In Tennessee’s U.S. Senate race, Democrat Phil Bredesen presents himself as a centrist candidate who just wants to fix problems. The Senate Leadership Fund aimed to change that image with an ad that casts him as a radical leftist when it comes to health care.

The Republican super PAC, built by allies of Senate Majority Leader Mitch McConnell, R-Ky., is spending $1.2 million on a television ad that opens with the bold headline: "Bredesen supports single-payer health care."

"Phil Bredesen is on record supporting single-payer health care," a woman’s voice says. "He even wrote a book pushing socialized medicine."

The ad pops the cover of Bredesen’s 2010 book Fresh Medicine.

Bredesen made a small fortune as a health care executive. He was an early critic of Obamacare but now says he does not want to repeal the law. Single-payer health care didn’t seem quite like his style, so we cracked open his book and took a look at the ad’s claims.

Key takeaways

In 2010, Bredesen had a plan that would give every American a voucher that they could use to buy basic health coverage –– not from a traditional insurance company but from newly created "systems of care."

The money for the vouchers would come from a payroll tax of about 20 percent. Providers would redeem the voucher money from the government, but the government would not be paying claims as it does under Medicaid and Medicare.

Bredesen today says he opposes single-payer health care.

Super PAC makes its case

The Senate Leadership Fund draws heavily from Bredesen’s 2010 interview on C-SPAN about Fresh Medicine.

"Single-payer, the federal government collecting the money and then turning it over, I mean that’s what I think actually we should do," Bredesen said Oct. 20, 2010. "Single-payer in the sense of Medicare, where government is collecting the money and then is paying all the claims, I think would be a disastrous direction for the country."

In that one answer, Bredesen used the term single-payer two different ways, and had totally opposite takes on each.

In another of the super PAC’s examples, Bredesen redefined Medicare for All, a popular shorthand for single-payer care.

"What I was proposing was really a two-piece thing," Bredesen told Governing magazine in 2010. "It's Medicare for All, but give people a voucher and limit the amount of it. I don't think you can solve it by leaving it as an open-ended entitlement."

Bredesen’s proposal went way beyond vouchers, but the idea of vouchers for Medicare, often called premium-support, is something most Democrats have pilloried, and some Republicans, such as House Speaker Paul Ryan, have supported.

Not your grandfather’s Medicare for All

There is a bill in Congress by Sen. Bernie Sanders, I-Vt., to create a Medicare for All program. It would provide soup-to-nuts care for everything that is "medically necessary." From family doctors, to prescription drugs, to long-term care, Medicare for All would cover it.

Importantly, every American of any age would be eligible and the government would pay doctors, hospitals and every other type of provider. That means no vouchers.

As the advocacy group Physicians for a National Health Program put it, "single-payer national health insurance, also known as ‘Medicare for All,’ is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands."

Bredesen’s proposal would cover every American, and government would play a huge role in defining what is and isn’t covered. But after that, his approach takes a different path.

In his 2010 book, Bredesen envisioned a country filled with large multi-faceted provider networks he calls "systems of care."

"What I mean specifically by this phrase is a formal organization that receives a determined payment for each of its patients, takes responsibility for the delivery, quality, coordination and payment for health care for for those who belong to it, and which competes with other systems of care in its geographic area for the business of citizens," Bredesen wrote.

So the government would determine how much a standard basket of care would cost, give everyone a voucher for that amount and let them pick the network they liked best. The network would know that the voucher is all it would get for each person.

If people wanted more, they could buy it from their own pocket.

Employer-sponsored health insurance would be gone, and in large measure, so would insurance companies. The money for the vouchers would come from payroll taxes, which would be high, but less than the premiums people pay today, Bredesen argued.

This table summarizes some of the key similarities and differences between Medicare for All and Bredesen’s plan:

Everyone covered Basic package of care Voucher Government pays providers Medicare for All Yes Yes No Yes Bredesen Yes Yes Yes No

"Single-payer implies that there is one entity such as the federal government that collects funds and pays for health care," said RAND health economist Christine Eibner. "The voucher system described –– which involves multiple competing payers –– wouldn’t fit into that category."

Health policy professor Paul Ginsburg at the University of Southern California also said that today’s single-payer label wouldn’t apply.

Ginsburg does see some key similarities between Bredesen’s idea and today’s Medicare Advantage program. With Medicare Advantage, a person over 65 picks a private plan and pays premiums, with some additional payments coming from Washington.

"Large delivery systems are partnering with insurers to offer Medicare Advantage plans with networks built around the system," Ginsburg said.

Eibner told us that while Bredesen’s approach doesn’t fit with the popular understanding of single-payer plans, the term is not precisely defined.

Bredesen today vs. 2010

Bredesen’s vision for a future health care system built on organizations that don’t yet exist comes from a book he wrote eight years ago. Where he stands today is less clear.

At a June 20, 2018, campaign event in Tennessee, he said he was "not for single-payer, particularly."

His campaign website gives no details of his plan, although it does offer a link to Fresh Medicine. We asked his campaign if he had a policy paper on health care and heard that he does not.

Our ruling

The Senate Leadership Fund said Bredesen supports a single-payer plan. Bredesen used those words in a 2010 book interview, but in the same breath, he said a single-payer plan would be disastrous.

Health policy researchers find telling differences between Bredesen’s ideas and single-payer plans as they are proposed today. Most important, Bredesen proposed a voucher system and the government would not pay provider claims. By that yardstick, they said his proposal does not fit the single-payer category. Plus, Bredesen said recently that he is not for a single-payer plan.

The ad obscures some very important details and misleads voters on Bredesen’s stance. We rate this claim Mostly False.