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Achieving Trump’s health care promises would likely require single payer reform

President Donald J. Trump’s proposal to replace the Affordable Care Act with a health care law that achieves more coverage, better benefits and lower costs could be attained through single-payer reform, according to a commentary published in Annals of Internal Medicine.

“President Donald Trump and congressional Republicans have vowed to repeal and replace the Patient Protection and Affordable Care Act (ACA),” Steffie Woolhandler, MD, MPH, and David U. Himmelstein, MD, both from the City University of New York at Hunter College, wrote. “Replacing it with ‘something great’ is much trickier. The president has promised universal coverage and reduced deductibles and copayments, all within tight budgetary constraints. That is a tall order, unlikely to be filled by proposals that Republicans have offered thus far.”

Speaker of the House Paul Ryan and HHS Secretary Tom Price, MD, have offered ACA replacement proposals that would diminish poor and low-income individuals’ access to coverage while maintaining or even expanding expenditures for some higher income individuals, according to Woolhandler and Himmelstein. By shifting costs onto patients and state budgets, their approach may save federal dollars; however, it will also require the reduction of revenues and profits of corporate giants that increasingly dictate health care — an unlikely outcome, they added. 

Woolhandler and Himmelstein argue that such proposals would not achieve Trump’s overall goal, but a single-payer reform could. They said that single-payer reform — a single, public plan — would provide coverage for everyone needing medical care. Such reform could save nearly $220 billion this year by decreasing overhead to Medicare’s level and could also significantly diminish billing and paperwork costs for physicians, hospitals and other providers, they wrote.

Approximately $504 billion can potentially be saved annually on bureaucracy through single-payer reform, Woolhandler and Himmelstein estimated. They acknowledge that the reform would attribute to costs in addition to savings. Twenty-six million individuals who are currently uninsured would gain insurance through a full coverage plan, thus further increasing clinical expenditures; however, this would most likely save tens of thousands of lives each year, they wrote. According to Woolhandler and Himmelstein, single-payer reform has been assessed carefully in Canada and other nations with better access, lower costs and similar quality to the United states.

“The ACA has helped millions. However, our health care system remains deeply flawed,” they concluded. “Nine percent of persons in the United States are uninsured, deductibles are rising and networks narrowing, costs are again on the upswing, the pursuit of profit too often displaces medical goals, and physicians are increasingly demoralized. Reforms that move forward from the ACA are urgently needed and widely supported. Even two-fifths of Republicans (and 53% of those favoring repeal of the ACA) would opt for single-payer reform. Yet, the current Washington regime seems intent on moving backward, threatening to replace the ACA with something far worse.” – by Alaina Tedesco

Disclosures: Woolhandler and Himmelstein report being founders of and active volunteers for Physicians for a National Health Program, and serving as unpaid advisors to Senator Bernie Sanders’ presidential campaign.