“Single-payer,” “Medicare for All,” and “socialized medicine” all mean the same thing to most Americans — pushing out private care and forcing people into a government-run health care delivery system.
The concept of imposing a socialist, non-private health system has been debated for more than 100 years in the U.S., yet, depending on how the polling questions are asked, well over 50 percent of American voters today are satisfied with their health insurance. They want to keep the employer-paid and individual-market insurance and private health care access.
Imposing total government control of our health is still unacceptable to the majority of people in the country. Supporters of socialist medicine, however, have used an insidious, incremental movement toward their goal for the past 80 years. President Franklin Roosevelt included nationalized health care in his New Deal legislation. Americans revolted, and because FDR strongly wanted a Social Security law, he agreed to throw out the socialized medicine portion of the bill.
Employer-paid health benefits began in the U.S. in 1943, and most Americans like the arrangement. Congress and the Truman Administration passed the Hill-Burton Act which provided taxpayer loans and grants to communities to help them build hospitals. The law did not nationalize health insurance, but it did impose government mandates and did firmly entrench the government in the American health care delivery system.
Fast forward to 1965 when the Medicare and Medicaid programs began. Although there was an active private health insurance market for seniors in the 1960s, the argument for a government plan was that low-income seniors were priced out of that market. Tragically, but predictably, Medicare crowded-out the private insurance market. By the early 1970s, Medicare had become the only major medical care available for seniors in the U.S. — regardless of income.
Even though low-income non-seniors had hospital access through the Hill-Burton Act and could use charity care for other health care related activities, Congress passed the Medicaid entitlement. The program began as a basic safety-net plan for low-income families with children. Now it has been expanded dramatically to include low-income, able-bodied 18 to 64 year-olds, as well as an increasing percent of long-term care in the U.S. The entitlement further deepened the government grip on our health care.
The Affordable Care Act, also known as Obamacare, was narrowly passed in 2010. The two main benefits are a Medicaid expansion for low-income people and taxpayer subsidies to help middle-income individuals purchase health insurance in the exchanges. President Obama admitted that the ACA is simply another step toward full socialist health care. Twenty million Americans now depend on Obamacare for their health insurance.
Today, approximately 40 percent of all Americans are enrolled in a government health insurance program. Compare that to less than five percent at the end of World War II.
Although advocates today are clamoring for a single-payer system, 50 percent of Americans still receive their health insurance from their employers. The vast majority of these people are satisfied with their health care insurance and access. They would be forced to give up insurance they liked to go under a socialized medicine plan with its long wait times and other forms of rationing.
Consequently, the quiet march to a single-payer system is subtle and unrelenting. There are currently multiple ideas being discussed. These include a Medicare buy-in, expanding Medicare to people under 65, a Medicaid buy-in, and a “public option” or socialist government-plan in the ACA exchanges.
All of these ideas seem reasonable and inconsequential at first, yet taken together they use a stepwise plan to dramatically move the country closer to a single-payer system. Without a “Medicare for All” law, advocates can still reach their goal of socialized medicine in the U.S. The real question is how Americans who now have private insurance will react to this understated but persistent movement.
Dr. Roger Stark is a retired physician, the author of two books and the Center for Health Care Policy Analyst for Washington Policy Center.