Bernie Sanders Introduces in the Senate a Single Payer Bill: The American Health Security Act of 2013

by Don McCanne, M.D.

With the intense efforts taking place to implement Obamacare (The Affordable Care Act), a surprising result is that there has been a surge of interest in single payer reform. Single payer is often characterized as an improved version of Medicare that would replace our current dysfunctional system of financing health care with a new, efficient public plan that covered everyone.

Although most progressives have long wished for a single payer system and have used the current turmoil during the Obamacare startup to remind the nation that we could have had single payer, it is those on the right who have been the loudest in saying that we are already headed toward single payer.

The right contends that if Obamacare is fully implemented, we will eventually have single payer. Little does it matter that we are headed in a different direction since Obamacare actually increases the role of private insurers and locks in fragmented, multi-payer health care financing. Some on the right seem to be threatening us with the scourge of single payer if we do not do something to stop the implementation of Obamacare, but others seem to believe that once Obamacare is shown to fail miserably in achieving the goal of affordable care for everyone, then the only real option remaining to achieve this goal would be a single payer system, much to their chagrin.

Because of this renewed interest in single payer, Senator Bernie Sanders’ decision now to introduce in the Senate a single payer bill is very timely. S. 1782, The American Health Security Act of 2013, joins its sister bill in the House of Representatives, H.R. 1200, sponsored by Representative Jim McDermott. Also in the House is H.R. 676, The Expanded and Improved Medicare for All Act, sponsored by Representative John Conyers, along with 53 cosponsors.

The bills have in common the goal of providing everyone with affordable and comprehensive health care services while using an equitable system of public financing to pay for health care. There are a few differences in the bills. For instance, the McDermott/Sanders bill emphasizes state-based administration with federal financing, whereas the Conyers bill emphasizes conversion of the for-profit sectors of the health care delivery system into non-profits in order to ensure that the patients hold the position of primacy in health care as opposed to passive investors holding a position of primacy in profits and rent-seeking.

At this time it is tempting to dissect out the differences between these bills to see which one is “better.” But what really is important is not the differences between these bills since they adhere to fundamental single payer principles. The important differences to look for are the contrasts between single payer versus the multi-payer model that we now have which is being perpetuated by Obamacare. Also the differences in the replacement model supported by the conservatives in Congress offer even greater contrasts.

Single payer is the simplest and most equitable model of financing health care. Everyone is automatically covered for life. Benefits are comprehensive. Care is affordable for everyone since it is paid for through equitable taxes deposited in a common public fund. Much of the profound administrative waste of our current fragmented system of financing care is recovered and redirected to where it should go – paying for health care. Choice of health care is left with the patient, including free choice of health care professionals, hospitals and other institutions and services.
As far as the comparatively minor differences between the single payer bills are concerned, the committee markup processes and the joint conference committee process could iron those out.

Obamacare perpetuates the profound administrative inefficiencies of our current financing, which waste hundreds of billions of dollars each year.  The private insurers under Obamacare take away choice of physicians and hospitals by restricting care to networks of providers selected by the insurers – lists that grow shorter everyday. The rapid growth in high-deductible plans places financial barriers between patients and their health care, and leave them exposed to medical debt, making under-insurance the new standard in America. When Obamacare is fully implemented, it is estimated that this program that was supposed to be universal will still leave 31 million residents without health insurance. It is the most expensive model of health care financing, yet it falls intolerably short on goals of universality, affordability, and equity.

The current iteration of the conservative approach to financing health care is H.R. 3121, The American Health Reform Act of 2013, sponsored by Representative David Roe, with 117 co-sponsors, including Representative Steve Scalise. It would first repeal Obamacare. Then it would open the market to cheap plans that would skimp on benefits and expose patients to much higher out-of-pocket costs, making care for major disorders unaffordable for a majority of Americans. They would greatly expand the use of health savings accounts (HSAs) with no realistic proposal on how those accounts could be funded. Empty HSAs cannot protect patients from medical debt or bankruptcy. They propose that those with serious disorders be enrolled in state-sponsored high-risk pools, yet would provide only $2.5 billion in funding for them. When you consider that the 20 percent of people with serious disorders utilize 80 percent of our health care dollars, that $2.5 billion is not even a drop in the bucket for our $3 trillion in national health expenditures. In essence, they would shred what little bit of health security we have and then walk away. It would fulfill their goal of making health care an individual responsibility.

We can thank Sen. Sanders for bringing single payer to the forefront again, and thank Rep. Conyers and Rep. McDermott for their steadfast support of single payer through their years of legislative efforts as they continue to reintroduce their single payer bills in each session of Congress.

It is now left to us to educate ourselves on the benefits of single payer and the profound deficiencies of the Obamacare patches. Then we need to carry the word to the entire nation. It will take an informed people to lead the way since Congress will not act until the people demand it. Until then, the insurance industry, pharmaceutical firms and the rest of the medical-industrial complex are making the demands, and too many members of Congress are following their money.

Suggested reading:
To access these bills, go to and enter in the search box at the top of the page the letter(s) S or HR and the number of the bill
S. 1782, The American Health Security Act of 2013
H.R. 1200, The American Health Security Act of 2013
H.R. 676, The Expanded and Improved Medicare for All Act
H.R. 3121, The American Health Reform Act of 2013