Amid PPACA Exchange Rollout, Senator Pitches Single-Payer Bill

By Bob Herman
Beckers Hospital Review, December 13, 2013

This week, Sen. Bernie Sanders (I-Vt.) introduced Senate Bill 1782, which would establish a single-payer healthcare system in the U.S.

Sen. Sanders proposed the 189-page American Health Security Act of 2013 as the exchanges within the Patient Protection and Affordable Care Act have endured a tough rollout. Since its launch last month, the federal exchangewebsite — — has experienced numerous technical issues, such as people not being able to create accounts, frustrating consumers and drawing criticism from the healthcare reform law's opponents. Federal officials have said "substantial progress" has been made in repairing the website.

Sen. Sanders told The Daily Beast the PPACA rollout has been "a disaster," and even if the law had unfurled smoothly, "it would be only a modest step forward to dealing with the dysfunction of the American healthcare system."

The proposed bill has many of the same provisions as other single-payer bills that have made their way through Congress, including the Expanded and Improved Medicare for All Act proposed by Rep. John Conyers Jr. (D-Mich.) this past February. Rep. Jim McDermott (D-Wash.) also filed a companion bill in the House in March.

Essentially, all U.S. residents would receive healthcare coverage, which includes inpatient and outpatient hospital services, physician services, dental, mental health and many other services. Hospitals, health systems and other facility-based providers would be paid under an annual global budget. Physicians would be also be paid under global fee payment methodologies.

The government would fund the system through different taxes. There would be a 6.7 percent excise tax on employers and self-employed income, and residents would pay individual taxes based on their income. For example, people who make less than $200,000 would pay 2.2 percent of their taxable income toward the single-payer system. At the high end, people who earn more than $600,000 would pay $19,200 as well as 5.2 percent of the amount beyond $600,000. Those filing joint returns would have a different, lower tax schedule. Other progressive taxes would apply to high-income earners.

No timetable was given for when Congress would act on the legislation, and it likely faces stiff opposition from conservatives. A study published over the summer by Gerald Friedman, PhD, a professor of economics at the University of Massachusetts at Amherst, found that a single-payer health system could save the U.S. $1.8 trillion over the next decade.