The hidden agenda of the course was to give Harvard’s perspective on a national universal health system, which seemed imminent at the time. So believed most of our Harvard instructors.
What about a single-payer system as a way forward, as proposed by Bernie Sanders in his Medicare-for-all proposal? Not a chance says Jonathon Oberlander, a health care analyst at the University of North Carolina in the April 14 New England Journal of Medicine, "The Virtue and Vices of Single Payer Health Care."
"Single payer has no realistic path to enactment in the foreseeable future. It remains an aspiration more than a viable reform program. Single-payer supporters have not articulated a convincing strategy for overcoming the formidable obstacles that stand in its way. Nor have they, despite substantial public support for single payer, succeeded in mobilizing a social movement that could potentially break down those barriers. The pressing question is not about whether Medicare for All can be enacted during the next presidential administration — it can’t — but where health care reform goes from here."
"It’s possible that some states could, through waivers that begin in 2017, consider adding a public option to their marketplaces or even adopt single-payer systems. Yet Vermont’s recent struggles to make a modified single-payer plan work underscore the challenges to state action. At the federal level, incremental steps toward Medicare for All, such as expanding program eligibility to younger enrollees, are conceivable — though challenging in this political environment. Moreover, the fight over Obamacare is not over. Preserving and strengthening the ACA, as well as Medicare, and addressing underinsurance and affordability of private coverage is a less utopian cause than single payer. I believe it’s also the best way forward now for U.S. medical care."