Many Americans will be cautiously optimistic after the US Senate voted against the repeal of Obamacare—but there’s little saving grace for the current state of American healthcare. If the Democrats want to launch a credible platform for 2020, single-payer health care must be on the agenda.

Single payer is another name for universal healthcare—a system in which all residents are covered for all medical needs. The current American system is based on private coverage, funded through premiums paid by the recipients of care. A single-payer system means the government—a ‘single payer’—funds health care through taxation. Obamacare fell short of this ideal. It expanded the pool of those eligible for ‘Medicaid’—an existing programme providing coverage for certain Americans, such as the poor and the elderly—and ensured that no individual with ‘pre-existing conditions’ was denied coverage. This ensured that many more Americans were covered, but still left tens of millions uninsured because they were unable to afford the cost of insurance premiums. Single-payer healthcare—in theory—ensures universal coverage.

Bernie Sanders, who has long pushed the mantra that “healthcare must be a right, not a privilege”, announced that he will launch a month-long campaign (followed by concrete legislative proposals) to enact single payer. Although likely to fail in the House of Representatives, the lower house of the US Congress, it will force Democratic Senators to reveal their stance on the issue at a time when voters are already looking at potential candidates for the 2020 primary elections.

In a landmark paper published in 1963, Kenneth Arrow argued that a laissez-faire health-care system is not only ethically questionable, but inefficient. Arrow’s basic insight was that a consumer buying a car, microwave or laptop is in a vastly different situation from a ‘consumer’ seeking treatment for cancer or care for a broken foot. Making decisions on healthcare requires specialised knowledge and often happens under great pressure. If you get an operation, it might take years for you to discover if the service you received was good or bad—and you can’t return a bad medical procedure for a refund. “The idea that this can all be reduced to money,” Paul Krugman wrote in The New York Times, “that doctors are just “providers” selling to healthcare “consumers” - is just sickening.”

In an interview with Physicians for a National Health Program, an organisation advocating for single-payer health care, Arrow said that:

“A single payer [that is, the government] will have control that will allow it to prevent things like differential pricing from happening. If the government was allowed to use its bargaining power, it would dominate. There will be monopolies, but they would be facing a single payer. A monopoly usually has power because it is the only one facing a large market of diverse individuals”.

Single payer, he concluded, is “better than any other system [of healthcare]”. Economically, it is ostensibly inefficient to leave health care unregulated, even to staunch believers in the free market. Ethically, treating people in need of care as consumers is dubious at best. So why is there even a debate?

Opponents of single payer, including many Republicans, argue that it would lead to an increase in healthcare spending, which they say is already excessive. Donald J. Trump has claimed that “single-payer will bankrupt our country, because it’s more than we take in, for just health care.” But recent studies have shown this to be wrong. The Lewin Group, when analysing a single-payer plan for Minnesota, concluded that a “single-payer plan would achieve universal coverage while reducing total health spending for Minnesota by about $4.1 billion, or 8.8 percent.”

Put simply, public insurance is the cheaper option—for two reasons. Firstly, governments are generally more efficient at bidding down prices from hospitals and health care providers due to their monopoly power—essentially meaning that doctors can’t ‘revolt’ and leave their private insurer for another one. A study by CNN Money found that a “government program typically pays only 80% of what private insurers do.” Secondly, the administrative work that goes into dealing with private insurers drives prices upwards for hospitals—these additional costs are passed on to consumers.

I contacted leftist cultural critic Peter Coffin about the American fight for single payer. “We need single payer because not everyone is wealthy. In fact, almost no one is wealthy, relatively speaking”, he wrote, before adding:

“Single payer does not automatically solve all of these issues, but it does provide a solution and is a stepping stone to other solutions. It’s one of the cornerstones of a legitimately progressive agenda because it helps to remove economic pressure points that open the doors to solutions for social marginalization. We can’t keep looking at health care as just a profit driver. Even as a public service, health would still be a massive driver of our economy—so why the hell don’t we want everyone to have it?”

So far, there’s a compelling argument for the Democrats to support the scheme as a centrepiece of the so-called ‘Better Deal’, the party’s new manifesto. Whether on economic or ethical grounds—single payer is the expansion of Obamacare that America needs.

The pressure is being put on—to little avail. I spoke to Tina-Desiree Berg, a Californian activist currently pushing for SB 562—a health care policy that aims to “guarantee that every resident of California will receive comprehensive healthcare services” while building on the advancements made by the Affordable Care Act. She noted that, “We just had a single-payer bill here in California tabled by a Democrat in a democratically controlled legislature. Why?” To Berg, the question that needs to be asked is, “Who is benefitting?” Her answer: “The corporations and bought legislature.” It’s no surprise to many on the left that the Democrats have continued to unabashedly pander to their donors and lobbyists.

Like Coffin, Berg also acknowledges that single payer will involve tax increases. “But here is the catch. Those increases will be much less than what we are paying currently in premium, co-pays and the like. It’s a bogus argument and the majority of voters are realizing this.” Polls suggest that she’s right—a Pew study shows that there’s been an uptick in support for single payer, which now stands at 33%, up 5% from the start of the year. Among Democrat voters, support is now at 52%.

A Pew study shows that there’s been an uptick in support for single payer this year. Pew Research Center

On a national level, the Democrats are in an internal battle — and it’s one that will likely shape the next election. But let’s not forget—Democrats do not represent the entirety of the American left. The fight for single payer does not start and end on Capitol Hill. As R.L Stephens wrote last month in Jacobin, “Our organizing can’t just speak to the everyday crises of people’s lives under capitalism. It has to intervene in them.” He then went on to cite the Black Panthers and their breakfast programme which fed thousands of hungry children. The Democratic Socialists of America, the largest socialist organisation in the US, has homed in on this philosophy, and has been an integral part of getting single payer to the Californian Democrat table.

Single payer healthcare isn’t socialism. But, as Coffin wrote, it’s a “stepping stone” towards a fairer healthcare system, one in which people don’t fear their hospital bill more than the condition that put them there. It’s an issue which the American left needs to continue to rally around. It could save the Democrats, reinvigorate the left and, most importantly, help millions who face inadequate and exorbitant healthcare today.

Lead photo of Bernie Sanders. AFGE / Flickr

Kumail Jaffer is a final year PPE undergrad at the University of Warwick/University of Waterloo and an intern at The Dial.