DAVOS, Switzerland — In recent weeks, former Secretary of State Hillary Clinton and Vermont Sen. Bernie Sanders have traded accusations about their healthcare plans — the former’s campaign has defended the private insurance industry that has financially supported Clinton’s political career, while the latter has proposed to create a Medicare-for-all system, with the government as the single payer. But while the two positions seem different, Health and Human Services (HHS) Secretary Sylvia Mathews Burwell told the World Economic Forum Thursday that the political debate is missing a key point: Today's so-called Obamacare system is really a hybrid of the two ideas.
Responding to a question about the intensifying political debate over healthcare, Burwell said President Barack Obama's 2010 Affordable Care Act “created a marketplace that has both government payment as well as market payment.” But, she argued, the United States may be closer to a government-supported system than many realize.
“Many times we don’t recognize everyone in the United States is supported by the government in their healthcare if they have it in any form — in some form, most likely,” she said. “If you’re in Medicare, obviously you’re being subsidized by the government. Let’s just say you’re in employer-based care. Well tax benefits are a huge subsidy that the American taxpayer is giving you for that care. Let’s say you’re in Medicare — Medicaid. Medicaid is being subsidized by the government, and in the marketplace, 8 out of 10 folks in the marketplace have subsidies.” (She clarified that there are a few people in the marketplace whose healthcare isn’t supported by the government because they don’t qualify for subsidies).
As Congress debated healthcare legislation in 2009, some lawmakers pushed to expand traditional Medicare or add a government-administered insurance policy known as a “public option” to the proposal. Those initiatives were ultimately blocked, after furious lobbying by the private health industry. In the lead-up to the final vote on the legislation, then-HHS Secretary Kathleen Sebelius asserted that the Affordable Care Act was tailored to prevent the creation of the kind of single-payer, government-run system that many industrialized nations today have, and that Sebelius herself had endorsed in 2007.
"I think that's very much the case,” she told National Public Radio when asked if the bill was designed to prevent single payer. “If you want anybody to convince people of that, talk to the single-payer proponents who are furious that the single-payer idea is not part of the discussion."
The same cannot be said for today, as Sanders — who is the only 2016 candidate to cast a congressional vote for the Affordable Care Act — is now pledging that if elected president, he will push to create a single-payer system that guarantees government-sponsored healthcare to all Americans.
Clinton has portrayed single-payer as a costly effort to fully roll back the current Affordable Care Act. However, Burwell this week suggested that in practice, the two do not necessarily have to be mutually exclusive: she said that — despite Sebelius’ earlier comments — there is nothing in the current Affordable Care Act that prevents states from trying to create their own single payer systems, as Vermont initially attempted, and as Colorado voters will likely consider during their 2016 election.
“Can states choose to do things within this system? Sure. But they have to meet pretty high standards,” she told International Business Times. In the meantime, as the campaign debate over healthcare continues to simmer, she said her department is focused on implementing the current legislation as it is.
“Right now we are in a system that has a market and a system that has direct pay by the government, and that’s a system we’re working hard to make work,” she said. “What we want to do is make the system in front of us work, because we’ve seen it reduce the uninsured by 45 percent ... We’ve seen progress on affordability and quality, but not as much as we’d like.”