Some of the most powerful people in the US are talking about a massive change to healthcare

Doctor patient concern worryGerald Herbert/AP ImagesIn a Friday, May 6, 2016 photo, LSU medical student Felicia Venable, left, briefs fellow students and medical residents on a patient they are visiting during daily rounds with a group of medical residents and medical students at Our Lady of the Lake Regional Medical Center in Baton Rouge, La.

Once confined to the fringes of debate, the idea of single-payer healthcare is making a comeback with support from some unlikely places.

Single-payer healthcare is a system used in Canada, France, the UK, Australia, and other countries. In theory, it provides near-universal coverage through the government rather than private insurance companies (some countries use a hybrid public/private structure).

While progressive groups have long pushed for a single-payer system in the US, Democratic Party leaders are starting to suggest they are open to advocating for such a system.

“We’re going to look at broader things” for the nation’s healthcare system, Senate Minority Leader Chuck Schumer said on ABC. “Single-payer is one of them.”

Some of the richest and most powerful Americans — many of them Republicans — have recently brought up the possibility of shifting to the single-payer system. It comes as the Republican-controlled government has spent months attempting to revamp the US healthcare system with legislation that would move the system further away from single-payer.

Perhaps the most striking was the recent admission by Aetna CEO Mark Bertolini, at a private conference, that the US should start considering the idea.

According to Vox’s Sarah Kliff, Bertolini told Aetna employees at a town-hall-style meeting in May that regarding single-payer, “I think we should have that debate as a nation.”

Kliff said, according to a person who was in attendance and provided the comments, that Bertolini did not support a total government-run single-payer system, but could be open to a private-public system that is used in some nations.

“So the industry has always been the back room for government,” Bertolini said. “If the government wants to pay all the bills, and employers want to stop offering coverage, and we can be there in a public private partnership to do the work we do today with Medicare, and with Medicaid at every state level, we run the Medicaid programs for them, then let’s have that conversation.”

The idea for Bertolini is that the government would finance insurers to provide the care, similar to a Medicare-for-all. The Aetna CEO, however, didn’t think total government run healthcare was the solution, which makes sense considering it would put him out of business.

“But if we want to turn it all over to the government to run, is the government really the right place to run all this stuff?” Bertolini said. “And that’s the debate that needs to be had. They could finance it, and if there is one financier, and you could call that single-payer.”

The shift is understandable for Aetna, since for the first-time most of its business is coming from government programs like Medicare and Medicaid. Additionally, as Bertolini repeatedly likes to point out in interviews, the insurer was the first Medicare provider in 1965.

In addition to the CEO of one of the five largest public insurers in the US, the single-payer idea has also received recent calls of support from business titans Warren Buffett and Charlie Munger.

Munger, who is a Republican, railed against the current US healthcare system at Berkshire’s annual meeting on May 6, and in subsequent interviews said the country should shift to single-payer.

“The whole system is cockamamie,” Munger said in an interview with CNBC’s Becky Quick on Monday. “It’s almost ridiculous in its complexity and it’s steadily increasing cost and Warren is absolutely right. It gives our companies a big disadvantage in competing with other manufacturers. They have got single-payer medicine and we’re paying it out of the company.”

Buffett, when asked by Quick if he supported single-payer, said, “I personally do.”

Buffett also bemoaned the fact that the US pays roughly 17% of GDP to healthcare costs (according to the Centres for Medicare and Medicaid Services, it was 17.8% of GDP in 2015), much higher than any other developed nation. The Berkshire CEO noted that these increased costs for businesses are holding back American competitiveness, rather than the corporate tax rate.

Even President Donald Trump, who has supported Republican-led efforts to overhaul the healthcare system, has praised Australia’s public-private system (the government pays roughly 70% of all healthcare costs). He did so in a meeting with Prime Minister Malcolm Turnbull and in subsequent tweets.

“I shouldn’t say this to our great gentlemen and my friend from Australia … cause you have better healthcare than we do,” Trump said in his meeting with Turnbull on May 5.

After critics noted that Australia has a universal healthcare system in which the government pays roughly 70% of all costs, Trump took to Twitter to defend the comment the next day.

“Of course the Australians have better healthcare than we do — everybody does,” Trump tweeted.

With Republican control of the presidency and Congress, much of the talk about single-payer will amount to just talk on the national level. There is some action being taken on the state level, though. Both California and Illinois have recently discussed legislation that would provide single-payer in those states. Other states have also discussed the issue in the past.

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