Single-Payer Activists’ Views on the Individual Mandate

The Supreme Court’s Affordable Care Act hearings last month renewed debate over the individual mandate within the single-payer movement. As expected, there are a wide variety of views on this issue. It’s important to take some time to reflect on some of the arguments made about the mandate. This is by no means comprehensive, but a sampling of some of the various positions we’ve heard. We think it’s important to keep the discussion going, and learn from each other and this political moment.

The mandate can be traced back to at least 1989 with a proposal by conservative think tank The Heritage Foundation. The proposal draws a comparison between car owners being required to have auto insurance, and recommends such a requirement for “all households to protect themselves from the potentially catastrophic costs of a serious accident or illness.”

Proponents of the mandate explain its need the same way we explain the necessity for universal coverage: bringing everyone into the pool – both healthy and sick – lowers costs because you need the money paid by the healthy to offset the costs of the sick. Dr. Ezekiel J. Emanuel, a former health policy adviser to Obama, said “[the Obama administration’s] internal modeling showed that a mandate would extend coverage to 32 million uninsured people. Without such a requirement the administration estimated it could cover 16 million people at three-fourths the cost of covering the 32 million.”

Before the ACA was even passed in late March 2010, there was opposition to the mandate from the single-payer movement.

In 2006, Physicians for a National Health Program (PNHP) said, “individual mandates do nothing to control the rising cost of care, continuing to funnel health dollars though wasteful private insurers and hospitals. Instead, they mandate that cost of covering the uninsured should be incurred by the uninsured themselves.”

In 2009, PNHP released a press release highlighting that Massachusetts – Massachusetts health reform being the model on which the ACA is based – actually had a slight increase in uninsured residents after state health reform, including a mandate, was implemented.

PNHP-New York Metro Chapter released talking points on the mandate prior to the passage of the ACA, including, “The plan is completely inadequate in expanding coverage and controlling costs. It is essentially an insurance industry bailout.”

The California Nurses Association/National Nurses United (CNA/NNU) released a statement early in March 2010 listing ten significant problems with the legislation – number one being “The individual mandate forcing all those without coverage to buy private insurance, with insufficient cost controls on skyrocketing premiums and other insurance costs.”

Single-payer supporters’ perspectives on the mandate haven’t changed since the ACA became law.

Single Payer Action, It’s Our Economy, and 50 doctors filed an amicus – or friend-of-the-court – brief with the Supreme Court arguing that the individual mandate is unconstitutional with the argument, “The failure of Americans to purchase health insurance from private insurance companies does not in any way obstruct the power of Congress to regulate the national healthcare market. As Medicare and the VHA demonstrate, Congress is capable of regulating healthcare markets effectively… by implementing single payer systems.” This, however, was just one of more than 100 amicus briefs – one of the largest number filed for a case in history – by both people in support of and against the ACA.

Healthcare-NOW! released an action entitled Never Mind the Mandate encouraging our members to send emails to Congress and the President with the message, “No matter the outcome of the Supreme Court hearings, we still need single-payer healthcare.” Nearly 3,000 members participated in this action.

The debate generated by this court hearing, and the political implications of its decision, will have far reaching effects. What follows is a sampling of arguments made, both for and against, the individual mandate by single-payer supporters. Comments are from Healthcare-NOW!’s website, individual emails, blog-postings and articles, and from our April 1, 2012 Activist Conference Call.

Economic Arguments

Ricardo (Comment on Without the individual mandate, people will wait until they need healthcare and then sign up for health insurance. The individual mandate increases the number of healthy people in the insurance pool and will lower cost… To oppose the Individual Mandate is to play into the hands of the right wingers who oppose the ACA and a single payer system. Opposing the individual mandate is a step backwards not forwards.

Daniel (Comment on In a free enterprise system competition serves to keep prices low. Because of this, most businesses try to set their prices lower than the competition to attract customers. At the same time, they try to offer more, or better, services than the competition to attract more customers. The mandate REMOVES this important economic driving force!

Moral Arguments

Dianne (Comment on The mandate must be repealed if for no other reason than the adverse effects that this scheme will have on the working class and poor. Basically, the way the MA plan and Obamacare works is the people who the politicians claim will be helped become the funding mechanism for this scheme. The tax credits (subsidies) go to the insurers – your tax dollars at work. And when more money is needed by the gov’t, the Exchanges (high-flying salaries and bennies for many tied to the industry) and the insurers, up go the premiums including those in the subsidized plans.

Kevin (Comment made during HCN’s April 1 Activist Conference Call.): I also wanted to talk about how being forced to buy insurance is an outrage. We’ve been hearing how bad a job the Obama industry has been doing selling the mandate. But every single American family and business has felt insurance abuse. And so Obama’s marketing team – who are great at marketing – couldn’t sell it because they are trying to sell something no one really wants.

Political Arguments

Kevin Zeese, Co-Director of It’s Our Economy (Presenter on HCN’s April 1 Activist Conference Call): We decided to file the amicus brief with the Supreme Court to get out the single-payer position on this debate. We felt very strongly that the mandate – forcing people to buy health insurance – was the exact opposite of what single-payer advocates would want. Single-payer wants to remove the insurance industry, and the mandate further entrenches the private health insurance industry – we don’t see the ACA as a step in the right direction, but rather getting us further away from it. I was very disappointed HCN and PNHP didn’t join in the amicus brief. I know Healthcare-NOW!’s board was divided on that.

Sandy, RN (Comment emailed in response to “The Supreme Court, Health Care and the Current Political Moment”): From developments in Massachusetts and subsequently at the national level, it is clear that the Democratic Party is as addicted to commercial health insurance money as the Republican Party is to pharmaceutical money. Just as single payer was ruled off the table at the beginning of the process that lead to the adoption of the Massachusetts plan in 2006, so too did the Obama administration and the leadership of both houses of Congress rule single payer (and shortly thereafter the so-called public option) off the table right at the beginning of the federal discussion in January 2009.

A couple of months ago, two of us from the Massachusetts Nurses Association approached our first-term representative in Congress to try to convince him to sign on to the Sanders/McDermott single-payer bill, the one that had been endorsed by the AFL-CIO. He proceeded to speak in glowing terms of all that PPACA would do. When I pointed out that all of that was put at risk by the deficit-reduction deal that he had voted for on August 1st, the conversation abruptly ended.

There will be no policy discord among main-stream Democratic incumbents or candidates. Politics trumps policy. After all, this is an election year.

Strategic Arguments

Helen (Comment made during HCN’s April 1 Activist Conference Call): I think the mass media isn’t covering us because the single-payer community hasn’t come out and taken a really clear position on striking down the mandate. I think it starts with Healthcare-NOW! who had a campaign saying “Never Mind the Mandate,” and I think it was a mistake to pitch it that way. I think we should have come out really really clearly against the mandate. And other single-payer groups – NNU – is saying, “Well. Let’s see what happens.” And I think that’s dodging. I think people were afraid to say so because they want to get Obama reelected.

Ken (Comment made during HCN’s April 1 Activist Conference Call): As a healthcare professional as well, I agree totally that the mandate is putting more power in the insurance industry and not where we want to go. But I agree that to some extent that argument doesn’t get us where we want to go. And there’s some people in the single-payer movement even who see real human beings being helped by parts of the ACA, and it’s hard to say we want those benefits to go away. I agree, we didn’t need the mandate to get those benefits, but that’s where we are.

Don (Comment made during HCN’s April 1 Activist Conference Call): The task is to build a mass movement, and in my 19 years of trying to build one, it’s much easier to have a discussion with a human being when you have a piece of legislation then when you don’t. It’s much easier than saying “we have this thing we want” [single-payer healthcare] and talking in the abstract. We do have visits, we do demonstrate in the state capitol, we do ask people to write letters. Because when people start making commitments to do something, the more they do.

Bob (Comment made during HCN’s April 1 Activist Conference Call): In regards to the mandate and this whole bill and why there’s so much antipathy toward this mandate is because this imposes a tremendous burden on the poor and will be a tremendous revenue stream for the insurance industry. Yes, there are good things in this bill, but those good things don’t come close to what this bill is going to do in terms of pumping up the insurance industry.

Francesca (Comment made during HCN’s April 1 Activist Conference Call): I think what this comes down to is a difference in organizing tactics. It’s not just that a lot of people are supporting the Democrats, but that people believe there are different ways that social change happens. Some believe voting and lobbying are the ways to make change while others believe in civil disobedience and direct action. I think that’s where the discrepancy comes in – that we weren’t unified in how to portray a message as opposed to not being able to unite on a message.

This is only a summary of various arguments we’ve heard made about the future of the individual mandate and its impact on the single-payer movement. We are eager to keep this conversation going, and to continue to learn from each other’s experiences on how best to respond to this issue. Please continue to email us your thoughts or comment below.

To participate in the monthly Single-Payer Activist Conference Calls you must be a Healthcare-NOW! member. To be a member in good standing we ask that you make a donation of any amount at least once every twelve months. Go here to become a member today.


  1. Barbara on April 13, 2012 at 11:36 am

    I think our movement missed a golden opportunity in not coming out full force behind the 50 brave doctors who filed the Supreme Court amicus brief for fear of angering those who want to see something good in PPACA [and by the way the “PP” (Patient Protection) has been dropped] from the official title.

    Allowing dependents to stay on parent’s policy til they reach 26 is merely a figleaf to keep a portion of Americans content while they roll out the increasing premiums and copays. By 2014, we will
    ALL be paying for our pre-existing conditions.

    Extending MedicAid to more people might also seem good, but how many here with private insurance would convert to the Medicaid rolls, where it’s hard to find a doctor/dentist who will care for them and a toothache can only be treated with an extraction. This only perpetuates a class-based health care system. We must all solidly support a basic level of comprehensive health care for all!

    We could do much better and we should all be writing to the Supreme
    Court members now… strike down this insurance-based mandate and give us a chance for a real health care system….Medicare for all, birth to death, “everybody in, nobody out”!!

  2. Theresa Welsh on April 13, 2012 at 11:49 am

    The insurance industry adds a huge layer of bureaucracy to health care and implementing the mandate will add yet another layer. Single-payer is a simple system that reduces complexity and bureaucracy. That adds up to savings. It would also eliminate one of the most idiotic aspects of our current health care environment: tying health care to employment. This makes people dependent on their employer for health care, and in the recent debates, employers are saying they should not have to pay for health care services which they don’t believe in (such as contraception for women). This debate would go away if we took employers, along with insurance companies, out of health care.

    I strongly oppose the mandate! Yes, it will pretty much kill the ACA, but it will force future reform efforts to take a better path.

    • Barbara on April 13, 2012 at 2:25 pm


      Your thoughts about health care coming from the employer is very important for the single payer issue and I think the movement must speak from one mouth when it comes to funding. I support health care funding coming from a tax, either payroll or income and should no longer be a benefit with conditions and prices determined by an employer. There is a term called “job lock” that describes the predicament precisely. It’s here:

      For myself, this will mean paying more than I am now, but think of the freedom it will give our society and the revitalization it would give to our labor force! If I’m not mistaken there is no other western couuntry where the benefit structure exists. Health care is THERE, supported by taxes and does not depend on how much or where one works or job mobility.

      Another facet to this….currently large group employers never have to screen their employees for pre-existing conditions before they give them health care. Others in small business and individuals get put under the microscope before they qualify or NOT. This is a form of discrimination and I am not sure how it will play out in 2014.

      Dissolving this connection is going to be a tough sell for many unions because of the past sixty years of fighting for health care as a benefit. Some unions have come to realize the burden it places on them and that their members are really trading health care for REAL wage increases and improving/maintaining other labor standards.

      I hope we see some consensus in the single payer movement soon on this important issue. The more unified on our vision and demands, the better!

  3. Mona on April 13, 2012 at 1:12 pm

    I think part of the problem in tackling this issue is a lack of understanding about the law – as it applies to various income groups. Bob mentions that the poor will be hurt by the law and mandate – my understanding is the opposite. The poor benefit from this law because Medicaid is expanded and insurance premiums are subsidized – even entirely from certain income groups. The affordability of the mandate becomes a problem as you climb in income, don’t qualify for subsidies, but can’t afford the premiums – which aren’t brought down low enough because there’s no strong public option.

    I haven’t heard from any representatives laying it out and saying: “Look, if you’re in this category, this is how much you will or won’t pay” – “if you here, this is what happens,” etc. My reps support the legislation – it’s going to flood a certain amount of money into the state (how wisely it’s used is another issue … certainly more people will get more health care, but the system is highly flawed, speaking from a personal experience). We also have one of the Republicans who’s challenging the mandate in our state.

    The most specific information I got was that, if you earn 35,000 or under per year, you will qualify for Medicaid. And I believe that’s for a single person – but I’m not even sure.

    Another issue that I think needs to be tackled are the “projections” out there stating that single payer is “inevitable.” I’m talking about numbers and figures and economic analysts. Not whether or not people should or shouldn’t speak up and make an effort (since of course they should). The argument, as I get it, goes something like – the law changes the basic rules of underwriting such that insurance is no longer a profitable undertaking since they have to accept everyone. Therefore, the costs are increasingly shifted to government, and government will have no choice but to pass single payer because they will not be able to afford it otherwise.

    So .. I think people need more information and analysis .. they need to know where they fall and where other people fall — and that should be tackled head on. There also should be frank and more in-depth discussion of these projections, which have been around, but in a very general kind of way, for quite a while.

    Lastly, I think there should be some discussion of how single payer is being used as a flag for various factions that may or may not support its existence. I’m just a person who wants a Canadian style system. But you see these reps in California who said they wanted single payer, and then they didn’t vote for it. They didn’t think it was “the right time.” Ridiculous. They’re only supporting it when it doesn’t have a possibility of passing?

    Clearly there are reps who support it, who are not subsidized in their campaigns by the insurance industry, but were eventually pressured into caving for various reasons (as we all witnessed with the legislation process).

    We should analyze these issues more in order to prevent it from happening in the future.

    Also – I would like to hear more exposition on the contributer’s statement that the Democrats are with the insurance industry (that seems quite clear) and the Republicans are with the pharmaceuticals – and what that means and how that plays out in this legislation, and so forth.

    Lastly, we need to tackle the jobs issue. Obama stated, at some point, that he did not want to go with single payer because people in the insurance industry would lose their jobs. And there are a lot of people who work for insurance companies, and they are not all big CEOS gobbbling profits. Some of them may be nasty as hell, but they may not even making that much money.

    My understanding is that the single payer legislation like HR 676 absords some of those jobs in an expanded Medicare, just as it would absord jobs from the Medicaid (including giving some Medicaid people more productive activities than policing individuals to see if they’re really poor and not driving cadillacs, as the stereotype goes). But I think there should be more specific analysis, discussion, and direct tackling of that matter. Because if you are basically up against an entire industry that you are stating, in essence, “We’re putting you out of business,” I think it could be a good idea to talk about that more, and what will happen to those people. While being very firm, that no one will have any qualms about throwing them overboard and letting them look for work like anyone else in a capitalist freemarket economy, which they have advocated fiercely in the name of their activities for some time now.

    Just some thoughts; thank you for reading, if you’ve read this far.

  4. Mona on April 13, 2012 at 1:15 pm

    Oh – I will add – as far as our state is concerned – the state plan (not Medicaid) had over 100,000 people on it. Some dying of cancer, for example. I think – but am not an expert – that the law will make it possible for people to get on to these plans. So it is no light matter opposing this legislation. And I am saying that as a single payer supporter. I think single payer is the best.

  5. Mona on April 13, 2012 at 1:39 pm

    100,000 on a waiting list, that is. There was a man posting on a newspaper – desparate because his wife was dying of cancer. “Throw some off theirs so my wife can get on! It’s only supposed to be a temporary policy!” At the time, I was on that policy, and I felt very badly for this man – that he was so despaarate for health care, he was demanding that other people get thrown off their health insurance. The plan was not supposed to be temporary either. The state sent notices encouraging people to make sure they didn’t lose their policy because it would hard to get back on. And, although I was fine when he was saying this – not long after, I was brought into emergency, and my life was saved, thanks to having access to health care because it was covered. I would have just died, otherwise. Eventually, that plan began researching if they could clear people into Medicaid – they pushed some people that way, promising they’d be back on, right away, if they lost their Medicaid. Then, instead of expanding the state plan, Gregoire and Democrats cut it even more. So that waiting list is still growing.

  6. Mona on April 13, 2012 at 1:42 pm

    I wanted to give that man’s wife my insurance at the time – when I thought I was well. That’s how I felt – and I would have, if I could have, reading his cries of anger and helplessness in this disgusting health care system. “Just take my policy for your wife.”

    And I’m just an ordinary person. Lots of ordinary people would have done this for this man, if they could have.

    But look at these insurance companies, these wealthy CEOs, these politicians in Congress. And what they do.

  7. Melanie on April 13, 2012 at 2:19 pm

    While I’m actually for the ACA in general, the mandate is hurtful and just plain wrong, though I would argue for it just to keep the rest of the ACA conditions, such as getting rid of preexisting conditions and the lifetime cap on coverage.

    What I mainly object to is this: First, this is entirely a giveaway to the insurance companies. Okay, they’re grumbling about how they’ll have to cover people they wouldn’t have normally covered, which will affect their bottom line, but the fact is, they don’t cover much, anyway, so boo hoo. Second: my objection is the TREMENDOUS burden this would place on poor people like myself.

    Anyone who thinks the poor won’t buy insurance because they don’t “want” to is wrong. The fact is that the alleged “discounts” which will be offered to those who are poor PALE in comparison to the savings of not buying insurance at all and paying the penalty instead. Were this to be in effect right now, my husband and I would have to figure out a way to pay the penalty, because even with a discount on coverage because our income is so low, we wouldn’t be able to afford insurance. Even the penalty would be too much for us. IIRC, my husband figured it would be $500-something per year…we’re so far behind on our bills, due to our income stagnating in this economy, $500 is unrealistic for us to pay, and it’s still FAR cheaper than insurance, even with a discount.

    Until insurance companies are regulated, until there’s a cap on how much they can realistically charge for coverage, the mandate is doomed to fail. Just saying they want “everyone” covered is not good enough. Forcing people to pay WAY too much for something they’d have if it weren’t so expensive NOW (why do we think so many MILLIONS are uninsured NOW…because they want to play the “I bet my life that I won’t die from an illness” lottery?! No, it’s because they CAN’T AFFORD insurance!) isn’t the answer. You have to cut costs and make it AFFORDABLE to all FIRST, before you mandate that they actually BUY it.

  8. Nicole Cook on April 13, 2012 at 3:01 pm

    The Individual Mandate is a side effect of using insurance. I do not want Health Insurance, I want Health Care. Hence I am against the mandate. I want to pay more taxes and be guarenteed Health Care like in so many other non-third world counties.

    Insurance is Inflation, you take lots of money from lots of people pay for the few who have a need for treatment before they die or loose their job (and if you pay slow and cause them to die you get to keep some)and then use the rest to make a few investors and executives rich and create a superfolous kingdom of workers.

  9. Janet Foster on April 13, 2012 at 3:36 pm

    Insurance is just a method for corporations to make a profit from people’s health care. What is needed is a level cost of health care for all of us. 3%,say, of every single individual’s total yearly income would work, as long as people like Warren Buffet and Bill Gates (and all the other billionaires) pay 3% of their income and receive the exact same level of care that the rest of us do. This (and several other methods) works in various other developed countries that actually have a better rate of health than the USA, so it really can be done!

  10. susan dean on April 13, 2012 at 4:14 pm

    I support100% – a single payer system. It is important to the health of our people , our nation, our children and our future. Our children’s education is also going through an evolutionary spurt of growth and early childhood development programs are being studied to improve them and provide more resources. Michelle Obama also brought eating for health and the importance of exercise to the forefront!
    I’m for the single payer system. We are all in this together! . . . And we breath and eat and drink the poisons poured into our environment!

  11. susan dean on April 13, 2012 at 4:15 pm

    Thanks for this informative post!

  12. John "Hai" Knapp on April 13, 2012 at 7:16 pm

    I am really for HR-676, not insurance buying mandates. But, mandates will give insurance companies opportunity to show some integrity. We’ve given all kinds of chances to prove their integrity; the health insurance pirates blew every one of those offers.

  13. John "Hai" Knapp on April 13, 2012 at 7:28 pm

    As an activist for single-payer I have often heard “I Don’t Wanna Pay for Your Healthcare!”
    Here is a video of a song response to that, bringing up the bible account of the Very Rich Man and Poor Lazarus. I might respond “I don’t wanna pay for yours either; but I more don’t want some things! I don’t want to get hurt or killed by someone who is having a psychotic episode because he couldn’t afford to see his psychiatrist or stay on his medication.”

    • Hal on December 15, 2012 at 7:46 pm

      How very prescient, this being written immediately after 2 such incidents in our nation.

  14. Mona on April 14, 2012 at 6:07 pm

    Again – I hope this organization and website will post clear information about how much the mandate will actually cost people according to income and family size – and how you can calculate your subsidy. With all due respect, hearing people post about how much it will cost them is not empirically legitimate argument since we have no way of knowing what the income they are referencing is, and how they arrived at these figures based on the legislation. If you are “poor” – according to government definitions – you qualify for Medicaid – which is being expanded beyond that definition. And beyond that are the subsides. So I am not convinced that people have accurate information – and I think this organization could go a long way in eliminating that issue by publishing the relevant information for people to make that determination for themselves. If the mandate is no good, let the facts speak for themselves. You have nothing to fear, if you are really armed with the facts and the truth. I challenge Healtcare-Now.Org to provide that information with the relevant references.

  15. Mona on April 15, 2012 at 2:55 am

    I think everyone can agree that single payer in the best system. But without a link to a chart that clearly shows premium rate/mandate per family size and income less subsidy — the converasation about cost-effectiveness also stops 2 bus stops away from each person’s door. Because no one has the shared and same tools for caculating where they fall in the mandate system. Then we might get some where. Know HOW to get somewhere.

    • Barbara on April 15, 2012 at 9:27 pm


      The Affordable Care Act is approx 974 pages long and at this point there is much left to do before it is up and functioning and a shared responsibility betweent the federal and state governments. Here is the text:

      The essential benefits question has not been resolved. The Health and Human Services dept held public listening sessions to determine what essential benefits had to be in any of the plans. More here:

      And as far as patient/consumrer costs…”The cost-sharing features will be addressed in separate rules and will determine the actuarial value of the plan, expressed as a “metal level” as specified in statute: bronze at 60% actuarial value, silver at 70% actuarial value, gold at 80% actuarial value, and platinum at 90% actuarial value. For more information about actuarial value and cost-sharing, see our bulletin (PDF – 123 KB).

      At this point, I don’t think there are any exact figures on how much we’ll be paying at the above ‘metal levels’.

      More here….

      • No Difference on August 27, 2012 at 2:28 am

        The Canada Health Act of 1984(?) was less than 25 pages, and that includes French and English versions. And it covers EVERYONE. Period; end of nonsense.

  16. Bill Todd on April 15, 2012 at 9:22 pm

    Mona –

    You want detailed numbers for individual income brackets, but a) those details are meaningless without the coverage details behind them and b) we don’t need them as long as we understand the OVERALL impact of the ACA vs. a single-payer solution.

    1. The ACA provides subsidies for those who need them, but even if those subsidies covered 100% of a family’s premiums that family would STILL have to pay out the difference between what the plan covered and the actual bill. The subsidized plans are minimal plans, covering as little as 70% (as little as 60% at one point, and that may still be in there) of covered procedures, leaving additional bills of several thousand dollars (before additional subsidies kick in – if they do at all) for the family to pay if they need any significant amount of care.

    By contrast, any single-payer solution funded as Medicare is will take only whatever relatively small fixed percentage of income is necessary to cover all national health-care costs. If your income is small, the amount of the tax is a small percentage of that small income – end of story.

    2. Using private insurers costs at least 25% of every health-care dollar funneled through them (around 3/4 of which is insurer overhead and the other 1/4 of which is overhead which PROVIDERS incur in dealing with over 1,300 individual private insurers each with its own quirks and hurdles to overcome). The ACA if anything exacerbates this situation (currently insurers have an incentive to negotiate down provider prices, but once the ACA is fully active that incentive disappears: the higher the amount they pay providers, the larger the percentage of permitted overhead (15% for large plans, 20% for medium, small, and individual plans) amounts to in absolute dollars that they can keep for themselves.

    By contrast, Medicare’s overall overhead is about 5%. That means we could save at least 20% of every dollar CURRENTLY funneled through private insurers (while they’re still negotiating down provider prices) by instead funneling it through Medicare. Once it ceases to be in insurers’ interest to negotiate down provider prices, the savings from moving to single-payer would be significantly greater.

    So the bottom line is simple: every individual or family who finds the cost of health-care a serious (or even just a fairly significant) financial burden would pay significantly less, for significantly better coverage, under a single-payer system than under the ACA (even if you ignore the fact that the Congressional Budget Office projects that even as late as 2019 the ACA will still leave over 23 million people without ANY coverage, while a single-payer system would cover everyone). The total savings and far more progressive funding curve under single-payer will certainly be sufficient to keep total national health-care costs out of the ‘critical’ category for over a decade, giving us time to evaluate whether any ADDITIONAL steps may be necessary down the road.

    By contrast, the cost of premiums to implement the ACA will rise sufficiently over that same decade to cause its subsidy provisions to be gutted long before that decade is up (hey, even Social Security, which fully funds itself without touching tax revenues or affecting the budget or deficit, is on the chopping block these days). This bill will die of its own accord, but unless we kill it now its death will cost a great deal and leave a great many people in even worse financial shape than they are under our current system.

    What more does one need to know?

  17. One of 50 Million on April 15, 2012 at 10:43 pm

    Many of the uninsured (at least the responsible ones) actually want to pay for their own healthcare but can not afford it. The United States currently has the world’s most expensive healthcare. The cost of insurance in the United States is almost twice what it is in Europe with its so called”socialized medicene”. Doesn’t it make sense to make healthcare less expensive, so more people can afford it.

  18. Bill Todd on April 16, 2012 at 12:02 am

    Actually, it’s the OVERALL per capita cost of U.S. health care (including insurance) that’s close to twice what it is in Europe: taking private insurers out of the system (as most of Europe has) would (as noted above) reduce that cost by at least 20%, thus bringing it considerably closer to Europe’s.

    Negotiate down prescription drug prices (as Europe does) and we’d get even closer to their costs. So the cost of the care per se isn’t all that different (and most of what difference remains can probably be explained by our having somewhat over-built our system beyond what’s actually required – which tends to happen in systems that lack any real cost controls).

    Incidentally, in a lot of Europe ‘medicine’ is no more ‘socialized’ than it is right here under Medicare: it’s only INSURANCE that’s ‘socialized’. In other parts medicine IS socialized, with providers working for the government (rather than as private businesses) as occurs in our Veterans Administration hospital system. My impression is that cost differences between those two approaches are far less than the difference between either of them and OUR current costs (and if that’s true then at least trying a single-payer system first rather than radically changing the way we PROVIDE care seems sensible to me) – perhaps someone who really knows how socialized vs. private providers compare in cost can chime in.

    All that said, even if we halved the overall cost of health care in this country if nothing else changed there would still be a great many people who simply could not afford it. So it’s important to make sure that EVERYONE will be covered (because otherwise those who aren’t and need care will still wind up costing our society in both tangible and intangible ways), and then to make the cost of that coverage as reasonable as we can.

  19. John P on April 17, 2012 at 6:26 am

    If you give health care to all; paid for through taxes; and remove the “for profit” component; you would save 30%+ right out of the gate. Some of the things you do need to spend money on to supply health care to someone is doctors, nurses, hospitals, drugs, medical equipment, clinics, etc. The one thing you don’t need is insurance companies. They offer no service except to jack-up the costs and provide a return for their investors at patients expense. Through sheer volume, we could self insure ourselves at a much cheaper price and more efficiently.

    Think about it. The only way an insurance company can make money is to collectively overcharge their customers the percentage of profit margin, over and above their expenses. The expenses include the paying of claims, but also include, executive pay and bonuses, employee pay, benefits, taxes (maybe not), Marketing and Administrative Expenses ( you even have to pay for their TV ads), utility costs, maintenance costs, and much, much, more; that are passed directly to the patient on top of already high actual health care costs.

    A 2004 economic study published in The New England Journal of Medicine determined that a national single-payer healthcare system would reduce costs by more than $400 billion a year “despite the expansion of comprehensive care to all Americans.” I’m sure that figure has increased since then.

    I think the cartoon at the bottom of this page says it all –
    Cheers :)

  20. Hal on December 28, 2012 at 1:55 am

    Health care is, and by right as a citizen of the United States of America, a private relationship between ONLY: Myself, the physician my insurance plan allows me to see, and the MBA sitting in an office building denying my health care claims.

    And if you don’t like that, you can just up-and-up move to the Soviet Union, or any other communist country that might still exist.

  21. Chris Hagel on February 8, 2014 at 8:44 pm

    Being that I can not very much decipher or translate the meaning and ideas Hal is attempting to convey, I will approximate it as I see it:
    Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa Blaa
    Blaa Blaa Blaa Blaa Blaa Blaa Blaa.

    Communist Canada Communist England Communist France Communist Germany Communist Netherlands Communist Finland Communist Norway Communist Sweden and so on…