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Why a Single-Payer Healthcare System is Inevitable


Why a Single-Payer Healthcare System is Inevitable

Robert Reich

The best argument for a single-payer health plan is the recent decision by giant health insurer Aetna to bail out next year from 11 of the 15 states where it sells Obamacare plans.Aetna’s decision follows similar moves by UnitedHealth Group, the nation’s largest health insurer, and by Humana, another one of the giants.

All claim they’re not making enough money because too many people with serious health problems are using the Obamacare exchanges, and not enough healthy people are signing up.


Way overdue is more like it. In fact, the Kleptocracy that is the American 'Health' Insurance business is a prime reason why I made sure to get a second passport in a country where getting sick won't bankrupt you.


Reich says we are going to have to choose eventually whether we want to have a single payer system. But first we need to have a democracy. Right now, if say a majority of people vote for Jill Stein of the Green Party, who has included single-payer in her platform, the electronic voting machines in enough states can be programmed to flip votes intended for Jill Stein so they appear as if they were intended for the establishment candidate, Hillary Clinton in this case, who will be installed as the next President and argue that since people voted for her and she had promised that single payer will never happen, it must be that voters do not regard single payer as a high priority, and therefore she will continue business as usual. There's a deafening silence on the question of rigged electronic voting machines, and any other discussion is superfluous until and unless we restore the essential rudiments of a democracy. In this case, we need to bring back counting of the ballots by hand, and open to the public. The examples of electoral fraud by electronic equipment are piling up, and the Democratic Primary was the latest example. See https://www.facebook.com/ElectionJusticeUSA/


So lower premiums don't happen? Have you done a study of all countries that use single payer? No? I can't believe you then.


"Patch up Obamacare in the short term by increasing (taxpayer funded) subsidies to insurance companies".

Subsidizing insurance and drug companies is what is WRONG with Obamacare. Expanding what is WRONG with Obamacare makes it worse in the short term AND in the long term.

We don't need PhDs from UC to understand that insurance is a financial product, not a health care product. Why do you continue to deny that fact, Mr. Reich ?


He actually said that there would be lower premiums - but "rationing".

Of course the rebuttal to his remark is simply that we have rationing in the US too - based on wealth. There are always decisions to be made for healthcare at end-of-life. The money and resources that could be spent to merely extend the life of some pain-wracked old dying person a few days is practically unlimited. So of course decisions need to be made.



The Canadian template must also be a good one, seeing how much the US is spending keeping single payer from invading the US from the north.

Why else would the US have beefed up its Canadian border security (Border Patrol, Customs, etc.) thirtyfold since the turn of the millenium ?


Please read the Constitution. Congress legislates, not presidents. It doesn't make any difference if Stein or Mickey Mouse is president, if Congress doesn't pass a bill enacting single-payer health insurance, we won't have single-payer health insurance.

We have a democracy where the people don't vote the way you think they should voter. Deal with it.


You must be unfamiliar with our system.Insurance companies ration care all the time and much of the time they delay payment by making physicians justify care to a non-medical clerk. They return 80 cents on the dollar to patients while Medicare returns 97 cents.

I'm on Medicare now and it is Much More Efficient. I am aware of this as a provider, a patient and as someone who has spent time in Canada in the medical area. Canada has an imperfect system that is much better than USA (why they rank higher)

USA ranks 37 in healthcare in the first world. The UK was number one in the recent past as was France.


True and they still do better than the USA with about half the cost.


We aren't preventing single-payer health insurance from invading (do you think health insurance is an army that invades countries?).

The only way to get single-payer health insurance is to elect a Congress that will produce single-payer health insurance and a President who will sign the bill into law.

I live in Nebraska (a flaming red state). Yet, we have public power. We the people own the power company. Private power companies can't even compete in Nebraska.

If Nebraska can pass public power, why can't the US pass single-payer health insurance? One reason: private insurance companies would be out of business if the US went to single-payer health insurance. Since the last thing a capitalist wants is to be out of business and not making money, capitalists will do everything possible to prevent single-payer health insurance. You do understand, don't you, that Medicare is single-payer (at least Parts A and B; Part D is like Obamacare, I have to buy prescription drug coverage from a private insurance company)? When Medicare was proposed under LBJ, Democrtats controlled Congress and it was passed over the strenuous opposition of Republicans and the insurance industry.

You leftists love to bash Democrats, but it was Democrats who gave us all the social welfare programs we now enjoy: Social Security; expanding Social Security to dependents and spouses; disability insurance; unemployment insurance; a minimum wage; Medicare; Medicaid; the ACA; and expanding Medicaid under the ACA (in states not controlled by Republicans).


I'm also on Medicare with Blue Cross as Supplemental Insurance. Blue Cross jacks my premium up every year even though I am on a fixed income (except for Social Security COLA's). My Medicare Part B premium can only go up if I get a Social Security COLA and the increase cannot be more than the COLA.

I recently had lithotripsy for kidney stones. I was in a urology surgical center (not a hospital) for two hours and sent home with a prescription for pain pills. My total bill was $22,000 (what I would have had to pay if I had no insurance). Medicare paid less than $5000 because Medicare only pays the Medicare-approved amount. With private insurance the market dictates what medical care costs.

The problem with getting single-payer health insurance is that the private insurance companies don't want it because they would be out of business and doctors and hospitals don't want it because they want the free market to determine what they can charge for services.

Basically is is the same old story. Capitalists don't like public programs because they can't make as much money if the government is paying. Our Congress critters side with the capitalists and against the people. We will never get social justice in this country so long as capitalists make all the rules.


If any progress is made on health insurance it will probably be adding the public option to Obamacare. This will create a hybrid system. If that ever comes to pass then an evaluation will be needed to see how well it works. Politically it is going to tough to get a single payer system. Most people now probably have better health insurance than single-payer system would provide. Most plans provide better coverage than Medicare. And there is also a strong conservative movement in the US that will oppose the US government being the only payer for healthcare.


That Medicare A&B is equivalent to Canadian coverage seems a widely believed truth - but it's false. Descriptions of what is covered by Medicare A&B closely matches what the Canadian system offers, including not meds. Canada has med cost support programs for people whose income is very low, and has a fairly decent tax deduction for those who pay taxes and also wrack up med costs over a year. A supplemental program is avail in Canada to support dental and vision needs, which is affordable for most and is often part of a pay package.

I lived, worked, and was enrolled in the British Columbia's system through employment for nearly 40 years. On retirement, in BC, in 2014, I'd have paid a small premium, $62.50/mo CDN$. (Not all provinces charge a premium). For that BC premium I'd have access to 100% no deductible, no co-pay physician consultation, diagnostic tests, treatments for any/all conditions in or out of hospital, including physio or other recovery programs. I moved back to the states in 2005. I'd worked in the US as a youth, teen, young adult but had not accumulated 40 quarters. Until the housing crash I worked to close the difference but only got to 34 quarters before suitable employment opportunity (in my extremely rural, low economic activity region) ran out. I'd inquired at a local office about access to Medicare when I arrived and - I think due to unusual situation and local lack of contact with any seniors but those with 'normal' work histories - I was told "must have 40 quarters". It was 2014 before, on my own, I stumbled across info that I could buy into Medicare even if short of quarters. But by then I'd missed my 'sign up window' by several years.

SO! I pay $420/mo USD, for A&B Medicare which are similar but by no means 'the same as' what I'd have in Canada. As a Medicare A&B I'm subject to a deductible (can't recall if it's for A or B) and in both A and B I have co-pays. Furthermore, if I need and use them (mostly B so far) I get tons of mail about it - both co-pay bills for me to pay and Medicare itemized "here's what you've had done and here's what we paid" statements. In 40 years in Canada I did not receive any such mail. Not one piece! Actually, my dental in Canada was similar to US health care and I don't think I even got a dental statement - my dentist's office did all the paper work, I wrote a cheque to cover what the dental program did not pay but wrote it to the dental office.

Oh, my premium monthly total includes penalty fees for late enrollment: "10% for each premium for 2x the years late enrollment"; one of them (I think A) will eventually be reduced when I've paid my penalty long enough (providing I live to that time) - the other penalty is "forever until you die". (They don't say 'until you die' but obviously = we're talking senior health care here!!)

There's more: I recently had a routine blood test but was reminded by my Dr that we'd have to make sure it was not even one day less than a full year from last year's test or I'd likely get stuck with a $3-400.00 lab bill. In other words, Medicare is similar to for profit care in the US in that it's got restrictions about when it will pay and by how much. (In Canada the labs that did these tests, as well as physio centers, were within the system and were not for-profit as is the case with labs here.)

The Canadian system certainly has its 'warts'. One that is also the case in the US is service to rural regions - there can be a shortage of GPs and specialists. But access to larger centers, even if distance is great, is built into the Canadian system. (Travel and lodging can be pricey but is often avail by non-profit service agencies that operate lodgings for just that need, and costs as with meds can be met or eased via special funding or tax deductions.)

Since my income is very modest (but not quite modest enough for Medicaid which has other objectionable issues even when available) I pay my way for A&B but cannot afford parts C and D.

As I write this your post on your kidney stone costs is right above my composition section ... the last line I can read is "Medicare paid less than $5K because (it) only pays the ... approved amount." That's quite a bill!!! (meaning the $$ left for you to pay) And would not be the case with the Canadian system, at least as late as 2014 when I last researched it. I think the general sense of 'community commitment' is quite different in the broad cultures of the two nations.

I think may be you and I would agree on much but I've made it a bit of a 'thing' to speak up when I catch references to A&B being 'similar to Canada', so that's my main point here.


I think the term "medicare for all" sounds more palatable to moderates than "single payer." Packaging matters to voters. (And by extension statesmen.)


The important thing is to maintain our separate "patch 'em up and send them out" health care system for our poor. There would be no logic in even trying to provide them with reasonably comprehensive health care, just to dump them back on the streets, with no way back up. Lack of adequate good and shelter takes a heavy toll. In fact, the overall life expectancy of the US poor has already fallen to age 60-63.


"It wasn't today's Democrats" ... a point that need to be made, often I think! There seems an amazing fondness for grabbing a party label and asserting or implying it has, does, and will forever be a reliable and trustworthy manager of governmental affairs. Both controlling parties are far cries from times of having served common weal and public interest, i.e. Republican Eisenhower's warning of military industrial complex, (although I do wonder why these warnings tend to come when the insider leaves office instead of while 'in the thick of it').


Health care should be nationalized and so should the fossil fuel industry.

We simply must stop making a profit off the sick and dying and prevent those who destroy our air and water to profit from their destruction.


You're kidding right?