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Nov. 22 2013
The botched implementation of Obamacare has created a bittersweet moment for advocates of a universal, single-payer health care system: They saw this coming, but they can’t gloat about it.
"We may have an ‘I-told-you-so’ moment, but it’s hard to get any pleasure out of it knowing how many people are actually going to get hurt," said Stephanie Woolhandler, a New York-based doctor who co-founded Physicians for a National Health Program, a group that pushes for universal health care. "You had a bad system, and you’re putting a patch on it using the same flawed insurance companies that got us here in the first place," she said.
In the seven weeks since the insurance exchanges created by the Affordable Care Act debuted, Obamacare has been defined by faulty websites, millions of canceled health plans and uncertainty about whether President Barack Obama’s administration can set up a new marketplace for private health insurance that protects consumers against industry practices like excluding the sick, while ensuring less-well-off Americans can afford coverage.
Single-payer advocates favor scrapping private health insurance and enrolling everyone in a program akin to Medicare with a comprehensive set of benefits that is financed through taxation, one whose primary focus is providing medical care, not earning profits.
To them, the messiness of Obamacare’s infancy was inevitable; the law is built upon a fragmented health care system and a private insurance industry that they believe, by definition, is focused on profit first and the needs of its customers second.
"What you’re seeing right now is the kind of compromise that was reached, kind of cobbled together, for the Affordable Care Act," said Sen. Bernie Sanders (I-Vt.) a vocal single-payer supporter who voted for the bill in 2010 after shelving his amendment to create a single-payer plan. “What’s happening now just reinforces to me that what we need is a simple system focused on providing health care,” he said.
The difficulties of launching insurance exchanges in every state and dealing with dozens of insurance companies are considerably greater than just signing up every American for a Medicare-like program, Woolhandler said. “The single-payer system’s simple. They rolled out Medicare less than a year after passage,” he said.
"I have always thought that was the most efficient way to deliver quality health care to people, keeping the best of the private enterprise system but, at the same time, making it possible for all Americans to be covered," said Rep. Jim McDermott (D-Wash.), a medical doctor who like Sanders has sponsored several single-payer bills.
When Congress debated health-care reform in 2009 and 2010, the creation of a government-run, single-payer program that would provide health coverage to everyone was never seriously considered. Although Obama and many congressional Democrats say they support the idea, none forced it onto the agenda.