By David U. Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.
The Hill, Feb. 29, 2016
Back in 1993, when we met with Hillary Clinton at the White House, she acknowledged that single-payer national health insurance was the best solution to America’s health care mess, but dismissed it as politically impossible.
She kept singing much the same tune until Sen. Bernie Sanders’ (I-Vt.) upstart campaign began rallying support for single-payer reform, and threatening Hillary’s glide path to the nomination. Then she started echoing Republican rhetoric, claiming that “Medicare for All” would break the bank and disrupt care.
Hillary’s flip-flop marked a stark departure from 70 years of Democratic Party policies. Single payer was integral to the party’s platforms from 1948 until 1992.
But even as party leaders and their policy advisers adopted more “politically realistic” reform options, they continued to acknowledge the advantages of single payer.
Sen. Ted Kennedy (D-Mass.), who sponsored a pure single-payer bill in 1971, urged us on several occasions in subsequent years to rally the support that could make single payer viable in the Senate, and in 2000 endorsed a single-payer ballot initiative in Massachusetts.
Barack Obama, a full-fledged single-payer advocate in 2003, continued to say as a presidential candidate that he’d prefer single payer “if we were starting from scratch.”
Hillary’s newfound belief that Medicare for All would be an economic disaster (and similar claims by economists Paul Krugman, Austan Goolsbee, and others) rests mostly on an analysis by Kenneth Thorpe, an Emory University professor and former Clinton administration official.
Like Clinton, Thorpe has changed his tune on single payer. Back in 2003 and again in 2005, he published detailed analyses concluding that single payer was the most economical route to universal coverage. In fact, he thought single payer was so good that it would actually lower costs while covering all of the uninsured and upgrading coverage for the tens of millions who were under-insured.
Back in 2003, Thorpe estimated that single payer would achieve huge administrative savings – more than 10 percent of total health spending, equivalent to $350 billion this year alone. Now he’s cut that estimate in half, despite evidence that the costs of health bureaucracy in the U.S. have climbed even higher, while they’ve remained low in single-payer nations such as Canada.
The most recent data suggests that single-payer savings would amount to at least 14.3 percent of total U.S. health spending.
Before his recent conversion, professor Thorpe estimated that single payer would cause a modest uptick in the utilization of care. Now – despite the fact that fewer Americans are uninsured – he’s decided there would be a huge increase. Moreover, the surge he forecasts would keep doctors working 24 hours a day and require hospital patients to double bunk. It simply can’t happen.
Instead, as in other nations that have started up single-payer programs, doctors and hospitals would cut down on the unnecessary care they’re currently delivering to well-insured patients (estimated at $210 billion in 2009 by the National Academy of Medicine) and shift more care to those who are currently uninsured or under-insured.
Thorpe thinks Medicare for All could reap only 20 percent savings on drug prices, far less than the 50 percent discounts that Canada, Australia and the UK have gotten.
Finally, he posits vast federal government costs on the theory that the feds would give state and local governments a huge bonanza – hundreds of billions annually – by allowing them to keep much of the money they’d save on Medicaid and public employees’ health benefit costs. But no one proposing Medicare for All – certainly not Bernie Sanders – has envisioned it as a gravy train for state and local authorities.
The old Kenneth Thorpe – and the old Hillary Clinton – acknowledged the facts about single payer. The new ones ignore them.
Himmelstein and Woolhandler are professors of health policy and management at the City University of New York School of Public Health and lecturers in medicine at Harvard Medical School. The opinions expressed do not necessarily reflect those institutions’.
PNHP note: Physicians for a National Health Program (PNHP) is a nonpartisan educational organization. It neither supports nor opposes any candidates for public office.