What’s the Issue?

     It’s no secret that healthcare is a sore point in US politics. Where there has been progress in recent history, it’s been incremental. President Reagan’s Consolidated Omnibus Budget Reconciliation Act, or COBRA, was the first in a line of a legislative pileup, which was followed by the Health Insurance Portability and Accountability Act (HIPAA) and the State Children’s Health Insurance Program (SCHIP) under the Clinton Administration followed by the Medicare Prescription Drug, Improvement, and Modernization Act, signed into law by President Bush. One of President Obama’s biggest accomplishments was his own addition to our list of healthcare laws, the Patient Protection and Affordable Care Act (ACA). And yet here we are. The 2016 election cycle is upon us, and healthcare reform is still a hot topic.

     I’m a voter. I have an interest in America’s healthcare being both high quality and affordable. I’m also an aspiring data analyst. I’m always looking for a topical analysis to hone my skills, so I decided to take a look at our healthcare system by the numbers. Unfortunately, what I found wasn’t good.

Give it to Me Straight, Doc. How Bad is it?

     So in the US, we do not have universal healthcare. People who cannot afford health insurance are not provided with free healthcare at the expense of the government (or the taxpayer, if you are so inclined). I’d like to know how we stack up, so I downloaded OECD health data and took a look at the countries by percent of people uninsured.

     Out of OECD countries, we rank 33/34 for percent of our people with health insurance. This data is from 2014, four years after the ACA was passed. 88.5% of Americans had health insurance in 2014. That is an improvement from before the ACA, in 2008, when it was only 85.2%. That small increase is actually very important. Millions of Americans now have health insurance that did not before the ACA was passed. That improvement is what Presidential Candidate Hillary Clinton is making the basis of her healthcare platform. She argues that steady, incremental progress is the way to bring us up to universal coverage. I don’t buy that. We’ll see how enrollments do in the next few years. It is likely that enrollments will continue to rise - and don’t get me wrong - that’s a very good thing. Will every uninsured person enroll? Not a chance. There will still be people who don’t understand how the exchanges work, who aren’t internet savvy and don’t know how else to enroll, who are so stubborn as to never enroll in ‘Obamacare’. How will Hillary Clinton address these groups, if she becomes president? What makes me question this approach is the simple fact that 20+ countries have solved this issue already. We’re not trailblazers, we’re lagging the developed world on this issue. There’s no good reason why we Americans can’t take good care of tired, our poor, our huddled masses.

     One potential explanation for America’s backwards healthcare system is simply that it is politically infeasible to implement a European-style replacement. President Obama once said about the controversial Healthy Americans Act, which proposed universal healthcare through private insurance markets and income-based subsidies, that it would meet ‘significant political resistance’. This kind of thinking is something that we cannot continue to tolerate from our politicians. The ironic outcome is that the Affordable Care Act is nearly universally hated by republicans, and although many democrats claim to support the bill, they think there is, at least, room for improvement, as evidenced by healthcare being a front-and-center issue in the 2016 election. We need to elect politicians who will propose and support legislation that is representative of the will of the people, even if that will is ‘radical’.

     I can sympathize with conservative values. No one wants to pay more taxes. Many people don’t want the government involved in their healthcare at all. Those are legitimate concerns that people are going to have with any plan that promises to provide health insurance to everyone at their expense. Unfortunately, the truth is that our current system costs more than any other country’s system. A lot more.

     What’s more, we have seemingly worse coverage. Consider that we have middle-of-the-road life expectancy, despite spending so much more per person on healthcare. Essnetially every country has a direct relationship between how much they spend on healthcare, and how long they live. Only the US is a major outlier in this trend.

So What Can We Do?

     The Affordable Care Act has, thus far, increased coverage - and cost - modestly. While the increase in coverage is a positive, the increase in cost means we’re still operating the absolute least effecient healthcare system in the developed world. Frankly, more of the same is not going to increase our coverage to 100%, and it’s certainly not going to cut costs. Clearly we must choose another option. If continued incremental progress, under the framework of the ACA is Clinton’s proposal, The other two candidates’ plans that we must consider are Donald Trump’s and Bernie Sanders’.

     Donald Trump’s platform for healthcare reform has the stated goal of making healthcare more affordable. His plan is based on free market principles and the key provision is to remove the barrier on insurance companies to sell their product across state lines. This increase in competition would, in theory, lower prices. It follows, in theory, that lower prices allow people to purchase insurance who could not previously afford it. Personally, I do not think that Candidate Trump’s plan would be effective. I am not a professional economist, and this is not an analysis of Trump’s healthcare plan, but I suggest that the added competitiveness of a market without state restrictions over the exchanges provided by the ACA would not be enough to increase coverage to 100%. In fact, I would suggest that no plan that does not explicitly provide coverage for everyone could increase coverage to 100%. On cost, Trump’s plan would ‘Allow individuals to fully deduct health insurance premium payments from their tax returns’. That sounds like a roundabout way of saying the government will pay for people’s health insurance, but creates more bureaucracy, and requires everyone, but particularly working-class people who would have a harder time making payments, to put up the money first.

     I believe that Bernie Sanders is the only candidate running for president with a realistic plan to bring our healthcare system into the 21st century. What he is proposing is called single-payer healthcare, and it’s what many of those European countries, that are paying less and getting more than us, have.

     Candidate Sanders is not the first person to propose single-payer in this country. In fact, we have a long history of universal healthcare proposals being rejected by our government. More recently, Congressman John Conyers, of Michigan, has been proposing his Medicare for all bill to the House every year since 2002. A 2003 proposal by the Physicians’ Working Group for Single-Payer National Health Insurance never saw the floor of the legislature, but nonetheless outlines how a single-payer system might look in the US. Now it is Bernie Sanders who is carrying the torch.

     Bernie Sanders’ plan suggests that we expand the existing Medicare system, with some improvements, to cover all people, not just seniors. To pay for his plan, he suggests raising income and payroll taxes, but in exchange, we eliminate insurance premiums. For 98% of Americans, this would result in a net decrease in cost. Bernie Sanders’ implementation of single-payer is just one proposal in a long line of similar plans.

     The specifics of what to cover and how to pay for it can always be discussed. What will be true of any plan, is that it will give the poor access to safe childbirth, and it won’t send them into bankruptcy; it will ensure that all children have access to pediatricians who will keep them healthy; it ensures that anyone who is sick or in pain can see a doctor and be diagnosed, without considering what the cost of a consultation might run them. The peace of mind for those living below median income is a benefit on its own, but furthermore, a healthy population contributes to a productive society. When people receive regular preventative care, they are more likely to receive early diagnoses and require less invasive treatment, as well as less emergency treatment. Fewer sick days, fewer emergency room visits, fewer late-stage debilitating diseases all lead to a more productive workforce. To top it all off, single-payer would likely save money overall because an increase in preventative treatment will lead to a decrease in expensive surgeries and other medical treatments. A single entity negotiating prices for medical supplies will get a much better deal than any one patient, hospital or doctor, so the price of medical equipment from bandages to MRI machines would be lower. Single-payer is an all-around superior healthcare system than the one we have now, and every day that we go without it, people are needlessly suffering, and even dying on our watch.

     Unfortunately, if Candidate Sanders loses the democratic nomination, or the general election, single-payer will be sidelined again. The worst part is that this is not even a radical or an unpopular idea among the American People. According to a recent poll by Morning Consult Intelligence, voters support a single-payer system by a margin of 54-29, with 16% responding no opinion. Although support does follow party lines, only 50% of republican respondents said that they oppose single-payer. On the other side, democrats support the idea by a margin of 70-16, and independents 53-26. These results are corroborated by other polls: AP-Yahoo, 2007; CBS News, 2009.

     The amount of public support for single-payer, especially among democrats, begs the question: why didn’t President Obama get it done in the Affordable care act, and why isn’t Candidate Clinton fighting for it now? Furthermore, why do Congressman Conyers perennial Medicare-for-All bills never gain traction? I don’t have the answers to those questions, but I can speculate: American voters are not nearly as involved in their political system as they should be. According to a Princeton study, the opinion of the average citizen, which is determined through polling, has little to no effect on the likelihood of a policy becoming law. The study did find, however, that the opinions of economic elites had a very large effect on the likelihood of a policy becoming law.

     Given American citizens’ lack of involvement in politics, this is not very surprising. Lawmakers who are deciding on policy know that they will face repercussions from various groups based on their vote. Past campaign donors, especially, will have their eye on a lawmaker’s vote, upon which future campaign contributions depend. What the American people seem to have forgotten is that they have just as much, if not more, power as wealthy campaign donors. The people are the ones who actually vote. The truth is, you don’t know how your congressperson voted on the Affordable Care Act. You might not even know who your congressperson is. Elected officials know that their constituents are not paying attention, and therefore don’t vote in their interests.

     The benefits of single-payer healthcare are clear: improve coverage and quality of care, and save money in the process. Americans support the idea, but Washington is not acting in our interests. It is your duty, as an American and as a voter, to hold your elected officials accountable. Write you Congressperson and Senators to express your views. Use your power to vote out officials who do not represent you, and vote in officials who do. Money can’t buy an election whose participants are active in politics. A voter who spends time and effort researching a candidate will not be swayed by a T.V. ad. My pitch to the American voter on either side of the aisle is pressure your elected officials to support single-payer healthcare. Not only because it’s the humanitarian thing to do, but because it’s the best choice for quality of care and for our wallet. Become an active member of your democracy, and together we can change our country for the better.