If “Ryancare” Is Dead on Arrival, Can We Please Now Try Single Payer?

The Canadian plan also helps Canadians live longer and healthier than Americans. . . . We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.  

— Donald Trump, The America We Deserve (2000)

The new American Health Care Act has been unveiled, and critics are calling it more flawed even than the Obamacare it was meant to replace. Dubbed “Ryancare” or “Trumpcare” (over the objection of White House staff), the Republican health care bill is under attack from left and right, with even conservative leaders calling it “Obamacare Lite”, “bad policy”, a “warmed-over substitute,” and “dead on arrival.”

The problem for both administrations is that they have been trying to fund a bloated, inefficient, and overpriced medical system with scarce taxpayer funds, without capping its costs. US healthcare costs in 2016 averaged $10,345 per person, for a total of $3.35 trillion dollars, a full 18 percent of the entire economy, twice as much as in other industrialized countries.

Ross Perot, who ran for president in 1992, had the right idea: he said all we have to do is to look at other countries that have better health care at lower cost and copy them.

So which industrialized countries do it better than the US? The answer is, all of them. They all not only provide healthcare for the entire population at about half the cost, but they get better health outcomes than in the US. Their citizens have longer lifespans, fewer infant mortalities and less chronic disease.

President Trump, who is all about getting the most bang for the buck, should love that.

Hard to Argue with Success

The secret to the success of these more efficient systems is that they control medical costs. According to T. R. Reid in The Healing of America, they follow one of three models: the “Bismarck model” established in Germany, in which health providers and insurers are private but insurers are not allowed to make a profit; the “Beveridge model” adopted in Britain, where most healthcare providers work as government employees and the government acts as the single payer for all health services; and the Canadian model, a single-payer system in which the healthcare providers are mostly private.

A single government payer can negotiate much lower drug prices – about half what we pay in the US – and lower hospital prices. Single-payer is also much easier to administer. Cutting out the paperwork can save 30 percent on the cost of insurance. According to a May 2016 post by Physicians for a National Health Program:

Per capita, the U.S. spends three times as much for health care as the U.K., whose taxpayer-funded National Health Service provides health care to citizens without additional charges or co-pays. In 2013, U.S. taxpayers footed the bill for 64.3 percent of U.S. health care — about $1.9 trillion. Yet in the U.S. nearly 30 million of our citizens still lack any form of insurance coverage.

The for-profit U.S. health care system is corrupt, dysfunctional and deadly. In Canada, only 1.5 percent of health care costs are devoted to administration of its single-payer system. In the U.S., 31 percent of health care expenditures flow to the private insurance industry. Americans pay far more for prescription drugs. Last year, CNN reported, Americans paid nearly 10 times as much for prescription Nexium as it cost in the Netherlands.

Single payer, or Medicare for All, is the system proposed in 2016 by Democratic candidate Bernie Sanders. It is also the system endorsed by Donald Trump in his book The America We Deserve. Mr. Trump confirmed his admiration for that approach in January 2015, when he said on David Letterman:

A friend of mine was in Scotland recently. He got very, very sick. They took him by ambulance and he was there for four days. He was really in trouble, and they released him and he said, ‘Where do I pay?’ And they said, ‘There’s no charge.’ Not only that, he said it was like great doctors, great care. I mean we could have a great system in this country.

Contrary to the claims of its opponents, the single-payer plan of Bernie Sanders would not have been unaffordable. Rather, according to research by University of Massachusetts Amherst Professor Gerald Friedman, it would have generated substantial savings for the government:

Under the single-payer system envisioned by “The Expanded & Improved Medicare For All Act” (H.R. 676), the U.S. could save $592 billion – $476 billion by eliminating administrative waste associated with the private insurance industry and $116 billion by reducing drug prices . . . .

According to OECD health data, in 2013 the British were getting their healthcare for $3,364 per capita annually; the Germans for $4,920; the French for $4,361; and the Japanese for $3,713. The tab for Americans was $9,086, at least double the others. With single-payer at the OECD average of $3,661 and a population of 322 million, we should be able to cover all our healthcare for under $1.2 trillion annually – well under half what we are paying now.

The Problem Is Not Just the High Cost of Insurance

That is true in theory; but governments at all levels in the US already spend $1.6 trillion for healthcare, which goes mainly to Medicare and Medicaid and covers only 17 percent of the population. Where is the discrepancy?

For one thing, Medicare and Medicaid are more expensive than they need to be, because the US government has been prevented from negotiating drug and hospital costs. In January, a bill put forth by Sen. Sanders to allow the importation of cheaper prescription drugs from Canada was voted down. Sanders is now planning to introduce a bill to allow Medicare to negotiate drug prices, for which he is hoping for the support of the president. Trump indicated throughout his presidential campaign that he would support negotiating drug prices; and in January, he said that the pharmaceutical industry is “getting away with murder” because of what it charges the government. As observed by Ronnie Cummins, International Director of the Organic Consumers Association, in February 2017:

. . . [B]ig pharmaceutical companies, for-profit hospitals and health insurers are allowed to jack up their profit margins at will. . . . Simply giving everyone access to Big Pharma’s overpriced drugs, and corporate hospitals’ profit-at-any-cost tests and treatment, will result in little more than soaring healthcare costs, with uninsured and insured alike remaining sick or becoming even sicker.

Besides the unnecessarily high cost of drugs, the US medical system is prone to over-diagnosing and over-treating. The Congressional Budget Office says that up to 30 percent of the health care in the US is unnecessary. We use more medical technology then in other countries, including more expensive diagnostic equipment. The equipment must be used in order to recoup its costs. Unnecessary testing and treatment can create new health problems, requiring yet more treatment, further driving up medical bills.

Drug companies are driven by profit, and their market is sickness – a market they have little incentive to shrink. There is not much profit to be extracted from quick, effective cures. The money is in the drugs that have to be taken for 30 years, killing us slowly. And they are killing us. Pharmaceutical drugs taken as prescribed are the fourth leading cause of US deaths, after heart disease, cancer and stroke.  

The US is the only industrialized country besides New Zealand that allows drug companies to advertise pharmaceuticals. Big Pharma spends more on lobbying than any other US industry, and it spends more than $5 billion a year on advertising. Lured by drug advertising, Americans are popping pills they don’t need, with side effects that are creating problems where none existed before. Americans compose only 5 percent of the world’s population, yet we consume fully 50 percent of Big Pharma’s drugs and 80 percent of the world’s pain pills. We not only take more drugs (measured in grams of active ingredient) than people in most other countries, but we have the highest use of new prescription drugs, which have a 1 in 5 chance of causing serious adverse reactions after they have been approved.

The US death toll from prescription drugs taken as prescribed is now 128,000 per year. As Jon Rappaport observes, with those results Big Pharma should be under criminal investigation. But the legal drug industry has grown too powerful for that. According to Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine, writing in 2002:

The combined profits for the ten drug companies in the Fortune 500 ($35.9 billion) were more than the profits for all the other 490 businesses put together ($33.7 billion). Over the past two decades the pharmaceutical industry has [become] a marketing machine to sell drugs of dubious benefit, [using] its wealth and power to co-opt every institution that might stand in its way, including the US Congress, the FDA, academic medical centers, and the medical profession itself.

It’s Just Good Business

US healthcare costs are projected to grow at 6 percent a year over the next decade. The result could be to bankrupt not only millions of consumers but the entire federal government.

Obamacare has not worked, and Ryancare is not likely to work. As demonstrated in many other industrialized countries, single-payer delivers better health care at half the cost that Americans are paying now.

Winston Churchill is said to have quipped, “You can always count on the Americans to do the right thing after they have tried everything else.” We need to try a thrifty version of Medicare for all, with negotiated prices for drugs, hospitals and diagnostic equipment.



Ellen Brown is the founder of the Public Banking Institute and a Research Fellow at the Democracy Collaborative. She is the author of a dozen books including the best-selling Web of Debt, on how the power to create money was usurped by a private banking cartel; and The Public Bank Solution, on how the people can reclaim that power through a network of publicly-owned banks. She has written over 300 articles, posted at EllenBrown.com; and co-hosts a radio program on PRN.FM called “It’s Our Money with Ellen Brown.”


25 Responses

  1. Reblogged this on Dreams of Liberty and commented:
    Hitting all the right points!

  2. No mention of over regulation of practitioners, drugs, supplements, and natural health companies, over paid god like status doctors and all those associated with the profession, lack of alternative practitioners, lack of promotion of real foods and healthy life style, etc. This is the real problem. Health care costs would be a lot lower if there was less regulation and more options.

  3. Reblogged this on and commented:
    Let’s make a deal with each other. To make single-payer health care available to everyone, let’s all agree to accept greater personal responsibility for our own health. How we treat each other and ourselves matters when it comes to health and well-being.

  4. Easier said than done. Controlling a couple of the most profitable segments in our society, insurance and pharmaceuticals, won’t be easy. Plus Republicans hate anything that has to do with big gov’t. Trump seems to also agree with this sentiment. What logically makes sense doesn’t always win.

    • On its surface, it sounds so good, I really (as a Repub) want to jump on board and say “hell ya!”- But the realist in me reminds myself that “anything government puts its hands on, it screws up”. One would think a thrifty govt could negotiate lower prices, but those in charge of said gov agencies are likely to be lobbied (as our corrupt leaders are) and bribed to step up the costs! Then were back in square one with high costs lobbied legally in place by UBER RICH Pharma, and mandated by the point of Gov Guns. No thanks, second thought, I’d rather free market greed bring in lower prices for higher sales. (with all monopoly laws in full effect of course)

  5. Interesting article. But I’m surprised, Ellen, that you would take Trump at his disingenuous word. Trump has made it abundantly clear that his administration is about, first, using the government as his personal piggy bank and, two, shoveling more money into his billionaire buddies’ pockets. The fight for single payer is one that will have to be fought against the Trump regime.

  6. Why do Americans want to live there? If I was American I would be trying my best to hightail it out as fast as I could. Guns, drugs, prisons, poor employment standards, racial problems, gigantic education costs. It is like people can’t think for themselves. Too much TV maybe and not enough talk about real issues. More pain pills please quips the American so I can zombie out.

  7. […] Ellen Brown Writer, Dandelion Salad The Web of Debt Blog March 14, […]

  8. […] “Ryancare” Dead on Arrival: Can We Please Now Try Single Payer? […]

  9. Healthcare is a public good,which has to be administered by the government. If not then the profit motive intrudes, at considerable expense.
    The healthcare system has to be funded by the national government. Only a national, monetary sovereign government can pay for the scheme. It is enabled under the Constitution with ultimate control over its Dollar, so it never needs to borrow or save its own dollars. It can simply buy all the healthcare dollars as they fall due, an ability unique to any and every such major grover so there is no cost

    Simple and direct!

  10. Reblogged this on zRants and commented:
    Health care costs cutting measures that America can take by following the success of other countries.

  11. […] Ellen Brown Global Research, March 15, 2017 The Web of Debt 14 March […]

  12. Reblogged this on The Most Revolutionary Act and commented:
    I love the quote from Donald Trump advocating for single payer health care in 2000.

  13. I just have a couple of very simple questions – under a single payer plan would I be able to opt out? Or would I be forced to participate?

  14. […] Ellen Brown Global Research, March 15, 2017 The Web of Debt 14 March […]

  15. How about set up a national insurance company (NIC), owned by the individual insurance companies like the Fed is for banking. This should get Republican support by cutting in insurance companies (much like the Fed Reserve got support by the illusion of being government run)

    Efficiencies in rolling over all health care into 1 agency and the negotiating power of 1 company representing 300 million customers will drop total HC costs from 3.3 trillion to 2 trillion. Allow the NIC to keep 6% paid out as dividends and the total cost should be no more than 2.1 trillion.

    No premiums or out of pocket expenses for consumers (citizens and legal residents) . Free healthcare for all. Congress has oversight and approves the budget that is allocated to the NIC to control cost increases.

    Where does the money come from? Federal, state/local and employer current contributions to HC are 1.7 billion at present. Keep those in place (rename medicare tax, add corporate health tax). The other 40 billion can come from some combination of a financial transaction tax and national sales tax as well as a 10% luxury tax on salaries/compensation worth more than 1 million a year paid by any company

    Those wanting better care like single rooms or plastic surgery can buy supplementary insurance coverage. Most individuals will have more disposable income for spending into the real economy (not spending into the fictitious economy which helps nobody but a few rich folks) which as we know will trickle up to the rich

  16. We can expand Medicare to everyone without raising taxes on the middle class by creating a national network of genuinely nonprofit clinics and member-owned health plans.  This will cut HMOs out of the deal, reduce administrative overhead, and convert the system from greed to generosity. 

    National health insurance was pioneered in the United States 120 years ago by fraternal benefit societies– the funny-handshake people– whose members built hospitals, orphanages, old folks’ homes and, for pennies per week, received sickness and death benefits. Their genuinely nonprofit systems, serving one third of American households, could have merged to national scale but were gradually outlawed by corporate lobbyists.

    Canada’s national health plan began with the 1947 co-op model created by a Saskatchewan farm town of 15,000. In 1997 I started the Ithaca Health Alliance in the same spirit. We covered members for 12 categories of common emergency for $100/YEAR, then started our own free clinic.

    My book “Health Democracy,” based on that successful co-op, explains how: http://www.paulglover.org/books.html

  17. Ellen, you should push Californian Senator Lara to introduce a bill for a state owned California bank. He previously joined the effort in 2011 with AB-750 and introduced the current single payer health bill, SB-562. This bill is currently getting great traction.


  18. […] — source ellenbrown.com […]

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