Repeal and Replace with Single Payer

February 20, 2017

Proposals floated by Republican leaders won’t achieve President Trump’s campaign promises of more coverage, better benefits, and lower costs, but a single-payer reform would.

That’s according to a commentary published in Annals of Internal Medicine.

Republicans promised to repeal the Affordable Care Act on the first day of the Trump presidency.

But the health reform effort has stalled because Republicans in Congress have been unable to come up with a better replacement and fear a backlash against plans that would deprive millions of coverage and raise deductibles.

In the commentary, longtime health policy experts Dr. Steffie Woolhandler and Dr. David Himmelstein warn that the proposals by Speaker Paul Ryan (R-Wisconsin) and Secretary of Health and Human Services Tom Price would slash Medicaid spending for the poor, shift the ACA’s subsidies from the near-poor to wealthier Americans, and replace Medicare with a voucher program, even as they would cut Medicare’s funding and raise the program’s eligibility age.

Woolhandler and Himmelstein review evidence that, in contrast, single-payer reform could provide comprehensive first-dollar coverage to all Americans within the current budgetary envelope because of vast savings on health care bureaucracy and profits.

The authors estimate that a streamlined, publicly financed single-payer program would save $504 billion annually on health care paperwork and profits, including $220 billion on insurance overhead, $150 billion in hospital billing and administration and $75 billion doctors’ billing and paperwork.

They estimate that an additional $113 billion could be saved each year by hard bargaining with drug companies over prices.

The savings would cover the cost of expanding insurance to the 26 million who remain uninsured despite Obamacare, as well as “plugging the gaps in existing coverage — abolishing copayments and deductibles, covering such services as dental and long-term care that many policies exclude.”

Woolhandler, is an internist, distinguished professor of public health and health policy at CUNY’s Hunter College, and lecturer in medicine at Harvard Medical School.

“We’re wasting hundreds of billions of health care dollars on insurance paperwork and profits,” Woolhandler said. “Private insurers take more than 12 cents of every premium dollar for their overhead and profit, as compared to just over 2 cents in Medicare. Meanwhile, 26 million are still uninsured and millions more with coverage can’t afford care. It’s time we make our health care system cater to patients instead of bending over backward to help insurance companies.”

Himmelstein is a primary care doctor and, like Woolhandler, a distinguished professor at CUNY’s Hunter College and lecturer at Harvard Medical School.

“We urgently need reform that moves forward from the ACA, but the Price and Ryan plans would replace Obamacare with something much worse,” Himmelstein said. “Polls show that most Americans — including most people who want the ACA repealed, and even a strong minority of Republicans — want single-payer reform. And doctors are crying out for such reform.”