(Bloomberg View) — The Republicans' failure to repeal Obamacare has created a political opening. The American public, threatened with the withdrawal of health insurance from millions of people, has largely come to embrace the idea of universal coverage. At such a moment, Democrats are right to advance ideas for building on the gains accomplished by the Affordable Care Act.
Unfortunately, many of them are supporting Senator Bernie Sanders in his drive for a single-payer system. Universal coverage does not require single-payer — and pressing for that particular form of universal coverage is unwise both on the merits and as a matter of political strategy.
The legislation that Sanders introduced Wednesday — endorsed already by more than a dozen Democrats, several of whom might run for president — is needlessly radical. Supporters seem captivated by its apparent simplicity: Sweep away the current fragmented, wasteful system and have the federal government pay for all health care. In fact, implementing such an enormous, wrenching change might not save money and would be anything but simple.
A standard argument in favor of a single-payer system is that every country that has one spends less on health care. Actually, other countries' systems vary widely, and few are truly single-payer. They succeed in controlling costs not because the government is paying for everything but because the prices of treatments and drugs are aggressively regulated.
The U.S. is still averse to this approach. It's why Medicare isn't allowed to negotiate drug prices, and it's why Obamacare's Independent Payment Advisory Board, which is meant to trim Medicare spending, has been widely (and wrongly) condemned as a "death panel." Moving to a single-payer system would not, by itself, persuade Americans that rigorous cost-control is what they want.
A single-payer scheme could indeed simplify the system, but not without first putting it through tremendous upheaval. Keep in mind that half the population has employer-based health insurance, and many people like it. For these 156 million, a switch to single-payer would mean giving up that coverage and instead paying higher taxes to fund a program that would cost, by Senator Sanders's own estimation, some $3 trillion a year.
A better way to extend health insurance to the 28.1 million Americans who still need it is to take incremental steps — starting with the bipartisan effort to shore up the ACA now under way in the Senate. Strategies beyond Obamacare are needed, too: automatic enrollment in basic subsidized plans, gradually lowering the age for Medicare, maybe offering Medicaid buy-in as a public option.
Better cost control should be pursued at the same time, again building on the trials (of bundled payments and other initiatives) supported by the ACA. Medicare should be allowed to negotiate with drug companies, and the role of IPAB should be affirmed: Here too, overcoming resistance is best done step by step. In many cases, it makes sense to let individual states experiment, to find out which ideas expand coverage most effectively and affordably.
This more gradual approach can bring about universal coverage without the revolution that many Americans would resist -- and it can deliver progress right away. Sanders's plan, meanwhile, has no chance of success anytime soon. If anything, it will be a distraction, militating against the incremental advances that would otherwise be achievable.
Democrats are winning the argument that matters — America has come to accept that everybody should have health insurance. What a pity if they throw away their victory by pressing an approach that would undermine this new and barely formed consensus.
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