Why are we so afraid of single payer?
For the last two years, I have sponsored legislation to create a form of single-payer health care in Maryland. My bill is somewhere between Bernie Sanders’ “Medicare for All” (which federal law prevents us from doing at the state level) and Obamacare, and nowhere near the Republican version of health care Thunder Dome.
It recreates a model based on our state’s unique Medicaid system, utilizing the efficiency of our private Managed Care Organizations (MCO), but within strict parameters of benefits and reimbursement rates established by regulators. As with our current Medicaid system, Marylanders would go to private doctors, hospitals and health care providers, but the bills would go to the state. It would be paid for by a 10% payroll tax that lowers the cost to most employers (who usually pay more, on average, than 10% for coverage), and would virtually eliminate costs to individuals. More so, with the elimination of uncompensated care, the money we currently spend would help lower costs further. An analysis of my legislation conducted by the Department of Legislative Services also shows that after about five years, costs would go down even more.
Despite interest from a number of advocacy groups and legislative colleagues, we are still working to establish some traction for the bill. The biggest concern is that it is “too big,” and with Larry Hogan in the Governor’s Mansion, the bill will never become law. The irony is that in many ways we already do what my bill proposes, and the governor already supports it; he just doesn’t know it. Governor Hogan has supported, and even sponsored, other proposals that make up the elements of my plan. So it appears that we are not afraid of single-payer health care, we are afraid of the scale — or, more accurately, we are afraid of the optics.
Governor Hogan, along with legislative leaders, worked to create and strengthen this session a health care re-insurance plan under the Section 1332 waiver of the Affordable Care Act to lower insurance costs under health exchange plans. What exactly is re-insurance? It is a very complicated way of saying we will take (mostly) taxpayer money and subsidize insurance companies to lower the cost of potentially risky policies. Funny, that sounds just like our existing Medicaid program, except that the state provides enough in Medicaid to cover the total cost of care for a select group of people.
Governor Hogan also championed a renewal of our existing All-Payer Hospital Waiver program. Started in the 1970s by Governor Mandel, our all-payer waiver has helped to keep down the cost of care through cost and service efficiency and universal rates set by the State for hospital services, in return for billions in federal subsidies. Giving taxpayer dollars to private insurance and private hospitals in return for lower costs also sounds a lot like our existing Medicaid system. Setting consistent rates for medical services also sounds a lot like the Prescription Drug Affordability Board that we just passed this session, which the governor allowed to become law without a signature, despite opposition from his own party in the legislature.
In fact, when you take into account Medicaid, Medicare, Tri-care and other veteran health care, and government employees at the federal, state and local levels, you find that taxpayers cover the cost of health care for over 40% of Marylanders. When you factor in taxpayer subsidies through plans purchased on the exchange, that number pushes up closer to 50%.
So what are we afraid of? Scale? Optics? Fox News’ definition of socialism? Canada, Australia, Japan, Israel and countries all across Europe — all capitalist, by the way — have fully functioning single-payer health care. How many have changed back because the system bankrupted them or the public demanded a United States-style private pay health care system? None.
So, please ask yourself: Why are we so afraid of our own shadow?
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