As the health care debate continues nationally with Congressional Republicans attempting to repeal the Affordable Care Act, discussions about the future of health care in Washington state also continue.
Some liberals and Social Democrats like Sen. Bernie Sanders have pushed the idea of single-payer health care, similar to Canada, where health insurance would be nationalized and paid for by taxes on the rich and other broader taxes.
Marcia Stedman is the president of Health Care For All Washington, and said they’re seeking to implement a system similar to Canada’s in the state.
“The research and the data show that when people have access, unfettered access to care when they need it, they will go and get the care they need when they need it,” she said.
This would ultimately reduce overall costs, Stedman said, as sick people would get early treatment that could prevent more costly procedures later on.
However, Roger Stark from the Washington Policy Center, a think-tank opposed to single-payer health care, said Americans may not like the trade-offs that countries like Canada chose to make.
“It sounds great, and from a sociological standpoint the Canadian people love it, they get it,” he said.
But due to greater demand for health care and not enough medical staff to provide it, Stark said the Canadian system ends up rationing health care through longer wait times than in the U.S.
He said other states that have looked at state-wide single-payer health care, like Vermont or California, have decided against it, saying in Vermont, which has an annual budget of around $5 billion, a single-payer system would cost an additional $2 billion.
“Fundamentally, it’s a terrible idea,” Stark said.
But as wages nationally have stagnated and health care costs increased, Stedman said a single-payer system, where the government runs insurance but health care providers are still private entities, could help lower costs for most Americans.
One way to do this is it would allow the government to negotiate prices for services, drugs and medical equipment as well as premium prices.
“That is something that’s totally up to the insurance company (now),” she said. “If that’s in the mix, you are never going to get affordable health care.”
According to a 2012 Dollars &Sense analysis, health care costs have risen substantially faster than income in the U.S. over the last 50 years, growing from 5 percent of the gross domestic product in 1960 to nearly 18 percent in 2012.
Longer lives and improvements in care, along with increasing costs associated with a private health insurance system were cited in the study.
The study said a single-payer system could save around $570 billion nationally through administrative and monopoly profit cutbacks and through simplifying billing.
It would also raise taxes on the high-earners, financial transactions and payroll taxes as well as general taxes. But the analysis said this would ultimately lower the financial burden on the poor and working classes, as well as the middle class, providing a tax break for everyone other than the top 5 percent.
This includes $348 billion from the financial transaction tax, $285 billion on high-earners, a $496 billion payroll tax and only $4 billion from taxes directed at the middle and working classes.
As for its implementation, Stedman said instituting it on a state-by-state basis might make it more feasible.
It would allow the system to be closer to home and the citizens to have more control over how it was structured.
Canadian single-payer health care was officially implemented in the Canada Health Act in 1984, but before that the province of Saskatchewan and its residents and doctors began pushing for a similar system as early as the 1960s. By the 1970s, all provinces had some form of socialized medicine.
But powerful health care industry lobbyists have hampered progress in the U.S., said Stedman.
“The health care industry wants to keep making profits, they don’t want to lose out,” Stedman said.
Despite this, her organization continues to introduce bills in the state Legislature. In the most recent session bills in both the House and Senate stalled in committee.
The sponsors were also all Democratic lawmakers, including 48th District Sen. Patty Kuderer, among others.
“We are continually courting more co-sponsors, more legislators, to sign on,” Stedman said.
If Olympia fails to act on a proposal in 2019, Stedman said they are planning on presenting statewide single-payer health care as an initiative in the following election.
“We feel more confident than ever that we are going to be able to move forward with this,” she said.
Sen. Kuderer said in a phone interview last Friday that three pieces of legislation had been introduced during this last session. They included SB 5701 and SB 5957, both of which sought to create a single-payer health care system in the state.
Kuderer’s own bill, SB 5984, would have created a public option instead, which would essentially allow Washington residents to buy into Medicaid and create competition with private insurance companies. This could also lower prices as it would increase the bargaining power of the Medicaid program with private health care providers.
“The idea would be that there would be that competition there, which I think is kind of lacking right now,” Kuderer said.
With uncertainty about what will happen with the Affordable Care Act on a national level, Kuderer also co-sponsored SB 5701 to examine the possibility of a single-payer system as well.
However, unlike her proposal that would expand Medicaid, there are no federal waivers for a single-payer health care system available to the state.
“But I’m open to seeing the public hearing on this and the input from the stakeholders, and seeing where the bill can be improved,” she said.
She said the three bills which were pulled this year could be reintroduced next year, even though it is a shorter session than the 2019 one.
“I would like to see us approach health care from a smarter standpoint, because when we invest in health care, we use less of the system, I think, when we do have access to health care,” she said.