” I guess this question fosters another question. “What is the relationship of the average professor’s pay in relation to the average doctor or dentist’s pay?”


    • Our minds are very important but so are our bodies. Education is government controlled and pays less to providers than healthcare which is much more free market. A single payer system would change this by making healthcare also government controlled. But would we give up too much freedom in the process?

  3. In the meantime, our California folks are headed to single payer health insurance. They won’t need a natural disaster, i..e., a hurricane, to understand the financial implications of that commitment. Oh well, they all go under receiving a weekly massage. I apologize in advance for the sarcasm.

  4. Jack,
    I suppose we have to define freedom as well.
    By the way, I found drpaul’s exploration quite interesting. I hope the two of you can expound more.

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