Government coverage for all: Feasible?

WASHINGTON — In many ways, it seems so simple: Go to a doctor, find out what is wrong, get a prescription. No bills, no arguments with an insurance company.

As Republicans struggle to devise an alternative to

the 2010 Affordable Care Act, also known as Obamacare, progressives are turning once again to the simplicity of a government health-care system in which everyone could see a doctor and no one would face ruinous out-of-pocket costs.

Just last week in Columbus, Sen. Bernie Sanders declared that “after we defeat this disastrous Republican” health plan, “our job is to go forward and pass a Medicare-for-all, singlepayer system. If every other major country on earth can do it, surely this country can do it as well.”

The California Senate approved a single-payer model last month, and 112 Democrats in the U.S. House have co-sponsored a single-payer plan financed by taxes rather than premiums, outof-pocket expenses and co-payments charged by insurance companies and hospitals.

“Most people would be paying less than they are paying now, and they would get better health care,” said Gerald Friedman, a professor of economics at the University of Massachusetts-Amherst who helped design the singlepayer plan that Sanders, an Independent from Vermont, promoted last year during his presidential campaign.

“It’s a win-win, except if you’re a drug company or an insurance company or a hospital,” Friedman said.

But if the concept sounds too good to be true, there are a number of analysts and conservatives who say it is. They Australia Canada Denmark France Germany Japan Netherlands New Zealand Norway Sweden Switzerland United Kingdom United States cite Sanders’ home state, Vermont, which dropped efforts in 2014 to install a single-payer system after horrified state lawmakers discovered how high they would have to raise taxes.

And critics assert that, though the California Senate approved a single-payer plan, the State Assembly shelved the idea because it would require $200 billion a year in new taxes when the entire state budget is $297 billion.

“This is Lucy and the football,” quipped Thomas Miller, a resident fellow and health-care specialist at the American Enterprise Institute, a conservative Washington-based nonprofit organization. “The closer you get, the harder it is to kick it.”

John E. McDonough, a professor of publichealth practice at the Harvard School of Public Health, said, “Vermont is highly instructive as a case example because the governor and the legislature were so determined to do it. They gave it everything they had and couldn’t make it work.”

Although supporters of a single-payer system tend to cite the Canadian Medicare system as the ideal, the world has a wide variety of healthcare systems in which governments play widely differing roles.

In Canada, taxes finance 71 percent of all health costs, and all Canadians are covered. A patient does not pay to see a physician, and the doctor then bills the province for the fee.

According to the Commonwealth Fund, a foundation in New York City that analyzes health-care systems, more than 60 percent of Canadians also buy private insurance to pay for services not covered by government. Examples are vision, dental and prescription-drug coverage.

Great Britain offers a much more socialized system based on taxes financing a comprehensive system of free physician care and public hospitals, prompting Friedman to say, “They run the health system like the town of Amherst runs its fire department: It’s paid for, and if you need it, you use it.”

In 2013, the Commonwealth Fund showed that most industrialized nations — including Canada, Great Britain, Germany and Australia — spend less than 12 percent of their gross domestic product on health care, compared with 17 percent in the United States. They all have longer life expectancies and lower rates of infant mortality than the United States.

During his appearance last weekend before 2,200 people in the Arena District, Sanders said he lives “50 miles away from Canada; they manage to provide health care to all their people. Go to Germany, go to the U.K., go to Scandinavia, go to France. Every major country understands that in a civilized society, health care must be a right for all people.”

Yet most Americans have never warmed to a national healthinsurance system. In a statewide ballot campaign in California in 1994, only 27 percent of voters supported a single-payer system. A similar statewide ballot issue in Oregon in 2002 won just 21.5 percent of the vote.

Although Friedman argues that Americans would save money by paying taxes instead of health-care costs, Kenneth Thorpe, chairman of the Department of Health Policy & Management at Emory University in Atlanta, said Friedman is “not even close” to being right.

Last year, Thorpe, a former Clinton administration official, calculated that Sanders’ single-payer plan would require the federal government to raise nearly $14 trillion in new revenue over 10 years.

“We would need a value-added tax for single-payer; you’re not going to do that through the income tax,” said the AEI’s Miller. “This is make-believe land.”

In addition, the U.S. system produces substantially better results on sophisticated care without the longer waits for care that plague Canada or Great Britain. The Commonwealth Fund concluded that between 1995 and 2007, cancer mortality rates in the U.S. plummeted faster than in any other major country.

“I think if you look at the countries that spend less than us and have better outcomes, there are two reasons,” said Thorpe. “One is they have a better primarycare system. ... And second, they integrate better and spend more on social services, housing and things like that.”

“At the specialty level, we do very well on different types of cancer and cancer treatments and mortality rates,” said Thorpe.

A single-payer system based on reimbursing hospitals at lower Medicare rates than hospitals now charge would dent the rapidly expanding Ohio health-care system. The Cleveland Clinic, University Hospitals in Cleveland, OhioHealth in Columbus and Mercy Health in Cincinnati are four of the 10 largest employers in the state.

“If you say (go) live on a Medicare diet, you will drive most medical providers off a cliff,” McDonough said.