Is single payer health care a nonstarter?

Is single payer health care a nonstarter?
Washington Policy Center Healthcare Policy Analyst Dr. Roger Stark says the state’s single payer health care work should be disbanded. Photo: bestbrk

Although Washington state’s Universal Health Care Work Group has yet to make formal recommendations to the state legislature on how to implement a single payer system, one of the persistent challenges in those conversations has been the cost of implementation. It’s a dilemma that has previously killed other state plans for a single payer system, and it’s why Washington Policy Center Healthcare Policy Analyst Dr. Roger Stark believes the work group should be disbanded.

“For Washington state to even have an exploratory committee is sort of laughable,” he said during a July 16 Solutions Summit.

The work group was created through a budget proviso with the purpose of recommending how, rather than whether, to implement a universal system. The group is currently examining several possible “scenarios” in which a single payer system would be created that vary in both coverage and allowance for additional private insurance.

However, Stark noted that roughly half of state residents get their health insurance through their employer – a practice that would theoretically end were a single payer system implemented. Additionally, there are also a substantial number of Washington residents on Medicare.

“How do you get a major waiver to move them into the system?” Stark said. “Some of the issues that were predictable the committee is now grappling with.”

Chief among those issues is the cost. A 2019 study by the Washington Institute for Public Policy found that a state-run single payer healthcare system would require $28 billion in new revenue, an estimate some health care analysts have warned is on the low side.

“I can guarantee you the cost of this thing is going to be astronomical,” Stark said. “I can’t imagine a scenario where they (legislators) go to Washington state taxpayers and say: ‘Hey you’ve got to pay for this.’”

Yet, Stark added that the large price tag shouldn’t come as a surprise. Vermont in 2011 tried to implement a universal healthcare system, but it was scrapped at the last minute when Governor Peter Shumlin concluded that the proposed 11.5 percent payroll tax and 9.5. percent income tax needed to pay for it was “unfeasible.” Colorado voters rejected a single payer initiative by 79 percent in 2016, though state legislators are currently exploring a new proposal.

Although California has considered a single payer system for several years, it has yet to be implemented – one state report found the system would cost up to $400 billion annually. Pacific Research Institute Health Care Policy CEO Sally C. Pipes wrote in February that “implementing single-payer in California is not only financially impossible – it would diminish the quality of care for patients.”

Stark has a similar attitude toward Washington state. “Putting everybody in a single payer system…clearly would be to the detriment of our overall healthcare delivery system and certainly to the detriment of individual patients.”

Proponents of a single payer system highlight the higher spending by the U.S. on healthcare compared to other countries such as Canada and the U.K that rely on either nationalized healthcare or a public sector-run system. However, Stark said that’s because in either system “they limit access to healthcare. If they run out of hospital beds or they don’t have enough medicine, they ration what they have.”

He added that in Canada waiting times between seeing a physician and getting treatment are 21 weeks compared to roughly 20-24 days in America. Meanwhile, England is currently experiencing a severe nurse shortage that could double over the next decade.

Stark said that although “I don’t see us going to a single payer system overnight…but incrementally I worry about us moving in that direction.”

WPC’s next Solutions Summit is July 28.

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