As the Senate wrestles with finding the balance to pass its version of healthcare reform, a proposal by Senator Ted Cruz looks like it is gaining popularity. This amendment would allow insurers to offer plans which do not comply with the Affordable Care Act so long as they offer at least one plan which does comply. Designed to bring in Cruz and Rand Paul, two detractors of the initial Senate proposal, this is just one step along the way.
Meanwhile, Democrats led by Senator Bernie Sanders are planning to introduce a “Medicare for All” plan. Since the GOP controls the legislative agenda, it is unlikely that this proposed single-payer system will see any movement – and it doesn’t even appear that all Democrats are aligned in advocating for this change. Government-provided healthcare is popular in many countries throughout the world, but it also has issues. In a single-payer system, costs are controlled by limiting access. Long wait times in Canada for x-rays and some cancer treatment have been highlighted by opponents of this healthcare system. And even single-payer systems have not tackled healthcare inflation.
Recent medical advances have been astounding. But our ability to improve and extend lives is not without cost. In a single-payer system, the government takes the place of health insurers as the guardian of cost-control and the political process replaces the free market.
In the UK, basic healthcare for all is provided by National Health Service and many people purchase top-up plans to provide a higher level of care and access to the best providers. I advocate for this system. Basic healthcare should be a right. Striking the balance on what is “basic” will be difficult. Our culture and lifestyles – as well as tort system – in America would make managing this system a larger issue than in many parts of the world. There is also no mechanism to administer single-payer. Creating this system would be enormously complex. As evidenced by the healthcare.gov debacle, the U.S. government has not proven itself to be the best manager of a seismic shift. Radical change makes very distinct winners and losers in every system and the losers are very vocal. So, for all these reasons, in my view, the best course of action is to implement gradual incremental change.