I believe that healthcare is a right, not a privilege, and every American should have access to healthcare, no matter their income, age, or health situation. I believe that Bernie Sanders is right when he says we need to move toward a single-payer system in our country; it’s one of the main reasons I voted for him in the Democratic primary. However, single-payer can’t happen overnight. It won’t happen in the swift pen-signing of a single-bill. There are practical and political reasons why, but those who recognize single-payer as the end goal must accept that there are intermediary steps to help us get there.

The biggest reason why single-payer can’t happen overnight is the sheer size of the health insurance industry. As of 2015, 2.5 million people worked in the health insurance industry. Keep in mind that these are just insurance workers, not healthcare workers overall. Sure, a certain percentage would likely retain their jobs for those Americans who would still choose private health insurance over a government option, but the vast majority of those workers would be out of their current job.

A certain percentage of those workers would likely become government employees for whatever the new healthcare system would be. But, it will take time to expand the government so drastically and train all the new employees. Most importantly, Medicare only spends 1.5% of its costs on administrative work. Due to this incredible efficiency, a reason to move to single-payer, there will be millions of workers with a similar skill-set who will need retraining and unemployment benefits/welfare. All of that takes time to prepare and transition as well.

The First Steps

Last week, Senate Democrats introduced a bill to lower the Medicare eligibility age to 55 years old. I saw many progressives leaving comments on the internet saying that this policy is a neoliberal one and it’s just Democrats trying to get out of supporting single-payer.

On the contrary, this legislation is the first and one of the most important steps on the path to single-payer.

55 to 64-year-olds are easily the most expensive demographic group on private insurance today. Remember, that’s one of the reasons we have the Obamacare rule limiting insurance companies from charging that age group more than three times that of the healthiest age group. One of the biggest problems with the Republican health care bill was that it got rid of that rule, which led to drastically higher premium estimates, up to 200% higher, for the oldest demographic, while it showed a decrease in premiums for young people.

Dropping the Medicare eligibility age will have several profound effects.

First off, more people will be insured by the government, which is our goal after all. Any steps toward that goal should be welcomed, not repelled.

Secondly, taking out the most expensive demographic group on private insurance will make insurance on the private market cheaper for everyone else. The CBO analysis on the Republican bill showed how much younger people have to cover in order to keep prices older for 55 to 64 year-olds. After all, that's how insurance works. But, taking out the most expensive group of the private market will reduce health care costs for everyone under 55 as an auxiliary effect.

Finally, this stark reduction in total private healthcare expenditure will allow states to more easily expand to universal coverage if they wanted to do so. Several states have already considered expanding their Medicaid programs to be universal or have considered implementing another form of state single-payer system. If the federal government were to pick up the tab on the most expensive demographic group, 55 to 64-year-olds, it would make it far more likely that states would be willing to try out their own single-payer programs.

Expanding the number of people on Medicare, if coupled with regulations allowing for the government to negotiate drug prices, would also provide more bargaining power for negotiation. A larger negotiating base would, of course, guarantee cheaper drug costs and health care overall.

One step on the path

Our common goal is single-payer, government ensured (and insured) health care, but we cannot allow the goal from blinding us from solid legislation that can help us achieve that goal. Lowering the Medicare eligibility age to 55 is not only a solid progressive step in health care reform, but a substantial, practical, and politically-feasible step forward on the way to single-payer. Progressives should welcome any move towards the end goal, especially a large one like this; after all, absolute idealism likely will be a detriment to the end goal.