Constitutionally speaking, Americans do not have a right to healthcare. We have a right to free speech, a right to bear arms, a right to freely practice religion or to be free from religious practice, but we do not have a constitutional right to be cared for when we are sick. Supporters of a single-payer system, myself being one of them, are hoping to change that.
Legislation creating a single-payer healthcare system, aka “universal healthcare”, aka “Medicare for all”, would not change the Constitution, but it would guarantee all Americans publicly funded access to core medical services. Obamacare is not an example of this system, but it is perhaps a move in that direction, in the sense that it uses the federal government as a tool to get healthcare in the hands of people that the private market had previously left behind.
Unfortunately, the American Healthcare Act, supported by Trump and currently being considered by the Republican-controlled Congress, threatens to undo a lot of that progress. Needless to say, this is a pretty disheartening development for single-payer advocates who had viewed Obamacare as a significant step towards their ultimate goal. That’s why Minnesotan supporters of a single-payer system should turn their attention away from Washington and towards creating a single-payer system here in Minnesota.
In the United States, our federalist system of government grants significant leeway to its semi-sovereign states in controlling their own affairs. In terms of power, state governments may be inferior to the federal government, but they are not necessarily subordinate to it. This means that, in the case of healthcare, even though conservative legislators in Washington are fighting for further privatization, progressive state legislators can still fight to enact something more public within their borders. Even though the American Healthcare Act may have dire consequences for the poor, old, unlucky and underprivileged in other U.S. states, that doesn’t have to be the case for anyone in the state of Minnesota.
Trying to pass single-payer legislation at the state level would be an enormous challenge. Aside from the politics, the practicality of such a system is pretty daunting. First and foremost is the cost. In California, the most recent state to seriously consider a single-payer system, a legislative analysis estimated a $400 billion per year price tag. That is more than double the entire state budget proposed for next year.
And what about the system that we already have in place? As one write-up put it, a single-payer system “may be what any sane and progressive community would adopt if it was creating a health-care system from scratch,” but that is obviously not the case here in the U.S. The massive systemic overhaul that it would take to transition from the entangled clusterfuck of deductibles and co-pays to a system in which the state government replaces insurance companies, employers, out-of-pocket patients, and the federal government as the “single payer” is head-spinning to say the least.
And then there are the criticisms that we always hear of single-payer systems—the longer lines, the lower quality, and the lack of responsibility shown by citizens once they start to get something for “free”. Some of the criticisms may be exaggerated, but in spite of whatever benefits a single-payer system might bring, I don’t think that there is any doubt that, at least for some patients, these problems would become a reality.
But in order to be a success, a single-payer system doesn’t need to be perfect. It just needs to be better than what we currently got.
A single-payer system would be expensive, but the U.S. already pays more for healthcare than any other country in the world, including the myriad of countries that have already adopted single-payer systems. Even though the California proposal has a price tag of $400 billion, Californians already paid $367 billion for healthcare in 2016, and that doesn’t include the nearly 3 million uninsured residents that didn’t receive coverage, but would under the state plan. The real difference would be that, rather than paying a for-profit middleman like the private insurance and pharmaceutical companies that currently rake in all those dollars, Californians would be paying the government via taxes. And while those estimated costs still leave the price tag of single-payer significantly higher ($33 billion according to the estimates), it would also provide core medical services to EVERYONE.
With everyone being eligible to receive government-sponsored medical care, it would not be surprising to find lines that are a little longer or care that is of slightly lower quality for those accustomed to having the most prestigious of plans. But if this is the case, then the only reason that those lines were so short in the first place is because some people were not allowed to wait in them, and I’m not okay with that. Plus, one would imagine that, even under a single-payer system, the economically empowered would still be able to use their financial wherewithal to purchase goods and services not accessible to most.
Implementing a single-payer system of healthcare in Minnesota would not be easy. Even if the political will were there, inevitable setbacks and complications would surely make the transition process a frustrating one for many. I don’t know if it would be best to try to implement that system in one fell swoop or in a series of steps, but I do know that these are the types of discussions that should be taking place in the halls of the Minnesota State Capitol.
States are the laboratories of democracy, and Minnesota should be the first to experiment with single-payer healthcare at the state level. Minnesota may not be the economic powerhouse that California is, but smaller populations than us have made single-payer work, so there’s no reason that we can’t too. If we can be successful in this endeavor—successful in building a workable, government-funded system that provides quality healthcare to all its citizens—then perhaps Minnesota can serve as a model to other states, and eventually, the federal government. Healthcare is not a right in the United States, but in Minnesota, it can be and it should be. We just need to make it happen.