One by one, Democrats are moving on from the Affordable Care Act. And increasingly, they're embracing a full transition to a single payer system as an answer.
Bernie Sanders has been touting a Medicare-for-all plan for decades, of course, and gave the issue new prominence in last year's presidential primaries. But he's gaining company. HR 676, Rep. John Conyers' (D-MI) bill to establish a nationwide single-payer program, has 113 cosponsors in the House, nearly double the number he got for the same bill in 2015-2016. The cosponsors represent well over half the Democratic caucus.
Sen. Elizabeth Warren (D-MA), along with Sanders a leading left voice in the Senate caucus, is also on board, telling a Wall Street Journal interviewer that Democrats should campaign on the idea in 2018 and 2020. Perhaps most significantly, the California State Senate has approved a bill calling for the creation of a single-payer plan in the state.
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But the most ambitious single-payer plans are probably dead in the water. The California bill, like Sanders' campaign plan, calls for extraordinarily generous benefits that outstrip those offered by most real-world countries with universal health care. California's bill would have the state pay for all long-term care, nursing homes, dental, and vision, none of which the single-payer system in, say, Canada typically pays for (it doesn't even pay for prescription drugs or therapy sessions with psychologists).
That adds up. California's plan would cost $400 billion a year, according to an analysis by the State Senate Appropriations Committee, half of which would have be funded with huge increases in broad-based taxes. The committee estimated that paying for the plan with a payroll tax would require a rate of 15 percent. Much of that tax would be replacing current spending on health insurance premiums, but voters don't appear willing to accept a tax hike that large all the same. In 2016, Colorado went for Hillary Clinton by five points, but voted down a ballot initiative creating a single payer plan by 79 percent to 21; the plan would've been paid for by a 10 percent tax on both payroll and other income.
Thankfully, there is another way to achieve universal coverage, and move decisively toward single-payer, either federally or at the state level, one which doesn't require sudden massive tax increases.
In 2006, Rep. Pete Stark (D-CA) introduced the AmeriCare Health Care Act. And it provides a much more promising path the US could take to universal coverage. It wouldn't force employers or employees to abandon their plans overnight, and would cost a sizable but manageable amount every year. In many ways it's truer to Yale political scientist Jacob Hacker's Health Care for America Plan, which inspired the Affordable Care Act, than the law itself is.
Americare could also easily be adapted for use by a single state. It was partially inspired by a plan designed for California specifically by Berkeley professor Helen Halpin, called the CHOICE Option, and can be thought of as a more aggressive version of the Medicaid-for-all plan that passed the Nevada legislature this year.
If Democrats want to get to universal coverage, and ultimately to single-payer, this, not a big-bang approach like the California bill, is the way to do it. And there's no reason Democratic-dominated states like California, Connecticut, Maryland, or Oregon couldn't get started right now.