Dr. Susan Soboroff

The debate on single-payer (Medicare for All) national health insurance among the presidential candidates is a welcome one.

We all want a better system, one that provides access to quality, comprehensive and affordable medical care for everyone. Reform through the Affordable Care Act has failed to do this. Thirty million people still have no insurance, many millions more can’t afford deductibles and copays, and costs for us, as a nation, continue to rise. I would argue that we must eliminate all the multiple private insurance payers and provide a public Medicare for All plan to achieve this goal.

Critics of single payer say taxpayers will pay more. In fact, single payer pays for itself. Multiple analyses, including studies by the General Accountability Office and the Congressional Budget Office, show that a single-payer system would provide universal coverage at a much lower cost, per capita, than what we are spending now.

Why? The profit-driven private insurance industry spends up to 30 percent of our premium dollar on, well, profits, advertising, lobbying, denying claims and more. Medicare spends only about 3 percent on administration. The estimated $400 billion in savings would be enough to cover everyone comprehensively. Additional savings come from negotiating drug and medical supply prices, and from lump-sum budget payments to hospitals.

Would we all pay for this through our taxes? Yes, but this tax is fair, graduated and progressive, based on each person’s ability to pay. We already pay 64 percent of health care costs through our taxes, not only for Medicare, Medicaid and the Veteran’s Administration system, but also subsidies to private insurers for Medicare plans. Turns out, we now pay more, per capita, than countries like Canada with a universal system. In other words, we are paying for a national health program but not getting it.

With a single-payer system, 95 percent of U.S. households would save money on health care. Subtract premiums, deductibles, copays, “out of network” expenses and reasonable medical costs now denied by insurance. Even property taxes would be lower because counties would not have a Medicaid payment burden, and public employees would all be covered. Imagine no medical bills, no worry about drug costs, and job flexibility because health insurance isn’t tied to employment.

Some say the public doesn’t support single payer. Many surveys show that almost two-thirds of the U.S. population does, including 60 percent of physicians, more than 600 labor organizations, many civic and faith-based groups. Here in Tompkins County, several municipalities have passed resolutions supporting a single-payer plan in New York state. The NY Health Act passed the State Assembly last year, and its sponsors are working to pass it in the Senate. Like the successful Canadian system, won province by province, New York could begin a nationwide process.

Lastly, there is the argument that single payer is not “politically feasible.” Well, Bernie Sanders wasn’t either. He doesn’t take money from the private health insurers or Big Pharma, two of the few entities that stand to lose in a single-payer system. The rest of us will win. This is why I hope we’ll continue to debate the issue using the facts, the Canadian system as a model, and our experience as consumers and providers.

Dr. Susan Soboroff, or Trumansburg, is a family physician and longtime member of PNHP.