While a single-payer system might be the most effective at achieving universal healthcare coverage in the U.S., "political realities" as well as the makeup of the uninsured population mean that an incremental approach building upon the Affordable Care Act is actually the most feasible, according to Kaiser Family Foundation President and CEO Drew Altman.
In a blog post from the Wall Street Journal, Altman points out that the remaining uninsured are "not a monolithic group," so it will be necessary to chip away at the uninsured rate group by group. For instance, 7 million of the 30 million remaining uninsured haven't signed up for ACA coverage despite being eligible for tax credits to lower the cost, and 8.9 million who are eligible for Medicaid haven't enrolled in a plan.
The two Democratic presidential candidates' differing views on the issue were on display during Thursday night's debate. Hillary Clinton argued that Bernie Sanders' claim about how much the average family would save with his plan does not add up. But the Vermont senator stuck by his position, adding that the U.S. spends more than three times per capita on healthcare than the United Kingdom and 50 percent more than France, which both guarantee healthcare to all people.
But Clinton said the U.S. is fundamentally different than those countries. "What we have tried to do and what President Obama succeeded in doing, was to build on the healthcare system that we have, get us to 90 percent coverage--we have to get the other 10 percent of the way to 100," she said. "I far prefer that and the chances we have to be successful there, than trying to start all over again."
Altman writes that Sanders has acknowledged that a single-payer system may be difficult politically, especially in the absence of campaign finance reform.
But Sanders told the Washington Post in an interview Wednesday that he's optimistic his plan can be accomplished with enough public support. "We're going to have to rally the American people to accomplish it," he said. "If we do what I hope to do politically, it is realistic."
Single-payer plan gets boost from Bernie Sanders' big New Hampshire win
Bernie Sanders' healthcare plan: The trouble with nixing private insurers
Bernie Sanders details plan for single-payer healthcare system
Clinton vs. Sanders: Battle of the healthcare policies