Does San­ders’ sin­gle-payer plan have a shot?

Los Angeles Times - - OPINION - DOYLE McMANUS doyle.mcmanus@la­times.com Twit­ter: @DoyleMcManus

Sen. Bernie San­ders’ “Medi­care for All” plan, un­veiled last week, is an am­bi­tious and (to many) en­tic­ing idea: a sin­gle, gov­ern­ment-run health plan with gen­er­ous ben­e­fits for ev­ery­one — just like most in­dus­tri­al­ized coun­tries have en­joyed for decades.

If only it were fea­si­ble in to­day’s United States.

Alas, San­ders’ pro­posal is a pony with­out a price tag. The Ver­mont sen­a­tor has of­fered only vague es­ti­mates of what his plan would cost and a generic menu of tax in­creases to pay for it. But the big­gest prob­lem is pol­i­tics. As they pur­port­edly say in New Eng­land, you can’t get there from here.

His pro­posal, which would elim­i­nate al­most all pri­vate in­sur­ance, will run into a wall of skep­ti­cism from or­di­nary vot­ers — and not just con­ser­va­tives who hate ex­pand­ing the fed­eral gov­ern­ment.

Granted, most Amer­i­cans agree that the gov­ern­ment should guar­an­tee that ev­ery­one has ad­e­quate health in­sur­ance. And, ac­cord­ing to Kaiser Fam­ily Foun­da­tion polls, a grow­ing num­ber sup­port a gov­ern­ment-run “sin­gle-payer” plan as the way to do that.

But when the details are in­tro­duced, public opin­ion turns con­trary. Ac­cord­ing to the same Kaiser polls, most Amer­i­cans want bet­ter in­sur­ance, but they don’t want taxes to go up to pay for it. Most of them also dis­like in­creas­ing gov­ern­ment con­trol over the health­care sys­tem.

And most peo­ple with em­ployer-pro­vided pri­vate in­sur­ance say they like it — sug­gest­ing that they’d hes­i­tate to see it scrapped for a gov­ern­ment plan they’ve never used be­fore. That’s what doomed Bill Clin­ton’s health­care bill in 1994; that’s why Barack Obama left ex­ist­ing in­sur­ance plans pretty much alone. It’s not ir­ra­tional; it’s sim­ple aver­sion to risk.

At least three states have tried to en­act sin­gle-payer plans in re­cent years: Cal­i­for­nia in 2017, Colorado in 2016 and Ver­mont in 2014. The pro­pos­als were stymied not only by lob­by­ing from the health­care in­dus­try, but also by gen­uine qualms about costs and prac­ti­cal ef­fects.

I haven’t even men­tioned the most im­me­di­ate ob­sta­cle: A Repub­li­can-led Congress isn’t go­ing any­where near San­ders’ idea. In­stead, Repub­li­cans are still try­ing to re­peal Pres­i­dent Obama’s health­care law, which re­lies on pri­vate in­sur­ance com­pa­nies. Their most re­cent bill, spon­sored by GOP Sens. Bill Cas­sidy of Louisiana and Lind­say Graham of South Carolina, was tee­ter­ing just short of a ma­jor­ity at the end of the week.

That’s why the most im­por­tant health in­sur­ance bill to watch over the next few years may not be San­ders’ Big Bang ap­proach, but a less am­bi­tious pro­posal from Demo­cratic Sen. Chris Mur­phy of Con­necti­cut. He calls it “Medi­care Buy-In.”

Mur­phy’s plan wouldn’t put ev­ery­one into a sin­gle gov­ern­ment-run health plan. But it would give ev­ery­one ac­cess to Medi­care, the enor­mously pop­u­lar gov­ern­ment-run plan mainly for those 65 or older. “Ev­ery­one” in­cludes users of em­ployer-pro­vided health plans, who could buy into Medi­care in­stead of what­ever pri­vate plans their com­pa­nies of­fered.

What’s the hitch? Peo­ple would have to pay a pre­mium, just as Medi­care users do now.

It’s only a part-way mea­sure, but po­lit­i­cally it’s far more palat­able than San­ders’ plan. Peo­ple al­ready know Medi­care, if only through their par­ents or grand­par­ents. Of­fer­ing it as an op­tion wouldn’t be a leap into the dark of a new and un­tried sys­tem.

“If I were to de­sign a health­care sys­tem from scratch, it would be sin­gle payer,” Mur­phy told me last week. “The ques­tion is how we get there.”

“I think even Bernie would ad­mit it’s go­ing to be hard to get Congress to pass a bill that out­laws pri­vate in­sur­ance. Medi­care buy-in is an eas­ier lift,” he said.

“This doesn’t take any op­tions away from you. It just gives you bet­ter op­tions,” he added. “My be­lief is that, over time, most peo­ple would choose Medi­care.” And that would have the ef­fect of build­ing a sin­gle-payer sys­tem bit by bit.

Like San­ders, Mur­phy hasn’t of­fered de­tailed cost es­ti­mates, but he plans to get that done be­fore he un­veils a bill later this year.

“Ev­ery­thing I’ve seen sug­gests that a Medi­care prod­uct will be cheaper than pri­vate in­sur­ance. The ques­tion is how much cheaper,” he said.

One more po­ten­tial ben­e­fit: “The price of Medi­care will likely go down if the pool gets younger.”

Mur­phy isn’t the only Demo­crat work­ing on an al­ter­na­tive to the San­ders plan. Sen. Brian Schatz of Hawaii has pro­posed al­low­ing con­sumers to buy into Med­i­caid, the in­sur­ance pro­gram for the poor, which could be less costly but would rely on states to im­ple­ment. Sen. Deb­bie Stabenow of Michi­gan has pro­posed a more mod­est bill open­ing Medi­care to any­one 55 or older.

And, in the short run, Repub­li­can La­mar Alexan­der of Ten­nessee and Demo­crat Patty Mur­ray of Washington are work­ing on a bi­par­ti­san bill to sta­bi­lize Oba­macare — as­sum­ing Cas­sidy and Graham don’t re­peal it first.

Mur­phy is OK with the com­pe­ti­tion. “This is a mo­ment when we should hope for a lot of dif­fer­ent op­tions,” he said.

San­ders should be OK with it, too.

If any of the op­tions for ex­pand­ing health in­sur­ance ad­vance, the Ver­mont sen­a­tor will de­serve credit for mak­ing sin­gle payer part of the main­stream de­bate — and for mak­ing ideas that once seemed rad­i­cal, like sim­ply al­low­ing ev­ery­one to buy in to Medi­care, look down­right con­ser­va­tive.

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