Destiny of Single-Payer Healthcare

M. A. Iasilli
6 min readMay 15, 2017


Democrats and Republicans are at odds with Obamacare, but can they push a single-payer compromise?

Town hall gatherings poised to discuss the future of healthcare in America are bringing disenchanted voters out in droves. Chants like “do your job” and vocal questions about the AHCA are being seen on our television screens each night. Voters have clearly sent a booming message to congressional leaders. With the accumulation of more questions, “specifics” in the Republican plan to replace Obamacare become more opaque. However, in the midst of all the chaos is the political factionalism within the two parties occupying Congress. While the abundance of bickering continue on the subjects of “Russia,” “North Korea,” and how ‘the next press conference won’t be so pretty,’ the possibility of a single-payer health care system may actually come to fruition. Not only would it transform healthcare in America, but it could help broker a compromise between Democratic and Republican lawmakers dealing with the pervasive unease in their constituencies regarding healthcare reform. Moreover, it will hopefully put to rest the many trivial headlines clogging the mainstream’s airwaves, and perhaps, refocus the narrative on important matters close to home, like healthcare as a right.

The two parties are experiencing an identity crisis.

Since Donald Trump’s election, Republicans have had a difficult time governing, albeit they spent so much time as the opposition under Obama’s presidency. Likewise, Democrats are without a coherent message. However, to expound on why this is happening, it is important to note how there are inter-party divides becoming more clearer, making Republican and Democratic factions more distinct within their own parties. This is prompting more blockage for congressional action, and creating a series of ideological arguments that fan each side farther apart.

McCain and Grahm’s establishment are at odds with the anti-establishment Republicans’ more sympathetic relationship to Trump’s populist vision. Yet, these two factions are anathema to the libertarian wing led by representatives like Rand Paul. Libertarians and Tea Partiers alike expect to see a healthcare reform bill that repeals Obamacare completely, which includes a slash to government expenditures, and a significant roll-back of Medicare and Medicaid provisions. Meanwhile, the other two factions remaining are expected to continue a similar policy as Obamacare, which relies on the insurance exchange market to grow and sustain it. For them, this approach enables the same policy to extend its reach into the leviathan of private corporate interests so that enrollees will continue to see benefits, but not know government has helped them.

Likewise, Democrats have experienced quite a bit of political factionalism. Though subsided by the mainstream media’s delicate treatment of Democratic Party matters, they too have become just as disjointed as the Republicans. The far left progressive caucus is prepared to relinquish the remaining aspects of Obamacare so long as they can propel a single-payer system forward. On the other hand, the centrists have concluded Obamacare is just fine, and are willing to see how the current law’s standing will pan out, despite rising costs on middle and low income families.

It appears to be that both populist Republicans and progressive Democrats are aligned to repeal Obamacare. Even though both demonstrate different approaches to how to solve the crisis, Bernie Sanders is presenting more common ground with Rand Paul than one might initially think. He has been traveling around the country addressing working class voters, many of whom also voted for Donald Trump. These working class constituencies have been calling for single-payer healthcare, and Sanders sees an expansion of Medicaid and Medicare as a possible way to do it. Trump himself has seen the improvements made from a single-payer(like) proposal, marking the Australian health care system as “better healthcare than” the American system.

Subversively, anti-government Republicans like Rand Paul and mainstream Democratic moderates like Nancy Pelosi are rather in agreement when it comes to the possibility of an Obamacare replacement. Both do not want to increase expenditures or increase government oversight into the healthcare sector, fearing that it will dismantle the provisions put in place by the Affordable Care Act. For both groups, any step toward a single-payer is a ‘step toward socialism.’ Letting private firms run these crucial programs allows the government to thwart responsibility of fulfilling its promise, to meet the necessary obligations of its beneficiaries, onto the free market. Given the attitudes of mainstream Democratic leaders involved with the DNC debacle that led to the purge of 126,000 voter IDs in Brooklyn, New York; discrimination against Bernie Sanders’ Jewish heritage; and a questioning of Sanders’ admitted socialist ideas — the Democratic Party has inconspicuously aligned itself with many conservatives in Congress. Meanwhile, the progressive faction is, in a sense, its own opposition party.

Single payer, the ultimate equalizer.

Despite the obstruction coming from the anti-Trump movement and the internal dysfunction caused by party factionalism, there is a possibility this Administration could go along into signing a far reaching healthcare replacement bill to radically transform our healthcare. If so, it would stand as a complete reversal of modern Republican Party tradition. So many Republicans like Mike Pence won’t be too happy about such a move.

But since Trump has commended the Australian single-payer system, it is a sign the Administration could be mulling over a more progressive plan instead of what is being chalked up by conservatives in the Freedom Caucus. In fact, the CEO of Aetna publicly called for a meeting to discuss the possibility of implementing a plan that could advance the same mechanism as socialized medicine. Given that insurance costs have been increasing — as stated before with the passage of Obamacare — it would be in the health insurance industry’s best interest to bring about a restructuring plan to meet the needs of average people suffering from high costs.

Even though it may seem like a paradox for the right, it’s not unlikely for contemporary Republicans to garner enough support to pass through a single-payer plan. In fact, more Republicans are considering this option to replace Obamacare’s issue with rising costs.

The Administration can work out a deal with Aetna to transform its function into a provisional mechanism of centralized program dispersal and operations. For the last two decades, the United States has administered policies with economic sectors enacted with the responsibility to deliver services to beneficiaries. This wouldn’t be the first time the government did something like this, but chartered the oversight and codes in a formidable manner. The Medicare Modernization Act saw similar techniques applied to improve quality of care, access, and the ability to reach more people. Aetna’s CEO, Mark Bertolini stated, “I think we should have that debate as a nation. But let me remind everybody that Aetna was the first financial intermediary for Medicare. We cut the first check for Medicare in 1965 to Hartford Hospital for $517.57.”

Although this sounds like it falls in line with neoliberal policy trends, the construction of a single-payer system with private insurers as the middlemen would be slightly different. It would not only exert significant government command over a powerful private sect of the market economy, but it would also require a total expansion of Medicaid and Medicare, prompting contributions to be increased per person. This will significantly reduce deductibles, out of pocket costs, copays and hospital visits. Especially since most of it would be subsidized through the tax code. Also, clinics are becoming more widely used medical facilities in the United States. The federal government could encourage partnerships between clinic facilities and insurance companies so that they can operate in tandem, monitoring quality of care, public health frequency, and effectiveness.

Nevertheless, with widespread public disaffection regarding America’s healthcare system, the need for a replacement is becoming more pressing than ever. Aetna’s CEO is right: Americans need to be debating the possibility of a single-payer. Will it be Democrats who finally come to their senses on the failures of Obamacare? Or will Republicans work alongside progressive Democrats in implementing one of the most transformative policies in American history? Whatever it may be, Americans are heading toward significant change. So we should be talking about what matters, our common health.



M. A. Iasilli

Vi veri universum vivus vici: politics, history, and the occasional pop-culture.