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How Single-Payer Health Care Could Trip Up Democrats

How Single-Payer Health Care Could Trip Up Democrats

Many Democrats giddy from their recent health policy successes are starting to reach enthusiastically for a mountaintop goal: establishing a single-payer system for all Americans.

But they may want to learn the lessons of their opposition. Like “repeal and replace,” “single-payer” is a broadly popular slogan that papers over intraparty disagreements and wrenching policy choices. Republicans fumbled multiple attempts to replace the Affordable Care Act this year. If the Democrats eventually wrested back power, they could find themselves similarly factionalized and stymied over the details.

In a single-payer system, the government, not individuals or businesses, pays nearly all of the medical bills. Once at the edge of the political conversation, derided as a socialist fantasy, it is barreling into the mainstream of Democratic politics, usually under the slogan “Medicare for all.”

Since January, a majority of House Democrats have signed onto a single-payer bill brought by John Conyers of Michigan — a bill that has been introduced seven times before, without nearly as much support. Senator Bernie Sanders plans to introduce his own single-payer bill on Wednesday. Already, it has attracted three senators regarded as presidential aspirants: Elizabeth Warren of Massachusetts, Kamala Harris of California and Cory Booker of New Jersey have said that they will co-sponsor the bill.

The idea has gained more traction among the public, too. Recent polling from Gallup suggests that support for a “government-run” health care system is at 43 percent, nearly 10 percentage points higher than it was in 2010. Among Democrats, the notion attracts 63 percent support.

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“If you see more and more members of Congress saying, ‘I support single-payer,’ it is because now they know it is not as politically risky as it used to be,” Mr. Sanders said in an interview. “You’re not being an outcast. You’re not being a fringe member of Congress. If polling shows that a strong majority of Democrats support single-payer, what is the problem with coming on board?”

But the road to single payer may be treacherous. Senator Ted Cruz of Texas has described the Affordable Care Act as part of a slippery slope to government-run health care. Anthony Wright, the executive director of Health Access California, a consumer advocacy group that favors single-payer, says the journey to such a system is instead more like climbing a mountain.

“We may decide the view is fine here,” he said. “And it will be tough to get to the summit.”

The talking points about single-payer are clear and appealing to many progressives.

They promise a system that covers everyone and is cheaper, simpler and less profit-oriented. But the details matter. While it is true, as advocates often mention, that much of the world has some form of universal health care, there is wide variation in how those systems work. Nearly any single-payer plan would require substantial disruptions in the current health care system, upending the insurance arrangements of the 156 million Americans who get their coverage from work, changing the way doctors, hospitals, and drug companies are paid, and shifting more health care spending onto the government ledger. Such a proposal would reshuffle the winners and losers in our current system.

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