Q&A on Single Payer Health Care

This article was originally posted on LinkedIn.

I recently posted the following question on my LinkedIn and Facebook pages:

I’m working on an article about the next steps that are being made in CA and nationally towards single payer healthcare. What do you want to know?

Following are some great comments and questions I received from Steve Cagle, a Senior Advisor of Employee Benefits at Marsh & McLennan in Dallas, Texas.

No more important discussion than the Single Payer movement, Amy. A few questions come to mind. Putting aside the personal harm single payer brings to us as employee benefits brokers:

Q: Is healthcare a right for all legal, tax-paying Americans?

A: There is no direct guarantee of health care in the U.S. Constitution, and no Supreme Court ruling has ever interpreted the Constitution as guaranteeing health care. However, as the New England Journal of Medicine points out in a 2015 article called The Elusive Right to Health Care under U.S. Law, “…Congress has incrementally established health care rights through legislation, including laws creating Medicare and Medicaid, the Emergency Medical Treatment and Active Labor Act, and the Affordable Care Act.”

Further, the United Nations Universal Declaration of Human Rights (1948) states that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” This is often quoted by supporters of universal health care and shortened to the slogan “Health Care is a Human Right.”

Beyond the legal and governmental positions, there are people who believe that universal health care is a moral obligation, and some (like me) who believe that it’s a social responsibility, because none of the alternatives are acceptable. So, I guess the answer to the question depends on which authority you want to follow. Overall, it seems to me that most people end up at the same conclusion, even if we start at different points – that we need some level of basic care for everyone (even the ones who don’t pay taxes). I think we’ve moved past this question an on to the harder ones – what it looks like, and how we get there.

Q: Why is the U.S. one of only two countries in the entire world with employer-sponsored health insurance?

A: I’m not knowledgeable enough about systems in other countries (like Japan and Germany) where employers sponsor some of the health care coverage for employees, but I can address the history of the U.S. system. During World War II (1939-1945), when there was a decreased supply of domestic workers, the federal government but a freeze on wages to prevent unfair competition for available talent. Health insurance and other fringe benefits were excluded from the freeze, so employers used those to attract employees. Those benefits were also excluded from taxes for employers and employees, making them more desirable. In addition, labor unions negotiated for better benefits for their members. All of those factors contributed to the social contract between employers and employees that still exists today. (There’s also a entirely different conversation that can be had about the independent American spirit and the national aversion to socialism after WWII).

Q: Will a single payer system such as Vermont Senator Bernie Sanders “Medicare for All” program truly help our nation with out of control healthcare costs?

A: Proponents certainly believe it will. One of the fundamental issues (perhaps *the* fundamental issue) is the difference between a for-profit (what we currently have) and a not-for-profit (what they want) health care system. Proponents of government-run, universal care systems that are not-for-profit believe that the current for-profit system puts profits before people, and that removing the administrative complexities (like insurance carrier CEO salaries, brokers, claims processors) will greatly reduce costs. They also believe that a giant pool made up of everyone will give the government massive power to negotiate lower prices. So far, I haven’t seen anything that really explains how medical device and pharmaceutical companies (the two biggest cost drivers in the health care system) would respond to that scenario. I also don’t buy into the suggestion that profits are always evil – some profits are used for innovation in technology and treatments. What happens to those when the profits are stripped from the system?

Q: Why isn’t it time to consider a private/public solution?

A: I think it is time to consider solutions that create a public option and preserve the private insurance market for those who want it. We need to re-focus the conversation on the delivery of health care, not the delivery of health insurance (an inherent flaw in the Affordable Care Act). And I think we should stop taking public money and putting it into the private insurance system through programs like Medicare and Medicaid. Instead, use public money to build government-owned hospitals and employ government medical staff that provide a basic level of care to all citizens, and leave room for private insurance. Many countries with some version of universal care, including Canada, also have private insurance that supplements the government program. As does our Medicare system.

Q: As there enough support from Americans to break free from employer sponsored insurance?

A: If the individual insurance market was as robust as the employer-sponsored insurance market, I think that could move us towards the dissolution of that social contract between employer and employee. But right now, that’s not the case. Employers and employees also get tax breaks on the money they spend on insurance premiums. If employees were to buy coverage on the individual market, they wouldn’t get the income tax break, so their income dollars wouldn’t go as far. Also, employers use health insurance and other benefits to attract top talent. Which employer wants to be the first to stop offering benefits while his/her competitors continue to do so?

Thanks again for the great questions. Much of this is my opinion, and I look forward to hearing yours.