Froma Harrop: Single-payer isn’t the only alternative

The latest Republican push to essentially kill the Affordable Care Act through lawmaking is dead. Setting a time bomb to blow up current Obamacare benefits in 2027 would have been sneaky, sneaky.

Where were Democrats in all this? They were mostly on the sidelines letting Graham-Cassidy head for oblivion on its own outrageous terms. That was the politically wise place to be.

Where was Bernie Sanders? He was throwing Graham-Cassidy a last lifeline by staging a debate with its sponsors. That framed the issue as a false choice between the cruel Republican legislation and single-payer health care.

Republicans jumped at the opportunity, portraying their bill as an alternative to “single-payer socialism.” Fortunately, enough people saw the choice properly as between saving Obamacare and killing it.

Democrats need to come up with their own health care policy. That means shoring up Obamacare as they make incremental changes. The Sanders vision poses large problems that cannot be ignored with a dismissive wave of the Bernie hand.

However, his ideas deserve consideration. He appears to be advocating a more nationalized version of Canada’s single-payer system, with added benefits. Canada provides decent health care at a relatively low cost. But though its system is good, it’s not the best.

The Commonwealth Fund ranked the health care systems in Britain, Australia and the Netherlands as the top three for overall performance. Of the 11 rich countries studied, the U.S. was last, but Canada finished at an unimpressive ninth place.

Among the winners, only Britain’s system is truly socialized. The doctors work for the government.

Australia covers everyone under its government insurance plan but allows other payers. About half the population buys private insurance to access care outside the public system.

The multipayer system in the Netherlands is most like Obamacare, though better regulated. Every adult must obtain coverage or pay a fine, and there are subsidies for those with low incomes.

As Bernie says, health care should be the right of every American. But health care is just as much a right for citizens using the multipayer systems of France, Germany and the Netherlands as it is for Canadians under single-payer.

Sanders markets his plan as “Medicare for all,” a much easier sell than “single-payer.” Medicare is pretty good at setting fair rates of payment. And despite much grumbling, providers generally do not lose money serving Medicare patients. If that were the case, hospitals would not be lining Florida’s highways with billboards beckoning retirees to come on in.

Democrats should be asking themselves whether the public is in any mood to be sent back into the Mixmaster of another complete health care overhaul. That’s what Sanders’ four-year plan would do.

For starters, it would wipe out employer-sponsored health coverage as a benefit. Though this insurance is expensive, the great majority of workers on company plans say they are happy with the outcomes.

Sanders’ bill barely addresses financing. One estimate has his plan costing $32 trillion over 10 years.

“I don’t understand where the money is coming from,” writes David Anderson, a health care analyst at Duke University. The few financing details to emerge include tax hikes of a politically explosive nature.

Many Democrats support the more modest step of letting Americans 55 or older enroll in Medicare. That makes sense. People would sign up voluntarily. And it would not require a total renovation of American health care, stripped to the studs.

Smart Democrats, like Sen. Al Franken of Minnesota, describe the Sanders plan as “aspirational.” That’s a nod of respect for single-payer but short of worship.

There is nothing sacred about single-payer. It’s just another approach to universal coverage.