Jef Rouner
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America Does Actually Have a Single-Payer Health System

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It’s not 2024 yet. Heck, it’s not even 2024 yet and I am already watching my fellow Democrats and those leaning left start to eat themselves. More annoyingly, they are repeating the last election through the lens of misinformation and screamed talking points.

A bit ago, I ran across an Observer article talking about how Kamala Harris was starting to attract the attention of the donor class that backed Hillary Clinton. Now, it’s the Observer, the outlet that President Trump’s son-in-law stepped down from being the publisher of early this year. His spirit remains, though. The Harris article is full of both unsubtle boogeymen (the dreaded George Soros, who runs the world through his gay volcano lair made of aborted fetal tissue and confiscated weapons) and more subtle ones. The implications meant to continue the divide of the left hints of Harris having already been chosen as the nominee by corrupt moneyed interests in backrooms, handing the bitter Bernie Sanders supporters their first bit of ammunition to scream “rigged contest” when the whole damned circus gets going again. You’d think we’d learn when we’re being played like fiddles, but, nope.

One of the things that irked me the most about anti-Clinton leftists and a lot of presumed progressives, particularly as the question of healthcare reform’s future continues to bubble and churn under the scandal-ridden White House, was that Clintonian liberals sold Americans out on the subject by opposing a single-payer healthcare system. As you can see from the language that surrounds the conversation, it’s part of a plan to pit one side of the left as corporate sell-outs and the other side as the true socialist revolution that wants to scrap everything and be “just like the rest of the developed world.”

Here’s the problem: we have a single-payer health system. We’ve had one since the 1960s — two actually. Medicare and Medicaid are the American single-payer system. And while it has tremendous flaws, it does actually work. It was also designed to eventually be universal, and the people working towards that much more resemble Barack Obama and Hillary Clinton than they do people like Bernie Sanders.

The problem with Medicare and Medicaid is not that they aren’t single payer, it’s that they are not universal. However, just because they aren’t universal doesn’t mean they don’t cover an absolutely enormous amount of people under a tax system that is more or less identical to any standard single-payer model. More than 68 million Americans are enrolled in Medicaid alone, including half of all babies born in the country. Another 44 million Americans are enrolled in Medicare. A country where one out of every three people is part of a single-payer system is a country with a single-payer system, it just doesn’t have a wide enough one.

Expanding that net was a key part of the Affordable Care Act, and also the ones conservatives fought the hardest against. The Supreme Court ultimate ruled the states (which oversee Medicaid) could not be forced to accept the Medicaid expansion. Nevertheless, even with only partial implementation, the number of people who newly got to join the American single-payer healthcare system jumped by millions.

During the 2024 presidential election, Clinton proposed something both modest and radical at the same time; she said we should require all people 50 to 65 to purchase Medicare plans. It wasn’t Sanders “Medicare for All” complete overhaul, and that made it seem like some sort of Republican compromise, despite suddenly giving millions of more people that public option so many say they want.

But gradual implementation by walking down Medicare and walking up Medicaid is a far easier task than a national do-over. When Britain built its National Hospital System, it did so by, well, nationalizing their hospitals.  It was the dreaded government take over, and it allowed their state to regulate things like the cost of care.

The cost of care is a main reason why the American medical system is a mess. There’s a reason a heart surgeon makes five times in America what they might make in Britain. Unfortunately, price control is a really, really complicated subject with potentially disastrous results, especially when you’re talking a commodity as rare and costly to replace as a heart surgeon.

The United States does exercise some price control in medicine. They simply state what they will or won’t pay for a service, and if the doctors say no they lose out on getting a huge chunk of patients. By increasing that chunk bit by bit, allowing doctors and nurses to not see a radical drop in what they can charge all at once, the price of care goes slowly down. By bringing in people ten million or so at a time, increases in the payroll tax are manageable rather than catastrophic.

That’s the path to universal healthcare, a managed approach. The Democrats, even those dreaded establishment folks, have been chipping their way towards it at great cost for a long time. It will go a lot faster if we start realizing Medicare and Medicaid are single payer public options.

Then we can start demanding the conservatives stop keeping so many of us out.