Richard Feldman: Single-payer health care might be only future choice

Keywords Forefront / Opinion

FeldmanThe balance of power is now divided between a Democratic House and a more conservative Republican Senate. Obamacare will likely continue for now in limbo, maimed but not dead.

Obamacare’s flaws were left to languish by a Congress determined to see its demise. Even worse, Congress repealed vital portions, including the individual mandate that disrupted the basis of its functionality.

But Obamacare was a bold first attempt to expand health insurance to millions of Americans who desperately needed coverage. It is far from “socialized medicine” and is based on principles other countries have used to create successful universal high-quality and lower-cost multi-payer systems. But our toxic political atmosphere would not allow fixing Obamacare’s flaws to make it truly functional and equitable.

So, what’s next in health care reform? Medicare for all, a single-payer government system? More of the failed Republican approach of free-market principles, health savings accounts, and consumerism?

Health care does not follow the usual rules of economics. A Republican model would result in greatly contracted coverage. If combined with popular elements of Obamacare (like coverage for pre-existing conditions), which were never designed to be selectively used in isolation, it would result in unsustainable higher costs.

The American public is not yet ready for Medicare for all, presently promoted by the left hand of the Democratic Party. But if the next compromised paradigm fails, ironically, a single-payer system might be the only option remaining for a health care system left in shambles. America is the only highly developed country in the world that does not guarantee health care coverage for all people. The public will demand a different and more humane approach.

Americans are increasingly warming to the idea of single-payer. Although the results of surveys vary, a Kaiser Family Foundation poll found that 53% of the public now favors single-payer (43% opposed). The favorable response increases to 64% when termed “Medicare for all”. To no surprise, a majority of Democrats and independents are in favor, while 67% of Republicans are opposed.

Physicians are increasingly positive regarding single payer. Another Kaiser survey revealed that 56% of physicians are supportive. Doctors are tired of system complexity and bureaucratic and paperwork nightmares, and increasingly believe in the goal of universal coverage.

The most prominent single-payer plan belongs to Sen. Bernie Sanders. His Medicare for all plan is gaining significant support with Senate Democrats, unthinkable as a mainstream idea just a few years ago.

His plan eliminates Medicaid and almost all private and employer-sponsored insurance, ensuring comprehensive care to all people. It is considerably more generous than Medicare presently with no premiums, co-pays or deductibles, and covers virtually the entire continuum of medical care, including vision and dental. It includes negotiated lower-cost prescriptions and long-term care. Patients have free choice of providers and navigate a much less complex health care system.

However, the plan is enormously expensive, paid for mostly by tax increases to employers and individuals, which, according to the Kaiser poll, greatly erodes public support even though offset by virtually no out-of-pocket costs. That might be different in the future if there is no viable alternative. A less generous plan, or a government plan as an alternative choice, would be more financially and politically feasible.

The federal government now pays for two-thirds of health care costs; it wouldn’t be a stretch to get to 100%. My Medicare patients are actually quite content. Sanders’ plan is an introduction to the American public of what the future might hold.•


Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to

Click here for more Forefront columns.

Please enable JavaScript to view this content.

Story Continues Below

Editor's note: You can comment on IBJ stories by signing in to your IBJ account. If you have not registered, please sign up for a free account now. Please note our updated comment policy that will govern how comments are moderated.

3 thoughts on “Richard Feldman: Single-payer health care might be only future choice

  1. This is unmitigated garbage. What you are discussing is insurance reform, not healthcare reform. Having health insurance does not mean you have health care. Let’s get that straight. There are free market models growing now that don’t involve insurance or Medicare. You should really research direct primary care. The doctors that are leading the charge in driving costs down and increasing access are doing so because they’re no longer beholden to insurance or government payers.

    Your attempt at labeling free market policies failures is also laughable. The US government is responsible for over half of all health industry spending. We don’t have a free market system, not even close. We have an oligarchy that is already dominated by a single payer and it is disastrous. Why are you advocating to hand the keys over to them completely when they’re the reason we’re in this mess?

  2. Well said Christopher. Amazing that Dr. Feldman “failed” to mention the misrepresentations that were made in order to get Obamacare passed… Keep your Doctor, keep your plan, much less expensive, better care, not a step towards single payer, will not cover illegal aliens, etc. Not to mention the bribes necessary to get the last few Democratic votes necessary to pass and that Congress themselves have their own private health care program. Also, has he ever really studied the health care programs in other comparable countries? Why is there a two-tier systems in most of those countries..and why many of the people of means chose to come to US for their major health care needs. He wonders why public support is eroded by promises that increased taxes will be offset by no premiums and co-pays. Geez…maybe there is distrust in completely turning over the largest piece of the private economy to the gov’t. How has it done with the USPS, SS, VA, FAA, FDA, etc? If you think health care is expensive, now..wait till it’s free.

    1. Bingo. I’m also so tired of the “every other industrial country does this…” line. There’s a reason why the US is the only superpower. There is a reason innovation, ingenuity, and advances of civilization occur in the US. It is a belief and adherence to the invisible hand and the raw power of the market economy. It isn’t doing what other countries are doing.

{{ articles_remaining }}
Free {{ article_text }} Remaining
{{ articles_remaining }}
Free {{ article_text }} Remaining Article limit resets on
{{ count_down }}