In the Democratic presidential campaign thus far, the Hillary for America presidential campaign has used fear about implementing a single-payer health care system to portray her as the safe, electable choice for the presidential Democratic nominee. At her January 29, 2016, Iowa campaign stop, she stated that single-payer health care will “never, ever come to pass.” As opposed to Sen. Bernie Sanders, who proposes a single-payer health care system as part of his election platform, Hillary Clinton has argued that modest changes to our current health care system, including the Affordable Care Act (ACA), is the best way forward. During a February 11, 2016, Democratic presidential debate, Clinton further stated that “Senator Sanders’ plan does not add up.”
Her primary argument has been that the implementation of single-payer health care would be politically nearly impossible. Based upon the difficulty in the passage, political acceptance and implementation of the ACA, there is no argument that moving our current system – based on a patchwork of public funding and private insurance-based to a single-payer system – would be very challenging. However, it is possible. One politically palatable strategy would be to phase in Medicare eligibility by gradually lowering the eligibility age over the course of 10 to 20 years to the point of universal, single-payer coverage. This would provide the health care industry time to adjust, as well as allowing national popularity to grow over time.
Clinton’s secondary argument is economic. She has made much of the prospect that single-payer health care will lead to increased taxes, which Sanders concedes. However, Sanders has further explained that elimination of insurance premiums (and most co-pays and deductibles) will more than offset the modest tax increases. Thus far, Clinton has had no answer for Sanders’ analysis. Perhaps this is because her spokesman (and arguably her most influential adviser), former President Bill Clinton, has shared in Sanders’ analysis. In a speech at the Jeffries Global Healthcare Conference in 2011, Bill Clinton stated that the US could save $1 trillion per year by adopting any other developed nation’s health care system. While Bill Clinton may now argue that Hillary’s incremental plan approaches “universal coverage,” what he described in his speech was much closer to a single-payer system. That is because all of the other developed nations, including those he cited specifically, guarantee basic health care, including out-patient, primary and specialty care to all citizens, with nominal out-of-pocket expense to their citizens. All other developed nations’ health care systems are almost completely underwritten by the national government, unlike the ACA, with its 33 million people still uninsured and its high co-pay and deductibles. Additionally, ACA has still allowed the insurance industry, for-profit hospitals and pharmaceutical corporations to pay hundreds of billions of dollars annually to their wealthy share-holders.
During the February 11, 2016, debate cited above, Sanders reiterated his claim that under his Medicare for All health care plan, a median income American will spend an additional $500 a year in taxes, but will save $5,000 per year on health insurance premiums and deductibles, saving a net of $4,500 per year. Using Bill Clinton’s $1 trillion saving estimate from 2011, converting it to a percentage of the US health care spending total, 37 percent ($1 trillion of the total $2.7 trillion), and applying it to the most recent (2014) US health care per capita spending amount of $9,500, demonstrates that Bill Clinton’s earlier argument is close to Sanders’ analysis of ($3,500 versus $4,500) annual savings. Sanders is right to point to savings in premiums and deductibles as an offset to the increase in taxes, as essentially all health care spending in the US is ultimately paid for by the taxpaying health care consumer.