A recent congressional hearing on health reform provided a welcome change from the acrimony that usually accompanies this issue. On the agenda was a bill proposing a sweeping and controversial redesign of the nation’s medical system — the “Medicare for All Act,” which would make the federal government the nation’s health insurer.
Reforms like those proposed in the bill, introduced by Rep. Pramila Jayapal, D-Wash., would align U.S. health care more closely with nationalized systems like those used in Canada, Britain or Sweden. The April 30 hearing in the House Rules Committee featured both advocates and opponents of so-called “single-payer” health care, a term often used for a government-run system. The tenor of the meeting was remarkably respectful given the rancor that has marked the years since the passage of the Affordable Care Act, a much less dramatic overhaul.
Republicans and Democrats kept grandstanding to a minimum. Those who testified balanced passion with thoughtful answers. The exchanges renewed confidence that elected officials are capable of having an intelligent debate and that they recognize the current health system’s deficits — high costs and 29 million Americans under 65 who still lack coverage.
Solutions are needed but are complex, particularly the type of transformation envisioned by Jayapal and other single-payer advocates. That point was driven home by a Congressional Budget Office report issued soon after the hearing. Moving to single-payer would be a “major undertaking” that could be “complicated, challenging and potentially disruptive,” the report said.
That doesn’t mean it couldn’t be done. But it does mean that reforms like this are not a “flip the switch” type of change — a reality at odds with the two-year timeline in Jayapal’s bill. Understanding this is especially important as 2020 Democratic presidential contenders multiply and some candidates tout their single-payer support. Whether or not a candidate supports single-payer shouldn’t be a checkoff as candidates are evaluated.
Instead, voters should be drilling down and asking for details about who would be covered, what would be covered, how it would be paid for and how it stacks up to alternative approaches. Jayapal’s bill would enroll adults and children and cover a wide range of care, including nursing-home stays, while passing little cost directly onto consumers. The CBO has not yet provided an official price tag, but an independent analyst has estimated a system like she proposes could require at least $32.6 trillion in additional federal spending over 10 years.
There are less-disruptive paths toward the goal of universal coverage that are worth considering. Congressional Democrats have introduced legislation that would allow Americans of all ages to voluntarily buy into Medicare, the nation’s health insurance program for seniors, or to Medicaid, the nation’s other main medical assistance program. The CBO report points out international examples to consider as well.
Germany still relies on private insurers, though it tightly regulates them and expects enrollees to pay some amount out of pocket toward medical bills. But it also exempts children’s care from cost-sharing and caps these payments at 2% of annual household income for adults. An approach like this would likely be more feasible because it would build on the current American health care system. Another advantage: Systems like Germany’s have had fewer “provider capacity issues” — waiting lists, for example — and offer “greater choice of insurer and health benefits than single-payer systems,” the CBO concluded. The trade-off: Systems like this “tend to have higher total spending than single-payer systems.”
Hearings and careful debate are needed to evaluate all options, a process that will be time-consuming if it is done well. In the meantime, it’s important to improve upon the reforms put in place by the ACA. Congressional Democrats have offered practical fixes to the law that merit passage, such as expanding the pool of consumers eligible for financial aid to pay insurance premiums. Freshman Rep. Angie Craig, who represents Minnesota’s Second District, is pushing for another solid solution: a federal version of the “reinsurance” program that has held down premium costs in Minnesota.
“What we have to do is be pragmatic and make changes that stabilize today’s health care system while having a broader discussion or debate on how we move forward in a more strategic direction in health care,’’ said Craig, who does not support Jayapal’s Medicare for All Plan. “I believe you can do both at the same time.”