More States Are Proposing Single-Payer Health Care. Why Aren’t They Succeeding?

[Greenbeard]

FiveThirtyEight had a nice article this week looking at the recent surge in interest in some sort of state-level single-payer health care program, as well as the barriers to that approach. Plus a little foray into looking at the recent state attempts at state-level "public option" plans as an alternative to a larger systemic shake-up.

More States Are Proposing Single-Payer Health Care. Why Aren’t They Succeeding?

Health care policy researchers Erin C. Fuse Brown and Elizabeth McCuskey tracked the number of unique single-payer bills introduced in state legislatures across the country from 2010 to 2019, finding a sharp uptick in bills introduced since 2017. During each of those three years, at least 10 single-payer proposals were introduced, according to Brown and McCuskey’s research, for the first time since 2013. In total, state legislators proposed more single-payer bills from 2017 to 2019 than in the previous seven years combined. And for 2021, we’ve identified 10 single-payer bills that legislators introduced across the country, from liberal states like California and Massachusetts to more conservative ones including Iowa and Ohio.

What do all these proposals have in common? They’ve all universally failed. In fact, Vermont, the only state that managed to pass single-payer health care in 2011, ended up shelving its plan three years later.

The barriers aren't mysterious, they tend to fall into three intertwined categories.

• Regulatory. The biggest challenge here revolves around the fact that most people with private insurance have employer-based coverage, and most people with employer-based coverage are in self-funded plans (i.e., their employer effectively is their insurer, putting aside funds to pay for their health needs). And states can't regulate self-funded plans. That's a big one and would likely require either a very successful persuasion campaign aimed at employers doing business in the state, or more likely some heavy lifting by the state's Congressional delegation to write an exemption into federal law.
• Financial. There's two pieces to this, one of which intersects with the regulatory questions: (1) re-capturing federal money that currently flows into the state via various avenues (Medicare, Medicare, and Affordable Care Act premium subsidies), and (2) raising revenue to capture the rest from the state's tax base. The former requires some deft maneuvering but has some prospects based on various waiver authorities built into federal law, while the latter perhaps requires convincing enough people that their increased tax burden would just offset what they're currently spending on insurance premiums.
• Political. All changes create winners and losers, and it's generally easy to galvanize potential losers against their potential losses than potential winners around their potential gains. The losers could be hospitals, or insurers, or just people who think their tax burden will in fact increase by more than the value of their current premiums. The more a state tries to convince almost everyone they will win, the more generous the promises become and the more concentrated the losses become (galvanizing the losers even more, and leading to proposals more and more people scoff at as unrealistic).

Are these challenges insurmountable for a state? Maybe, but still seemingly less so than first trying to implement a single-payer system at the national level. And arguably some sort of successful state-level implementation ought to happen before considering any sort of national program. So who'll step up and take the plunge first? California? New York? Massachusetts?

 

[EdwinWillers]

Maybe it's because "STATES" aren't actually doing the proposing - a not-so-cleverly-disguised-Appeal to Authority-fallacy, but individuals within those states are.
And maybe the reason they're not succeeding is the same reason the majority of Americans have been against single payer from its inception - they don't want it.

 

[jotathought]

Who will pay for it, and what percentage of the population will actually contribute to the funding (considering nearly 50% of wage earners pay $0 in income taxes)?

 

[Checkerboard Strangler]

Are these challenges insurmountable for a state?

Possibly, but that's the point...risk pool size is the cornerstone of making single payer work properly.
Canada managed because they did it in 1967, Britain managed to implement fully socialized healthcare because they did it in 1948.
To make it happen in America today, it's going to take a risk pool of a couple of hundred million people ideally, not 20, 30 or forty million.

At the very least it would require a multi-state risk pool, say perhaps California, Oregon, Washington, Arizona, Nevada and New Mexico, thus combining
the Pacific Northwest and the Southwest....64,815,238 people.

 

[Grand Mal]

Who will pay for it, and what percentage of the population will actually contribute to the funding (considering nearly 50% of wage earners pay $0 in income taxes)?

You don't have to reinvent the wheel. There's a dozen different public health insurance schemes around the world. Just find one that does what you want it to do and copy it.

 

[BirdinHand]

Because it isn’t a popular idea?

 

[jotathought]

You don't have to reinvent the wheel. There's a dozen different public health insurance schemes around the world. Just find one that does what you want it to do and copy it.

Who would pay for it?

 

[Gateman_Wen]

More States Are Proposing Single-Payer Health Care. Why Aren’t They Succeeding?​

Scale.

 

[Greenbeard]

Maybe it's because "STATES" aren't actually doing the proposing - a not-so-cleverly-disguised-Appeal to Authority-fallacy, but individuals within those states are.
And maybe the reason they're not succeeding is the same reason the majority of Americans have been against single payer from its inception - they don't want it.

"States" here refers to state legislatures.

Who will pay for it, and what percentage of the population will actually contribute to the funding (considering nearly 50% of wage earners pay $0 in income taxes)?

Who pays for it now?

 

[Manc Skipper]

Because it isn’t a popular idea?

Why not? It works for every other developed nation. What's wrong with America that it's impossible there?

 

[jotathought]

Income taxpayers ... that actually contribute to the system .. instead of being a leech.

 

[ttwtt78640]

States should start with single-payer automobile liability insurance. That would eliminate any problems with federal competition, having such coverage is already mandatory and ‘bad’ drivers can simply have their licenses suspended or revoked (which must be respected by all other states). Funding could be accomplished by simply raising the state’s tax on motor fuels and coverage limited to those holding valid, state issued, drivers licenses.

As noted, state issued ’single-payer’ medical care insurance is much more complicated because competition involves the federal government. IMHO, the best that a state could do would be to offer some public option (thus no mandate or single-payer). The major problem with that would be the mandatory funding of it (via state tax increases), since it is unlikely that using voluntary premiums (alone) to fund it could compete with PPACA’s subsidized plans or Medicaid (especially expanded Medicaid).

 

[Checkerboard Strangler]

Who would pay for it?

Are you saying that no one is paying healthcare insurance premiums now?
Because that's what your question sounds like.

 

[ttwtt78640]

Who will pay for it, and what percentage of the population will actually contribute to the funding (considering nearly 50% of wage earners pay $0 in income taxes)?

That percentage is far higher in Texas.

 

[Greenbeard]

Possibly, but that's the point...risk pool size is the cornerstone of making single payer work properly.
Canada managed because they did it in 1967, Britain managed to implement fully socialized healthcare because they did it in 1948.
To make it happen in America today, it's going to take a risk pool of a couple of hundred million people ideally, not 20, 30 or forty million.

At the very least it would require a multi-state risk pool, say perhaps California, Oregon, Washington, Arizona, Nevada and New Mexico, thus combining
the Pacific Northwest and the Southwest....64,815,238 people.

A hundred million people?!

Scale.

Health plans operate successfully at much smaller scale than the population of an entire state today (e.g., BCBS of Vermont's individual market enrollment is ~18,000 people).

 

[Gateman_Wen]

A hundred million people?!



Health plans operate successfully at much smaller scale than the population of an entire state today (e.g., BCBS of Vermont's individual market enrollment is ~18,000 people).

Irrelevant. We're talking about single payer for all, not a for profit health insurance scam.

 

[Helix]

It needs to be done at the national level for it to work optimally. I think that it will take at least another thirty years, unfortunately.

 

[ttwtt78640]

You don't have to reinvent the wheel. There's a dozen different public health insurance schemes around the world. Just find one that does what you want it to do and copy it.

Few have state government funded systems.

 

[Greenbeard]

Irrelevant. We're talking about single payer for all, not a for profit health insurance scam.

Okay, but a state-level single-payer program would have a larger scale than any single plan operating in that state today (by definition). So in what sense is scale an issue?

 

[CaughtInThe]

Maybe it's because "STATES" aren't actually doing the proposing - a not-so-cleverly-disguised-Appeal to Authority-fallacy, but individuals within those states are.
And maybe the reason they're not succeeding is the same reason the majority of Americans have been against single payer from its inception - they don't want it.

... said as I'm sure many posters here are on Medicare.

 

[Grand Mal]

Who would pay for it?

Depends. I don't pay for my health insurance now that I'm retired because my income is too low but my premiums depended on my last income tax filing while I was working. When my income and my wife's income were high we paid around $135/month, if I remember right, but that varies too. In Canada It's administered by the provinces who handle the federal contributions. And it would be different in different countries but most of the funding comes from taxes, whatever scheme you look at.

 

[ttwtt78640]

Irrelevant. We're talking about single payer for all, not a for profit health insurance scam.

The OP is clearly about creating a state government funded medical care insurance plan.

 

[Gateman_Wen]

Okay, but a state-level single-payer program would have a larger scale than any single plan operating in that state today (by definition). So in what sense is scale an issue?

The whole country is hundreds of millions of people. The larger the pool the better it operates.

 

[PeacefulWarrior]

the same reason the majority of Americans have been against single payer from its inception - they don't want it.

Americans prefer Healthcare FrEeDuMbZ$™ over good quality CHEAP healthcare.

Ah well, you enjoy that! With my FREE Cadillac BidenCare™ plan all of that is history for me, at least for now.

Just got a notice in the mail yesterday, I thought maybe they were telling me it would be terminated and tell me when, but it was just a notice reminding me that I have about 6 more providers that I can choose from if I am not happy with what I've got now, and I have until Nov 22 of this year to change if I want to. They also want to send a professional out to my house to do an in home health workup and make sure I am aware of all the resources available to me BWAHAHAHAHA.

But no reason to change!! I have had every single thing I needed covered 100% for the last 14 months, and I have 4 major deals coming up which are all 100% covered. Including cardiologist, echocardiogram, psychotherapist, general wellness visit, and also a dermatologist appointment...ALL COVERED with NO premium and NO deductible.

You enjoy your FrEeDuMbZ$™ Ed, but as for me: I'm with Socialism!!!💯💯💯

And I can take THAT....to the BANK!!!!

Socialism R A W K S ! ! ! ! !

 

[Gateman_Wen]

The OP is clearly about creating a state government funded medical care insurance plan.

Which is why I pointed out the example was a private, for profit, insurance plan/scam.