Fraser Forum

Single-payer health care and presidential politics

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A new taxpayer-financed public health system that guarantees coverage for everyone will be voted upon by registered voters in Colorado in November 2016. An initial proposal garnered the 100,000 signatures needed for it to be voted upon in the state-wide referendum. The taxpayer-funded system would be paid for by a 10 per cent increase in payroll taxes, as well as a 10 per cent tax on investment income, people who are self-employed and some small business income.

The proposed plan would replace most private plans, although the federal government’s Medicare and veterans insurance programs would remain in place. Colorado residents would also be allowed to buy private insurance coverage beyond that provided by the state’s plan.

The push for a single-payer system in Colorado reflects, in part, widespread discontent with the Affordable Care Act (Obamacare). Colorado implemented its own state-wide marketplace under Obamacare and also expanded coverage for poorer residents under its Medicaid plan. While insurance coverage increased as a result, complaints have been growing about rising insurance premiums and limited choice of doctors and hospitals within the networks of providers covered by the private insurance plans that are offered by the state.

Supporters of the single-payer proposal argue that it will be cheaper than the current system, while also giving the typical Colorado resident an expanded choice of providers and more comprehensive coverage of treatments and procedures. Opponents argue that the higher taxes will drive high-income earners and businesses from the state, while an expanded bureaucracy will mean higher costs and poorer service.

The Colorado initiative might be the proverbial canary in the coal mine. Many Americans are critical of Obamacare and it’s an issue in the presidential primary campaign. Bernie Sanders has been a vocal proponent of a national single-payer system while the leading candidate for the Democratic nomination, Hillary Clinton, wants to “improve” Obamacare without fundamentally scrapping it. However, it’s conceivable that a universal health-care proposal could emerge from the Democratic national convention as part of that party’s platform, even if Clinton wins the party’s nomination, as currently seems likely. Clinton might well support such a proposal in order to pocket the votes of Sanders’ supporters in the general election.

The leading Republican candidate, Donald Trump, has said that he wants to dismantle Obamacare. After earlier announcing that he was in favour of a single-payer government health-care plan, he subsequently retracted the statement. At this point, it’s unclear what, if anything, he will propose in place of Obamacare. However, he promises that he will take care of the “sick and dying” even if they have no private insurance. The two other Republican candidates, Ted Cruz and John Kasich, also have put forward no specific proposals to replace Obamacare. To the extent that the Republicans fail to put forward a credible “private sector” solution to expand health-care coverage to uninsured or underinsured Americans, the policy field is open to those arguing for a single-payer system.

In short, it seems increasingly likely that Canadian health-care bureaucrats and policy experts will be sought out by various participants in the reemerging U.S. health-care debate to identify and explain the advantages and disadvantages of Canada’s single-payer system.