One by one, Democrats are moving on from the Affordable Care Act. And increasingly, they’re embracing a full transition to a single payer system as an answer.
But the most ambitious single-payer plans are probably dead in the water. The California, Sanders, and Conyers bills call for extraordinarily generous benefits that outstrip those offered by most real-world countries with universal health care. California’s bill, for instance, would have the state pay for all long-term care, nursing homes, dental, and vision, none of which the single-payer system in, say, Canada typically pays for (it doesn’t even pay for prescription drugs or therapy sessions with psychologists).
You can think of the AmeriCare approach as a public option on steroids. It would create a new single-payer program called AmeriCare that would take on everyone ensured by Medicaid and SCHIP, and would automatically enroll all children at birth. It would pay the same rates to providers as Medicare, meaning it’d be considerably less generous to doctors and hospitals than private insurers.
Sure, you can make US health care cheaper by paying everyone in US health care less money.
In the latter analysis, they found that over time as employers adjusted to the new reality, 85 percent of Americans would ultimately be insured in AmeriCare, 10 percent in Medicare, 3 percent would be eligible for multiple government programs, 2 percent would be in the military’s Tricare system, and a mere 1 percent would still have private insurance.
AmeriCare doesn’t eliminate the private insurance system, but it does make it small enough to drown in a bathtub.
But here’s the thing: Lewin finds that AmeriCare would take over because they assume that almost every employer would choose it over private insurance, because it’d be so much cheaper. “The combination of lower administrative costs and lower provider payment rates under Medicare makes Medicare coverage very attractive to employers,” Commonwealth’s Karen Davis wrote in 2007, using “Medicare” to refer to the new AmeriCare program. “When given the choice, most employers would purchase coverage for employees through Medicare.”
Ah, but those very much lower compensation rates are going to mean that US health care won’t be as good as it was. Nor as good as is available through private insurance. Nor will there be as much public sector health care either.
The whole idea works by degrading current health care standards. Leaving rather a lot of room for private on top of it, no?