The Search for an Obamacare Alternative

Congressional Republicans have failed so far to offer a comprehensive alternative to Obamacare, but there is a surge of support on the campaign trail to look at a single-payer health care system.

Congressional Republicans have failed so far to offer a comprehensive alternative to Obamacare, but there is a surge of support on the campaign trail to look at a single-payer health care system.

While congressional Republicans continue to look for an Obamacare replacement, others are stepping up with alternatives they may like even less but may appeal to a significant segment of the U.S. population.

Democratic presidential candidate Bernie Sanders has been a consistent voice for a single-payer national health care system, which could be a simple as having everyone enrolled in Medicare. His support for a single-payer health care system is credited by some political observers for his strong showing in early Democratic presidential polls as he challenges Hillary Clinton, who also has a reputation for health care reform.

The single-payer system Sanders has supported on the presidential stump is estimated to cost $15 trillion over 10 years. But Sanders and like-minded supporters say a single-payer system would eliminate $5 trillion in “administrative waste" in that same period. The plan would be paid for by what is described as a “progressive” payroll tax

A Colorado group has placed Initiative 20 on that state's 2016 general election ballot to create ColoradoCare. Under this universal health care coverage proposal, people who live or earn money in Colorado could choose their providers, but medical bills would be paid by the state.

Backers of the Colorado initiative would pay for ColoradoCare through a 10 percent payroll tax, which would generate an estimated $25 billion per year. Under the plan, employers would pay two-thirds of the 10 percent payroll tax and employees the remaining one-third. Self-employed individuals would pay the entire 10 percent on their net income, according to The Denver Post.

The concept of a national single-payer health care system has been floated before and generally beaten back because of fears of an even larger federal bureaucracy, increased health care costs and higher taxes. Hillary Clinton’s proposed health care reform measure stopped short of a single-payer system, as does the Affordable Care Act, which tries to reduce the number of people without health insurance by creating a government-managed marketplace.

While it is easy to point at warts in Obamacare, it is much harder to come up with a plan to replace it, which is why congressional Republicans have voted scores of times on repeal and zero times on a substitute. One reason for the difficulty is that the U.S. health care system has lots of parts. There is the part where workers and their families receive health insurance offered through their employer. Then there is Medicare, Medicaid, the Veterans Administration, Indian Health, federally funded clinics, school clinics, psychiatric care and alternative care such as naturopathy and chiropractic.

The complex health care system and health insurance coverage only partially overlap, which sometimes leads to awkward and expensive health care delivery, such as children from low-income families being forced to seek care in a hospital emergency room instead of a school clinic or people suffering from mental illness receiving prescriptions for psychotropic drugs from primary care physicians.

One of the underlying appeals of a single-payer system is its promise to consolidate the silos in the health care delivery system and eliminate (or at least shrink) the disparity between health care delivery and health insurance.

Skeptics question whether a single-payer health care system would live up to its promise in the United States, where many people are accustomed to a broad range of choices in providers and some providers decline to serve patients in a public health program because of lower fees. Skeptics also doubt Americans are willing to pay higher taxes and hand over more control of their lives to the federal government.

While those arguments have prevailed in the past, progressives such as Sanders and the Initiative 20 backers in Colorado are saying that tinkering with the health care system is not enough to stem rising health care costs and ballooning insurance premiums. They say if you want an alternative to Obamacare, here’s one to consider.

In the absence of another comprehensive alternative, the single-payer system appears to be gaining some momentum as a policy option.