The Senate’s Secretly Bipartisan Health Bill

By Avik Roy
The New York Times, June 26, 2017

In 2010, when Democrats passed the Affordable Care Act, Republicans complained that they did so with no Republican support. Democrats responded by pointing out that the centerpiece of their plan — tax credits to buy private insurance — came from a Republican governor, Mitt Romney of Massachusetts.

Something similar is happening today. Democrats are denouncing the partisan nature of the Republican effort to repeal and replace Obamacare. They’re right to note that if the new bill passes the Senate, it will do so along party lines.

But the core planks of the Senate Republicans’ health bill — the Better Care Reconciliation Act — borrow just as much from Democratic ideas as Obamacare borrowed from Republican ones.

The bipartisan heritage of the bill does not eliminate areas of philosophical disagreement between conservatives and progressives. It increases the role of private insurers, and decreases the role of state-run Medicaid programs in covering the uninsured. It reduces federal spending on health care, whereas Obamacare increased it. The Senate bill repeals or rolls back all of the A.C.A.’s tax increases.

But think about it this way. Imagine an alternate universe in which, in 2009, Democrats and Republicans passed a bipartisan health bill. That bipartisan bill — let’s call it the Baucus-Collins Act — expanded coverage to tens of millions of Americans through a system of means-tested, age-adjusted tax credits in a voluntary-but-regulated individual insurance market where insurers were required to charge the same premiums to the sick and the healthy and guarantee coverage for those with pre-existing conditions.

In the Baucus-Collins Act, this increased spending on the uninsured was paid for through reforms of the Medicare program. In addition, the alternate-universe bill enacted a near-replica of Mr. Clinton’s proposal for Medicaid reform in order to make the program fiscally sustainable over the long term. The act also capped the previously unlimited tax break for employer-sponsored health insurance, albeit at a high threshold.

Democrats and Republicans would be celebrating historic reforms that expanded coverage in a fiscally responsible way. Both blue states like California and red states like Texas would see substantial coverage gains. And we might be talking about further bipartisan efforts to strengthen the Baucus-Collins Act.

What I’ve just described as a bipartisan achievement is, in effect, the synthesis of Obamacare and the Senate Republican health care bill.

***

NYT Reader Comments

By Don McCanne, M.D.

Avik Roy’s framing is that there are two polarized partisan views of reform and that somewhere in the middle is the compromise on which we can all agree. Nonsense.

If we are to use linear polarization to frame the debate, then the two sides are health care policies that benefit the patients – all patients – versus health care policies that cater to special interests, whether they be the medical-industrial complex or the political ideologues.

The similarities noted by Roy are due to the fact that the neoliberal views of the Democrats are not that far from the conservative views of the Republicans, in spite of all the noise generated by this debate. Trying to establish policies that benefit the various special interests results in the profoundly expensive, highly wasteful, inequitable, fragmented, dysfunctional system that we have.

A well designed single payer system takes care of patients first, with much greater efficiency, effectiveness, and equity. The special interests that might otherwise appropriately benefit would do well in such a system though they would have to set aside personal greed and vacuous ideology.

https://www.nytimes.com…

***

The other reform model: Single payer

“If the GOP does not disengage the country’s health-care system from the disaster of Obamacare, we are headed for the misery of single-payer.”
Hugh Hewitt, The Washington Post, June 27, 2017
https://www.washingtonpost.com…

“Senator Elizabeth Warren now says Democrats should endorse a government-run, single-payer health insurance system for the upcoming 2018 midterm elections and beyond.”
Boston Globe, June 27, 2017
https://www.bostonglobe.com…

“Sen. John Thune (R-S.D.) said, ‘If we don’t get this done and we end up with Democratic majorities in ‘18, we’ll have single payer. That’s what we’ll be dealing with.’ Sen. Pat Roberts (R-Kan.) added that Congress has to pass an unpopular far-right bill, no matter what, because the alternative is single payer, ‘and that’s socialized medicine.’”
MSNBC, June 27, 2017
http://www.msnbc.com…

“Republicans have opened up the space for Democrats to go much further than they’ve been willing to before. It’s not impossible to foresee Democrats winning the House in 2018, then taking the presidency and the Senate in 2020 — and then taking the first steps toward making single-payer health care in America a reality.”
Paul Waldman, The Washington Post, June 27, 2017
https://www.washingtonpost.com…

“It wasn’t long ago that the mere mention of single-payer inspired gasps of horror among centrists and conservatives. Now, not so much.”
Caroline Baum, MarketWatch, June 28, 2017
http://www.marketwatch.com…

“Tom (Sullivan) warned that, if the GOP fails to pass a sufficient healthcare plan in the near future, a single-payer healthcare system in the United States could be inevitable.”
Tom Sullivan Show, Fox News Radio, June 27, 2017
https://radio.foxnews.com…

“Plans that are not single-payer, quite simply, are motivated by greed and fueled by ignorance. And they are cruel.”
Joshua Gear, Press Herald, June 26, 2017
http://www.pressherald.com…

“Anyone who argues in 2017 that single-payer health care is unfeasible is either ignorant, malignant, depraved enough to rationalize profit from human suffering, or absent of the basic moral imagination to aspire to something better.”
Timothy Faust, Jacobin, June 26, 2017
https://www.jacobinmag.com…

“With my limited knowledge, I think (single payer) probably is the best system.”
Warren Buffett, PBS NEWSHOUR, June 26, 2017
http://www.pbs.org…

***

Comment:

By Don McCanne, M.D.

The issue is simple. The nation is dissatisfied with the deficiencies of the Affordable Care Act, and now they realize that the repeal and replace movement was never founded on sound health policies and would leave us mired in the same old system. The Democratic and Republican politicians are quibbling over details of a dysfunctional, fragmented, inequitable health care financing system that costs too much and delivers too little. Now, more than ever before, the nation is realizing that the other real option is, instead, a single payer national health program – an improved Medicare for all.

Again, the real debate is not between the twins of ACA vs. AHCA/BCRA, but rather it is between our terribly mediocre health care financing system vs. single payer – improved Medicare for all.

The momentum for single payer is greatly intensifying. Next week members of Congress are returning to their districts as they try to reorganize their concepts and strategy on health care reform. They need to hear loudly and clearly our voice on health care justice for all – single payer!

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

The Senate’s Secretly Bipartisan Health Bill

By Avik Roy
The New York Times, June 26, 2017

In 2010, when Democrats passed the Affordable Care Act, Republicans complained that they did so with no Republican support. Democrats responded by pointing out that the centerpiece of their plan — tax credits to buy private insurance — came from a Republican governor, Mitt Romney of Massachusetts.

Something similar is happening today. Democrats are denouncing the partisan nature of the Republican effort to repeal and replace Obamacare. They’re right to note that if the new bill passes the Senate, it will do so along party lines.

But the core planks of the Senate Republicans’ health bill — the Better Care Reconciliation Act — borrow just as much from Democratic ideas as Obamacare borrowed from Republican ones.

The bipartisan heritage of the bill does not eliminate areas of philosophical disagreement between conservatives and progressives. It increases the role of private insurers, and decreases the role of state-run Medicaid programs in covering the uninsured. It reduces federal spending on health care, whereas Obamacare increased it. The Senate bill repeals or rolls back all of the A.C.A.’s tax increases.

But think about it this way. Imagine an alternate universe in which, in 2009, Democrats and Republicans passed a bipartisan health bill. That bipartisan bill — let’s call it the Baucus-Collins Act — expanded coverage to tens of millions of Americans through a system of means-tested, age-adjusted tax credits in a voluntary-but-regulated individual insurance market where insurers were required to charge the same premiums to the sick and the healthy and guarantee coverage for those with pre-existing conditions.

In the Baucus-Collins Act, this increased spending on the uninsured was paid for through reforms of the Medicare program. In addition, the alternate-universe bill enacted a near-replica of Mr. Clinton’s proposal for Medicaid reform in order to make the program fiscally sustainable over the long term. The act also capped the previously unlimited tax break for employer-sponsored health insurance, albeit at a high threshold.

Democrats and Republicans would be celebrating historic reforms that expanded coverage in a fiscally responsible way. Both blue states like California and red states like Texas would see substantial coverage gains. And we might be talking about further bipartisan efforts to strengthen the Baucus-Collins Act.

What I’ve just described as a bipartisan achievement is, in effect, the synthesis of Obamacare and the Senate Republican health care bill.

***

NYT Reader Comments

By Don McCanne, M.D.

Avik Roy’s framing is that there are two polarized partisan views of reform and that somewhere in the middle is the compromise on which we can all agree. Nonsense.

If we are to use linear polarization to frame the debate, then the two sides are health care policies that benefit the patients – all patients – versus health care policies that cater to special interests, whether they be the medical-industrial complex or the political ideologues.

The similarities noted by Roy are due to the fact that the neoliberal views of the Democrats are not that far from the conservative views of the Republicans, in spite of all the noise generated by this debate. Trying to establish policies that benefit the various special interests results in the profoundly expensive, highly wasteful, inequitable, fragmented, dysfunctional system that we have.

A well designed single payer system takes care of patients first, with much greater efficiency, effectiveness, and equity. The special interests that might otherwise appropriately benefit would do well in such a system though they would have to set aside personal greed and vacuous ideology.

https://www.nytimes.com…

***

The other reform model: Single payer

“If the GOP does not disengage the country’s health-care system from the disaster of Obamacare, we are headed for the misery of single-payer.”
Hugh Hewitt, The Washington Post, June 27, 2017
https://www.washingtonpost.com…

“Senator Elizabeth Warren now says Democrats should endorse a government-run, single-payer health insurance system for the upcoming 2018 midterm elections and beyond.”
Boston Globe, June 27, 2017
https://www.bostonglobe.com…

“Sen. John Thune (R-S.D.) said, ‘If we don’t get this done and we end up with Democratic majorities in ‘18, we’ll have single payer. That’s what we’ll be dealing with.’ Sen. Pat Roberts (R-Kan.) added that Congress has to pass an unpopular far-right bill, no matter what, because the alternative is single payer, ‘and that’s socialized medicine.’”
MSNBC, June 27, 2017
http://www.msnbc.com…

“Republicans have opened up the space for Democrats to go much further than they’ve been willing to before. It’s not impossible to foresee Democrats winning the House in 2018, then taking the presidency and the Senate in 2020 — and then taking the first steps toward making single-payer health care in America a reality.”
Paul Waldman, The Washington Post, June 27, 2017
https://www.washingtonpost.com…

“It wasn’t long ago that the mere mention of single-payer inspired gasps of horror among centrists and conservatives. Now, not so much.”
Caroline Baum, MarketWatch, June 28, 2017
http://www.marketwatch.com…

“Tom (Sullivan) warned that, if the GOP fails to pass a sufficient healthcare plan in the near future, a single-payer healthcare system in the United States could be inevitable.”
Tom Sullivan Show, Fox News Radio, June 27, 2017
https://radio.foxnews.com…

“Plans that are not single-payer, quite simply, are motivated by greed and fueled by ignorance. And they are cruel.”
Joshua Gear, Press Herald, June 26, 2017
http://www.pressherald.com…

“Anyone who argues in 2017 that single-payer health care is unfeasible is either ignorant, malignant, depraved enough to rationalize profit from human suffering, or absent of the basic moral imagination to aspire to something better.”
Timothy Faust, Jacobin, June 26, 2017
https://www.jacobinmag.com…

“With my limited knowledge, I think (single payer) probably is the best system.”
Warren Buffett, PBS NEWSHOUR, June 26, 2017
http://www.pbs.org…

***

Comment:

By Don McCanne, M.D.

The issue is simple. The nation is dissatisfied with the deficiencies of the Affordable Care Act, and now they realize that the repeal and replace movement was never founded on sound health policies and would leave us mired in the same old system. The Democratic and Republican politicians are quibbling over details of a dysfunctional, fragmented, inequitable health care financing system that costs too much and delivers too little. Now, more than ever before, the nation is realizing that the other real option is, instead, a single payer national health program – an improved Medicare for all.

Again, the real debate is not between the twins of ACA vs. AHCA/BCRA, but rather it is between our terribly mediocre health care financing system vs. single payer – improved Medicare for all.

The momentum for single payer is greatly intensifying. Next week members of Congress are returning to their districts as they try to reorganize their concepts and strategy on health care reform. They need to hear loudly and clearly our voice on health care justice for all – single payer!

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

H.R. 1628, Better Care Reconciliation Act of 2017

Congressional Budget Office, June 26, 2017

CBO and JCT estimate that enacting the Better Care Reconciliation Act of 2017 would reduce federal deficits by $321 billion over the coming decade and increase the number of people who are uninsured by 22 million in 2026 relative to current law.

Because nongroup insurance would pay for a smaller average share of benefits under this legislation, most people purchasing it would have higher out-of-pocket spending on health care than under current law.

https://www.cbo.gov…

***

The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?

By Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.
Annals of Internal Medicine, June 27, 2017

Abstract

About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine’s conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

From the Discussion

The evidence accumulated since the publication of the IOM’s report in 2002 supports and strengthens its conclusion that health insurance reduces mortality. Several newer observational and quasi-experimental studies have found that uninsurance shortens survival, and a few with null results used confounded or questionable adjustments for baseline health. The results of the only recent RCT, although far from definitive, are consistent with the positive findings from cohort and quasi-experimental analyses.

Several factors complicate efforts to determine whether uninsurance increases mortality. Randomly assigning people to uninsurance is usually unethical, and quasi-experimental analyses rest on unverifiable assumptions. Deaths are rare and mortality effects may be delayed, mandating large studies with long follow-up. Many people cycle into and out of coverage, diluting the effects of insurance. And statistical adjustments for baseline health usually rely on participants’ self-reports, which may be influenced by coverage. Hence, such adjustments may under- or overadjust for differences between insured and uninsured persons.

Our focus on mortality should not obscure other well-established benefits of health insurance: improved self-rated health, financial protection, and reduced likelihood of depression. Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.

Overall, the case for coverage is strong. Even skeptics who suggest that insurance doesn’t improve outcomes seem to vote differently with their feet. As one prominent economist (Paul Krugman) recently asked, “How many of the people who write such things… choose to just not bother getting their healthcare?”

http://annals.org…

***

Comment:

By Don McCanne, M.D.

Although the precise numbers are somewhat elusive, this comprehensive review of existing studies confirms that health insurance reduces mortality. The Congressional Budget Office concludes that another 22 million people will be uninsured compared to current law if the Better Care Reconciliation Act were enacted and implemented. If this Republican repeal and replace bill becomes law, more people will die as a result.

Obviously the reduction in mortality is not the sole function of insurance. As the authors of this Annals of Internal Medicine article state, “Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.” Importantly, it also provides financial protection, which otherwise would deteriorate under the Republican proposal. (The full landmark article by Steffie Woolhandler and David Himmelstein is available for free at the link above.)

If there ever was a time to intensify the policy debate, this is it. The repeal and replace movement became popular because of the acknowledged deficiencies of the Affordable Care Act – leaving millions uninsured, millions more with inadequate financial protection, perpetuation of a dysfunctional insurance market that takes away choices, while failing to remedy the profound administrative waste that uniquely characterizes the U.S. health care financing system.

The Republicans have done us a favor by showing us that replacement policies that assume perpetuation of our fragmented infrastructure of private plans and public programs cannot remedy the profound deficiencies in our system. With six years of debate, the policies proposed do not correct the fundamental flaws in the financing infrastructure and actually would only compound the problems, including increasing mortality caused by being uninsured.

It is not as if we do not understand optimal health policy. We do. A well designed single payer national health program – an improved Medicare for all – would ensure that all of us would have the essential health care services that we need in a system that would be affordable for each of us. And, oh yes, nobody would die simply because they were uninsured.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

H.R. 1628, Better Care Reconciliation Act of 2017

Congressional Budget Office, June 26, 2017

CBO and JCT estimate that enacting the Better Care Reconciliation Act of 2017 would reduce federal deficits by $321 billion over the coming decade and increase the number of people who are uninsured by 22 million in 2026 relative to current law.

Because nongroup insurance would pay for a smaller average share of benefits under this legislation, most people purchasing it would have higher out-of-pocket spending on health care than under current law.

https://www.cbo.gov…

***

The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?

By Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.
Annals of Internal Medicine, June 27, 2017

Abstract

About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine’s conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

From the Discussion

The evidence accumulated since the publication of the IOM’s report in 2002 supports and strengthens its conclusion that health insurance reduces mortality. Several newer observational and quasi-experimental studies have found that uninsurance shortens survival, and a few with null results used confounded or questionable adjustments for baseline health. The results of the only recent RCT, although far from definitive, are consistent with the positive findings from cohort and quasi-experimental analyses.

Several factors complicate efforts to determine whether uninsurance increases mortality. Randomly assigning people to uninsurance is usually unethical, and quasi-experimental analyses rest on unverifiable assumptions. Deaths are rare and mortality effects may be delayed, mandating large studies with long follow-up. Many people cycle into and out of coverage, diluting the effects of insurance. And statistical adjustments for baseline health usually rely on participants’ self-reports, which may be influenced by coverage. Hence, such adjustments may under- or overadjust for differences between insured and uninsured persons.

Our focus on mortality should not obscure other well-established benefits of health insurance: improved self-rated health, financial protection, and reduced likelihood of depression. Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.

Overall, the case for coverage is strong. Even skeptics who suggest that insurance doesn’t improve outcomes seem to vote differently with their feet. As one prominent economist (Paul Krugman) recently asked, “How many of the people who write such things… choose to just not bother getting their healthcare?”

http://annals.org…

***

Comment:

By Don McCanne, M.D.

Although the precise numbers are somewhat elusive, this comprehensive review of existing studies confirms that health insurance reduces mortality. The Congressional Budget Office concludes that another 22 million people will be uninsured compared to current law if the Better Care Reconciliation Act were enacted and implemented. If this Republican repeal and replace bill becomes law, more people will die as a result.

Obviously the reduction in mortality is not the sole function of insurance. As the authors of this Annals of Internal Medicine article state, “Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.” Importantly, it also provides financial protection, which otherwise would deteriorate under the Republican proposal. (The full landmark article by Steffie Woolhandler and David Himmelstein is available for free at the link above.)

If there ever was a time to intensify the policy debate, this is it. The repeal and replace movement became popular because of the acknowledged deficiencies of the Affordable Care Act – leaving millions uninsured, millions more with inadequate financial protection, perpetuation of a dysfunctional insurance market that takes away choices, while failing to remedy the profound administrative waste that uniquely characterizes the U.S. health care financing system.

The Republicans have done us a favor by showing us that replacement policies that assume perpetuation of our fragmented infrastructure of private plans and public programs cannot remedy the profound deficiencies in our system. With six years of debate, the policies proposed do not correct the fundamental flaws in the financing infrastructure and actually would only compound the problems, including increasing mortality caused by being uninsured.

It is not as if we do not understand optimal health policy. We do. A well designed single payer national health program – an improved Medicare for all – would ensure that all of us would have the essential health care services that we need in a system that would be affordable for each of us. And, oh yes, nobody would die simply because they were uninsured.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Cost of Healthcare Is Americans’ Top Financial Concern

By Andrew Dugan
Gallup, June 23, 2017

The cost of healthcare is now the top financial problem facing U.S. families. Concern about healthcare costs is at nearly the same level now as it was in 2007, a time before the recession and the passage of the ACA.

What is the most important financial problem facing your family today (open ended)?

17% – Healthcare costs
11% – Too much debt/Not enough money to pay debts
10% – Lack of money/Low wages
10% – College expenses
9% – Cost of owning/renting a home
8% – High cost of living/Inflation
Other choices 6% or less (see table at link)

http://www.gallup.com…

***

Public support for ‘single payer’ health coverage grows, driven by Democrats

By Jocelyn Kiley
Pew Research Center, June 23, 2017

A majority of Americans say it is the federal government’s responsibility to make sure all Americans have health care coverage. And a growing share now supports a “single payer” approach to health insurance, according to a new national survey by Pew Research Center.

Among those who see a government responsibility to provide health coverage for all, more now say it should be provided through a single health insurance system run by the government, rather than through a mix of private companies and government programs. Overall, 33% of the public now favors such a “single payer” approach to health insurance, up 5 percentage points since January and 12 points since 2014. Democrats – especially liberal Democrats – are much more supportive of this approach than they were even at the start of this year.

Among Democrats, 52% now say health insurance should be provided through a single national insurance system run by the government, while fewer (31%) say it should be provided through a mix of private companies and government programs. The share of Democrats supporting a single national program to provide health insurance has increased 9 percentage points since January and 19 points since 2014.

Nearly two-thirds of liberal Democrats (64%) now support a single-payer health insurance system, up 13 percentage points since January.

Two-thirds of adults younger than 30 (67%) say the government has a responsibility to provide health coverage for all, with 45% saying coverage should be provided through a single national program.

Among Republicans, a greater share of those younger than 30 (39%) than those 30 and older (28%) say the government is responsible for providing health coverage for all; more young Republicans than older Republicans favor single payer (22% vs. 10%).

The share viewing this as a government responsibility has increased 9 percentage points since 2016, from 51% to 60%.

http://www.pewresearch.org…

***

Comment:

By Don McCanne, M.D.

Cost of health care is the top financial concern of Americans, and that has been increasing, now as high as it was before the Affordable Care Act was enacted. The more reassuring news is that support for a government responsibility to provide health coverage for all remains high, and preference for a single payer approach is increasing.

That increase in single payer support is greater amongst Democrats, especially liberals, and amongst adults under 30. Although the concept of single payer is less popular amongst Republicans, some do favor it.

We should take advantage of being sure that those not yet sold on single payer understand two things; 1) They are correct that the Affordable Care Act is not satisfactory because it falls far short of universality and it fails to prevent financial hardship, and thus it needs to be replaced, and 2) The six years of vacuous proposals of the Republican legislators have obliterated any hope that a solution lies within the fantasies of a free market health care nirvana. The Republican proposals acknowledge that government involvement is essential, but they propose an emasculated role – the worst kind of government, heavy with bureaucracy but placing our tax funds into the hands of entrepreneurial rent seekers.

More people are realizing that the circuitous route taken by our health care dollars wastes tremendous resources while depriving too many individuals of the health care access and financial protection that they need. Conservatives and the business community are beginning to understand this. We have to make sure that we provide the information to them that they need to have a clearer understanding of optimal health care financing policy. Not only is $3.2 trillion at stake, our health is as well.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Cost of Healthcare Is Americans’ Top Financial Concern

By Andrew Dugan
Gallup, June 23, 2017

The cost of healthcare is now the top financial problem facing U.S. families. Concern about healthcare costs is at nearly the same level now as it was in 2007, a time before the recession and the passage of the ACA.

What is the most important financial problem facing your family today (open ended)?

17% – Healthcare costs
11% – Too much debt/Not enough money to pay debts
10% – Lack of money/Low wages
10% – College expenses
9% – Cost of owning/renting a home
8% – High cost of living/Inflation
Other choices 6% or less (see table at link)

http://www.gallup.com…

***

Public support for ‘single payer’ health coverage grows, driven by Democrats

By Jocelyn Kiley
Pew Research Center, June 23, 2017

A majority of Americans say it is the federal government’s responsibility to make sure all Americans have health care coverage. And a growing share now supports a “single payer” approach to health insurance, according to a new national survey by Pew Research Center.

Among those who see a government responsibility to provide health coverage for all, more now say it should be provided through a single health insurance system run by the government, rather than through a mix of private companies and government programs. Overall, 33% of the public now favors such a “single payer” approach to health insurance, up 5 percentage points since January and 12 points since 2014. Democrats – especially liberal Democrats – are much more supportive of this approach than they were even at the start of this year.

Among Democrats, 52% now say health insurance should be provided through a single national insurance system run by the government, while fewer (31%) say it should be provided through a mix of private companies and government programs. The share of Democrats supporting a single national program to provide health insurance has increased 9 percentage points since January and 19 points since 2014.

Nearly two-thirds of liberal Democrats (64%) now support a single-payer health insurance system, up 13 percentage points since January.

Two-thirds of adults younger than 30 (67%) say the government has a responsibility to provide health coverage for all, with 45% saying coverage should be provided through a single national program.

Among Republicans, a greater share of those younger than 30 (39%) than those 30 and older (28%) say the government is responsible for providing health coverage for all; more young Republicans than older Republicans favor single payer (22% vs. 10%).

The share viewing this as a government responsibility has increased 9 percentage points since 2016, from 51% to 60%.

http://www.pewresearch.org…

***

Comment:

By Don McCanne, M.D.

Cost of health care is the top financial concern of Americans, and that has been increasing, now as high as it was before the Affordable Care Act was enacted. The more reassuring news is that support for a government responsibility to provide health coverage for all remains high, and preference for a single payer approach is increasing.

That increase in single payer support is greater amongst Democrats, especially liberals, and amongst adults under 30. Although the concept of single payer is less popular amongst Republicans, some do favor it.

We should take advantage of being sure that those not yet sold on single payer understand two things; 1) They are correct that the Affordable Care Act is not satisfactory because it falls far short of universality and it fails to prevent financial hardship, and thus it needs to be replaced, and 2) The six years of vacuous proposals of the Republican legislators have obliterated any hope that a solution lies within the fantasies of a free market health care nirvana. The Republican proposals acknowledge that government involvement is essential, but they propose an emasculated role – the worst kind of government, heavy with bureaucracy but placing our tax funds into the hands of entrepreneurial rent seekers.

More people are realizing that the circuitous route taken by our health care dollars wastes tremendous resources while depriving too many individuals of the health care access and financial protection that they need. Conservatives and the business community are beginning to understand this. We have to make sure that we provide the information to them that they need to have a clearer understanding of optimal health care financing policy. Not only is $3.2 trillion at stake, our health is as well.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.