The US has nearly universal, single-payer health insurance for everyone from age 65. The programme is known as Medicare. It is not quite universal because there is a requirement that the beneficiary (or spouse) have a minimum of forty quarters (ten years) of contributions to Social Security.
I have long thought that the easiest way to achieve universal health insurance coverage in the United States is to give Medicare benefits to everyone: remove the contribution requirement and lower the age of eligibility to zero. A social scientist at the University of Chicago points out that achieving this, though technically simple, is not easy to do. Why? Because policy changes create losers and winners. The losers will oppose the reform. If they have sufficient power and wealth, they may successfully block the change.
But doesn’t the “winners and losers” argument apply equally to the Patient Protection and Affordable Care Act, known as Obamacare? And Medicare does have the advantage that it is easier to explain to voters.
For whatever reason, only two US candidates for president endorse Medicare for all: one Democrat (Bernie Sanders) and one Republican (Donald Trump).
Harold Pollack, in an online column, provides insights into why legislating single-payer health insurance is difficult in the United States.
The Hillary Clinton campaign is taking some hard knocks from liberals over its maladroit attacks on Bernie Sanders’ single-payer proposal. In one sense, the knocks are well-deserved. Even if single-payer markedly lowers medical expenditures, … a tax increase of at least 8 percent of GDP would likely be required to finance it.
Yet as proponents rightly observe, these taxes would replace many visible and invisible ways we now provide to support a health sector that consume more than 17 percent of our economy. ….
The pitch for single-payer is admirably simple: We cover every (legal) resident. We mail a Medicare card to everyone. Everyone is covered. That’s a lot easier to explain and market than it is to explain the convoluted structures of Medicaid and state marketplace plans. ….
[There is a problem, though.] A huge reform that creates millions of winners creates millions of losers, too.
As with ACA [Obamacare], the biggest winners would be relatively disorganized low-income people in greatest need of help. The potential losers would include some of the most powerful and organized constituencies in America: workers who now receive generous tax expenditures for good private coverage, and affluent people who would face large tax increases to finance a single-payer system.
Harold Pollack, “Here’s why creating single-payer health care in America is so hard“, Vox, 16 January 2016.
Harold Pollack is a professor at the University of Chicago School of Social Service Administration.
Surprisingly, Professor Pollack fails to mention that Republican candidate Donald Trump supports a single-payer system, and has words of praise for the health-care systems of Canada and Scotland. Unsurprisingly, though, Trump is often rather vague when answering questions on this topic.