While greater access to healthcare has been the subject of political discourse for many years, it is only with the onset of the 2015 presidential election cycle that the subject of universal health care has risen in prominence. Both Democratic candidate Senator Bernie Sanders and presumptive Republican candidate Donald Trump have spoken in support of universal health coverage, but there are still many secondary issues related to this topic that should be addressed.
The most important issue related to a single-payer healthcare system is the cost. Bernie Sanders favors a substantial tax hike to pay for implementation of a government-run healthcare system. He has argued that the additional taxes would be outweighed by the eliminated healthcare costs, leaving the middle class in a much improved financial position. He has proposed a 6.7 percent payroll tax coupled with a progressive income tax. In a single-payer system, Americans would have government-issued insurance for hospital stays, doctors' visits, prescription drugs, dental procedures and mental health services. Mr. Trump has not proposed a way to pay for universal healthcare.
How he would pay for a single-payer system is, of course, very closely tied to the political situation. In a two party government in which one party is ideologically opposed to raising taxes, it would appear that a universal healthcare system is a bridge too far. Even if the Democrats could take back the U.S. House of Representatives and the U.S. Senate, there is still a substantial number of conservative Democrats who would oppose raising taxes for universal coverage.
A liberal revolution would also be predicated upon a Democrat in the highest office. While there is a strong possibility that Hilary Clinton could defeat a Republican adversary in the general election, there is little chance that Bernie Sanders, who is perceived as far too liberal, could win the election. Despite leading in favorability ratings against Republican opponents in a new Quinnipiac University poll, i.e. vs. Trump (48% - 42%), Cruz (49% - 39%) and Kasich (45% - 41%), the popular consensus is that Sanders would wilt under the national spotlight and attack ads that would highlight his "socialist" platform.
The political opposition to a single-payer system would be heavily bolstered by the insurance lobby. Fearing a complete destruction of the health insurance sector, the lobby would likely spend many times what they spent to defeat the Affordable Care Act, at least $102.4 million.
These enormous political and budgetary obstacles could be overcome if American voters were sufficiently motivated, but that appears unlikely despite serious deficiencies in the healthcare system. The United States ranks poorly in many healthcare metrics, including infant mortality (53rd) and life expectancy (27th), despite being first in healthcare spending.
Medical professionals would probably support a transition to a single-payer system that would substantially cut down on administrative responsibilities. The average physician currently spends one hour out of each day on paperwork, equivalent to almost $83,000 a year. A single-payer system would eliminate insurance intermediaries, reducing between 19% and 24% of national healthcare expenditure.
Article written by:
Robert Moghim, M.D.
CEO, Health Carousel Locum Tenens