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Monday, March 25, 2019

Reprinted with permission from Creators.

The other day, Rep. Tom MacArthur, R-N.J., held a town hall meeting where constituents grilled him about his role in passing the American Health Care Act. When he claimed the insurance market is “collapsing,” a chant went up: “Single-payer, single-payer!”

That chant will be heard again, and it should worry Republicans. It reflects the fact that their replacement for Obamacare is unpopular even before its effects have been felt. It suggests that undoing Barack Obama’s alleged government takeover of health care could open the way to a real government takeover of health care.

One House Republican said in 2012, “Today America is threatened with a stage 3 cancer of socialism, and Obamacare is Exhibit 1.” In reality, it was a centrist attempt to preserve the existing framework — which relies mostly on private insurance, largely provided by employers — while using various measures to expand the number of people with coverage.

Though some Democrats preferred a single-payer system similar to Canada’s, Obama rejected it, and his party mostly concurred. Sen. Bernie Sanders, who has long favored the idea, acknowledged in 2010 that “in the Senate, there are at most 10 votes for a single-payer plan.”

But the GOP rallied furiously against Obama’s blueprint, nearly keeping it from being enacted and opposing its implementation at every turn. Republicans in Congress vowed to repeal and replace it if they ever had the chance, which this year they do.

They’ve found that the task was more alluring in theory than it is in practice. For most of its life, the Affordable Care Act has been underwater in opinion polls, with a plurality of Americans taking a negative view. But since Donald Trump became president, its popularity has grown.

A March Monmouth University poll showed that 58 percent of Americans favor keeping it, and a Quinnipiac University survey found that only 17 percent support the GOP replacement plan.

Republicans are learning what Democrats discovered: Americans are maddeningly hard to please. They dislike paying for health insurance, jumping through hoops to get it, dealing with claim forms and copayments, and being denied whatever they want whenever they want it.

In 2007, according to Gallup, 56 percent of Americans said there were “major problems” with our health care system. Only 25 percent were satisfied with the “availability of affordable health care.” But when Obama tried to address those issues, they were not happy with his remedies. Rest assured, though, that if Republicans repeal it, citizens will almost certainly dislike the replacement.

If none of these options is satisfactory, what others are left? The obvious one is a single-payer system, with the federal government providing coverage financed with tax revenue.

That’s the worst option from the GOP point of view. And it has a surplus of flaws. Sanders’ plan, according to the center-left Urban Institute, would swell the federal budget by more than $3 trillion a year and increase the nation’s total spending on health care. Liberal economist Paul Starr of Princeton says it “would require staggering increases in federal taxes.”

But if Democrats regain power, they’ll have no reason to tinker with the status quo. Obama tried that and got vilified. They might as well try something that would be simpler to explain and more far-reaching in its effects.

There are grounds to think a single-payer system would be comparatively popular. A third of Americans are already in one — through Medicare, Medicaid or military or veterans insurance. Three-quarters of people in these programs are satisfied — a higher figure than among those with employer-provided or individual policies.

Single-payer systems are not the only path to near-universal coverage. The U.S. could achieve it with some combination of employer-based insurance, subsidized coverage for individuals and adequately funded high-risk pools, alongside Medicare and Medicaid.

But if Republicans succeed in scrapping the law, they will reduce the number of people with insurance rather than expand it. They will also ensure that upon regaining power, the Democrats will not bother resurrecting Obamacare.

Democrats are more likely to try to build a single-payer system one brick at a time. Starr, for example, proposes “Midlife Medicare” — opening the program to uninsured people between ages 50 and 64. Further expansions could follow when the time is right.

Republicans had better find a way to meet the expectation of near-universal coverage if they want to preserve our system of private health insurance. They may never get another chance.

Steve Chapman blogs at Follow him on Twitter @SteveChapman13 or at To find out more about Steve Chapman and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at


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9 responses to “The Specter Of Single-Payer Health Care”

  1. ray says:

    Lets hear it for single payer healthcare.

  2. browninghipower says:

    The DC Dems as currently led by the octogenarians will never endorse single payer…cf Nancy Pelosi.

  3. Thoughtopsy says:

    The author avoids the other obvious benefit.
    When you have single payer and the Government is the largest healthcare provider in the country… it can then do to the Pharma and Medical device industries exactly what they do to everyone else… force them to sell at the rate they like.
    In this case, force them to move their profit margins from the levels of extortion and extreme graft… to levels associated normally with volume-driven businesses.

    This would then drive down the COSTS of healthcare… which is what is really causing the current unaffordability crisis. The Medical-Industrial lobby group screws over the US populace, and lobbies extraordinary amounts of money to ensure they can continue to do so… rapacious Insurance companies then add their graft on top… and you end up with a bloated, profit-driven, and largely corrupt health care industry which sees people as dollars… and doesn’t give a sh1t if they die as long as it makes more money.

    The EpiPen saga, or that lowlife Shkreli are perfect and recent examples of how this works. The Law banning Medicare from negotiating prices with Medical companies (they get to charge whatever they want… by LAW) that was enacted by the Pharma lobbyists is another great example… John Oliver’s latest piece on treating Kidney dialysis patients like assembly line parts or addicts, and medical care like a fast food business is another…

    Here’s a summary of the sh1tty US system as it currently stands:

    There’s also an excellent Time article called “Bitter Pill” by Stephen Brill that is worth reading on why Healthcare is so expensive:,33009,2136864,00.html

    In short… Republicans LOVE the “Free Market”… until it might disadvantage their corporate donors… then they create laws to ensure they are subsidized and their profits are protected.

  4. TZToronto says:

    One problem single-payer would have in the U.S. is the “tradition” of for-profit health care. Once insurance companies are removed from the system, doctors and hospitals will still want to charge whatever “the market” will bear. Unless costs are reined in, even single-payer will be too costly.

  5. secondclassguy says:

    Maybe a song similar to John Lennon’s imagine; Imagine businesses no longer burdened with providing health insurance. Imagine no more individual premiums having to be paid.

    Imagine doctors freed up of paper work dealing with multitudes of different insurers, rules and regulations. Imagine looking for work, or starting a business of your choice, without wondering if it will link to healthcare.

    Imagine all the money sucked from every sector, and individual, by the for profit healthcare industry going back into the economy.

    Imagine it being paid for by a small tax on wealth assets, which only finds its way out of our country, or handed down to children of the rich who already will have more than they need in 50 lifetimes

    you may say i’m a dreamer

  6. I of John says:

    The GOP could have kept the Obama/Romney insurance scheme instead of nationalizing health care. It was always a giant kludge formed as a middle ground between democrats and republicans to somehow compromise with the right anyway. But they couldn’t let Obama achieve anything at all, even if it was a partial measure toward health care. So now the republicans can erase an Obama achievement even as it hurts americans to do so. They deserve the outcries that follow its demise and the national health care system that will be replacing it. Enjoy it, because petty deeds deserve irony.

  7. FireBaron says:

    Going back to TZ’s comment, we really do not have a history of “for-profit” health care. For much of our history, hospitals have been operated by non-profit organizations, and staffed by individuals who were earning a “living wage”. Only the pharmaceutical and medical equipment companies actually made profits. It has only been since the deregulation madness of the Reagan era that health care has become a for-profit business.

  8. johninPCFL says:

    When did the NM writers forget that the original GOP rallying cry was never “repeal and replace”, it was always “REPEAL”. Remember “rip it out branch and root”? Remember 45’s rallying cries to “repeal, repeal, repeal”? Why allow the lie to stand? Why not call out the lies and hypocrisy?

    Repeal and replace only gained traction after the election when polls said the majority of the US wanted ACA preserved and improved. In the “adopt a district” town halls, the very first thing the dems should do is remind the voters who wanted them left adrift without insurance or healthcare, as was screamed from the rafters during the last election cycle.

    Succinctly put: 1) Don’t get sick. 2) If you get sick, die quickly.

  9. stsintl says:

    In the 1960s, corporations provided healthcare to the employees and managed it themselves. All an employees had to do was to take their bills to the HR department and give it to the clerk in charge. Couple of weeks later, they received the check from the company. Then came healthcare insurance companies, Independent Health & Blue Cross Blue Shield, and told the employer that why don’t you just give us a premium for each of your employees and we will mange it for you. Employees were given a choice between IH and BCBS. The IH had an office complex which looked like a 5 star hotel with shiny brass railings and wall hangings etc. They took over the healthcare industry with their CEO’s bonuses, overheads, and profits to make America’s healthcare most expensive in the world. They now own the US Congress, the White House, and the Supreme Court. Man/Woman will land on Mars before we get the Single-payer healthcare in this country.

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