"Some of the Democrats are concerned about pushing for full single-payer when they don't know what it's going to cost or how it's going to be paid for, so they're taking a stepping stone approach," Pipes says. "They're putting the public option back in, which was in the original House bill for the Affordable Care Act, before it went to the Senate."
The likelihood of any version of Medicare-for-all passing in the next two years is dubious, Pipes says.
Major reform is unlikely to happen at the national level under the Trump administration, though there could be movement on the state level while the Democrats keep the federal legislation warm on the back burner, Pipes says.
Impact not understood
Having lived with a single-payer system in her native Canada, Pipes opposes such a wholesale change in the American system. She notes, however, that out of 1,850 adults in the U.S. who were surveyed in a recent poll, 51% supported the idea of a single-payer plan.
"My worry is that the American people don't understand what single-payer means when the government is the only payer for your healthcare, what the tax increases would be, and the long waiting lists for healthcare," Pipes says. "The average wait to see a specialist in Canada is 21.2 weeks, over five months, having grown from 9.3 weeks in 1993. When you look at these various bills, the same things would happen in the United States if we go that way."
Those long waiting lists would come partly as the result of a Medicare-for-all plan driving healthcare professionals out of the business, Pipes says.
Physicians will not want to work for Medicare wages, she says, which are about 20% below what they typically get for treating private insurance patients.
Hospitals also will be stressed by the reduced revenue. That will make it difficult to pay nurses and other healthcare workers competitive wages, causing many of them to leave the industry also, Pipes says. Access to care and quality of care would suffer, she says.
"Doctors retiring early, the best and the brightest kids not going into medicine, and care being rationed because the government only has so much to spend even when they keep increasing taxes," Pipes says. "That's what would happen if these plans go through, especially a plan like the Sanders proposal that would go right to single-payer."
No agreement in D.C.
Republicans, particularly Ted Cruz (R-TX), have said they are not giving up on the goal of repealing and replacing Obamacare, but Pipes is doubtful that would happen any time soon because they don't want to stir up that debate before the midterm elections.
Gregory A. Freeman is a contributing writer for HealthLeaders.