The Diane Rehm Show Tuesday morning was devoted to the topic -- The Affordable Care Act Three Years In: What's Working And What's Not.
The guests on the show were Julie Rovner, senior correspondent, Kaiser Health News, Stephanie Armour, healthcare reporter, Wall Street Journal, and Susan Dentzer CEO of the Network for Excellence in Health Innovation (NEHI) -- what Dentzer describes as "a non-profit think-tank."
Just yesterday, the Washington Post ran an article about a Gallup poll under the headline -- Most Americans want to Replace Obamacare with Single Payer -- Including Many Republicans.
But single payer wasn't raised as a possibility by any of the guests -- until a caller raised it about three quarters of the way through the show.
In response, Armour, Dentzer and Rovner all talked about how much more expensive single payer would be than Obamacare.
Only Diane Rehm seemed sympathetic to single payer.
" Bernie Sanders' Medicare for All program would create a single payer system," Dentzer said. "It has very large payroll tax increases and income tax increases in it to fund it. A legitimate question is -- is the American public ready to move from the system we have now -- yes we have high deductibles for many people, yes they are paying high premiums -- but are we willing to move and float all of the those expenses through the government coffers and pay much higher payroll taxes and much higher income taxes?"
Rehm asks Rovner -- what would Bernie Sanders proposal cost?
"A lot more than he has floated in income tax increases," Rovner said. "The Urban Institute last week estimated that it is $18 trillion short of paying for itself."
With that statement, Rovner gave the back of her corporate hand to David Himmelstein and Steffie Woolhandler, who recently wrote that the Urban Institute's estimates "are ridiculous."
"They project outlandish increases in the utilization of medical care, ignore vast savings under single-payer reform, and ignore the extensive and well-documented experience with single-payer systems in other nations -- which all spend far less per person on healthcare than we do," they wrote.
Rovner said that "it's important to know that what Bernie Sanders is proposing is not what Medicare is."
"Medicare as it exists today has lots and lots of requirements for patients for co-pays," Rovner said. "The deductibles are not that high in Medicare, although the hospital deductible is substantial. But the ongoing out of pocket costs can be enormous. That's why most people who have Medicare have supplemental insurance. What Bernie Sanders is talking about is that there would be no need for supplemental insurance -- that this new Medicare would pay pretty much for everything. That is what would make it so expensive. And that would be a level that even other countries who have single payer plans don't have."
Ignoring the results of the Gallup poll, Armour says that while single payer "has intrigued people for decades, it has never gotten a majority of support and in the current political climate, it would be very difficult."
Given that Rehm had three guests dissing single payer, she felt she had to stand up for it. Since when, she asked, did Congress start ignoring "what people want"?
Armour said that while single payer has always had strong support, "it's been a plurality, not a majority."
"There simply isn't fifty percent plus one and there hasn't been," Armour said. "What we are seeing now is the other side -- give people more skin in the game. Make them pay more of their own health care bills. And maybe they will shop better."
Shop better? You mean like in states like West Virginia where there is exactly one insurance company in the Obamacare marketplace?
Shop better?
The last time the Diane Rehm show devoted an hour to single payer was in May 2009.
The guests were Bernie Sanders, David Himmelstein, Roger Hickey -- who was pushing a public option -- and Susan Dentzer, who was then identified as senior policy adviser, The Robert Wood Johnson Foundation, and on-air analyst on health issues, PBS NewsHour.
During that show, Rehm asked Dentzer why we don't have a single payer system in the United States and Dentzer replied -- "we had a private insurance industry develop."
"It now has revenues in excess of $400 billion a year. And it's a very effective interest group," Dentzer said.
Dentzer should know.
While Dentzer's group calls itself The Network for Excellence in Health Innovation, in fact if you look at its board of directors, it's dominated by executives affiliated with health insurance companies (Blue Cross Blue Shield of Massachusetts and HCA) and drug companies (Genzyme Corporation, Sanofi and Merck).
