Bringing single-payer healthcare to America, the stealthier way

Posted by Joshua Holland at 10:41 AM on July 24, 2006.

Talk about unsexy. Opening up the Medicare program to anyone who wants to enroll, a proposal that's long bounced around in Democratic circles, sounds pretty darn dull. It's tinkering at the edges of a broken healthcare system, changing the drapes while the house burns, right?

Not at all. The truth is that it's a back-door to universal coverage, a stealthy way to get what our political culture makes so difficult to obtain with a frontal assault.

The day you pass a law opening up Medicare enrollment to everyone who wants in, is the beginning of the end for our bloated, overpriced private healthcare system. Within ten years, we'd have universal, single-payer healthcare, with just a small percentage of Americans sticking with private insurance (like in the UK).

The reason is simple: when it comes to providing healthcare, private insurers will quickly get their asses kicked competing against a single-payer system on a level playing field.

People grumble quite a bit about their private HMOs, but survey after survey -- for years -- have shown high levels of satisfaction among Medicare patients. Two percent of Medicare's costs are administration and management while 20 percent of private "Medigap" plans are sucked up by administrative costs. Medicare, which doesn't need to turn a profit, does that with a much sicker (and more treatment-intensive) population than private insurers deal with.

Medicare costs less than private insurance across the board, not only in terms of administrative costs but also because Medicare has a huge amount of bargaining power with healthcare providers (except for Bush's new prescription drug plan, in which lobbyists from Big Pharma prevented the government from negotiating prices).

So, opening up Medicare starts a virtuous cycle (what private insurers and doctors would view as a vicious cycle). Employers would switch in a flash. Sure, they dump millions into think-tanks that bemoan the evils of single-payer healthcare, but if they're able to have contented employees and cut costs by 30-40 percent, they will. Then there are millions, like me, who want health insurance, are nowhere near the poverty line, but still can't afford private insurance. They'd sign up in droves, and the number of uninsured patients would decrease.

Uninsured patients often forego preventative care, and only seek treatment when they get sick and have to be treated, which results in higher costs. Lowering the number of uninsured will decrease overall healthcare expenses in the U.S.

Having many more patients in the system will, in turn, expand Medicare's buying and negotiating power, resulting in further cost reductions (which would bring still more people into the system).

With much lower healthcare costs, employers would offer health benefits to more employees. When it becomes unusual to be uninsured in America -- right now one in seven of us have no healthcare -- workers will be more likely to demand coverage.

In theory, Medicare patients can choose any doctor they want, but in practice many physicians limit the number of Medicare patients they see. When a much higher portion of the population are Medicare enrollees, they won't have that luxury. The result would be that Medicare patients would be able to choose from among almost all doctors, making the program more attractive, and bringing more people into the system.

Then, five years down the road, you can pass a little bill requiring the government to pick up the tab for minors in families that make less than … X number of dollars. Maybe less than the median income. That would be a good, moderate piece of legislation, with a populist flavor, that the Repubs would oppose at their own electoral risk.

Now you've whittled the number of uninsured way down, and you've decreased the cost-per-patient. So, after another five years, you can pass another bill that covers everyone making less than, say, double the poverty level.

Now, you've got most of the country under a single-payer system, universal healthcare for all those who can't afford private insurance, better preventative care and just a few holdouts getting ripped off by (the few remaining) private insurers.

The beauty of this approach is that you haven't compelled anyone to do anything against his or her will. It's a perfect bit of political tai-chi -- it uses your opponents' strongest arguments against them. When the right squawks about it -- and we know they will -- we can ask them why they're against patient choice. We can ask them why they don't believe in free and open competition. We can ask them why they hate America so much.

Put single-payer healthcare up against the patchwork of private insurers and let the best system win. It's the American way, at least in theory.

Joshua Holland is a staff writer at Alternet and a regular contributor to The Gadflyer.