Senate Republicans appear miles away from their long-sought repeal of Obamacare, returning to Washington on Monday with just a few weeks to put the pieces back together before they could be forced to abandon their partisan attempts at a health care overhaul altogether. 
 
 Over the July 4 recess, conservative demands hardened and surprising opposition to the Senate GOP’s first stab revealed itself in red states like North Dakota and Kansas. Republicans sniped over the merits of deregulating the health insurance industry and GOP senators began floating exit strategies in case they can’t agree on legislation, ranging from working with Democrats to amend Obamacare to simply repealing the law and figuring out how to replace it later. 
 
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 Senate Majority Leader Mitch McConnell isn’t giving up yet, and his staff and allies toiled over the break to fashion a compromise that can get 50 of the Senate GOP’s 52 senators on board. The calculating Kentucky Republican could still find a deal that unites his fractious party. But McConnell and his whip, John Cornyn of Texas, are facing the party’s toughest legislative task since taking the majority in 2014. 
 
 At best, the repeal effort stayed stuck in neutral over the past nine days, several Republicans familiar with the ongoing negotiations said. At worst, the bill McConnell unveiled before the recess has little chance of being saved. 
 
 “My view is it’s probably going to be dead,” Sen. John McCain (R-Ariz.) said on “Face the Nation” on Sunday. “I fear that it’s going to fail.” 
 
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 White House chief of staff Reince Priebus said on "Fox News Sunday" that such a result would be unacceptable. The rest of President Donald Trump's agenda is already moving glacially through Congress. If the GOP's six-month effort on health care is scuttled ahead of the August recess, the party risks coming up empty-handed during what is typically the most fertile period of legislating in a president's first term. 
 
 "The president expects them to get this done. The president expects the Senate to fulfill the promises it made to the American people," Priebus said. 
 
 The president also addressed the subject Sunday in a tweet: "For years, even as a 'civilian,' I listened as Republicans pushed the Repeal and Replace of ObamaCare. Now they finally have their chance!" 
 
 This week, McConnell is expected to receive critical guidance from the Congressional Budget Office on whether a flurry of tweaks made in June will improve on initial estimates that the bill would result in 22 million fewer people with insurance. The nonpartisan office is also considering whether premiums can be reduced further. 
 
 McConnell’s initial proposal was broadly similar to a version that passed the House in May, and it would repeal most of the taxes created by the 2010 Obamacare law and scale back subsidies that help people buy insurance. It also would make major cuts to the Medicaid program, which covers low-income families and people with disabilities, and allow insurance companies to charge older people more for coverage. 
 
 After that bill failed to get enough support among Senate Republicans, the GOP asked the CBO to weigh proposals that would leave in place Obamacare’s taxes on Medicare and wealthy individuals, allocate more money for low-income people’s insurance, allow pre-tax money to pay for premiums and supply $45 billion to fight opioid funding, according to senators and aides. 
 
 Republicans will also learn the impact of a proposal from Sens. Mike Lee and Ted Cruz to drag the bill further to the right by eviscerating Obamacare's insurance regulations. 
 
 In an interview Sunday evening, Sen. Bob Corker (R-Tenn.) said that Cruz "is trying to deal in good faith" and that his amendment that would allow the sale of some cheap, deregulated insurance plans "can be resolved." 
 
 "I hope it can be resolved in a manner that's kept from undermining the pre-existing conditions component," Corker said. 
 
 On Monday, McConnell will gather with his leadership team to begin plotting ways to resuscitate the ailing legislation. On Tuesday, the full GOP caucus will meet for the first time in nearly two weeks, which aides predicted would be a rowdy gathering pitting holdouts against McConnell allies. Republican senators will be pressured to choose between protecting Obamacare or supporting McConnell’s effort. 
 
 “Obamacare is failing. Whether or not we can come together, I don't know. Mitch is trying,” said Sen. Lindsey Graham (R-S.C.) on “Meet the Press.” “My advice is, if it does fail, work together in a bipartisan fashion to replace it.” 
 
 Rather than boasting about their chances of success, Republicans have spent the past few days fixated on what happens if McConnell does not succeed. The leader himself has said that doing nothing is not an option and that, if their repeal effort fails, the GOP will have to work with Democrats to stabilize unsteady individual insurance markets. In June, McConnell told Trump directly that if Senate Republicans could not agree on how to replace Obamacare, the party would have to negotiate with Senate Minority Leader Chuck Schumer (D-N.Y.). 
 
 Conservatives would rather repeal Obamacare immediately and devise a replacement plan later if the party’s simultaneous efforts fail. Treasury Secretary Steven Mnuchin predicted Sunday that if the Senate bill fails, Trump will advocate for a straight-up repeal. 
 
 Yet other Republicans disagree with that approach, and it seems unlikely 50 senators would agree to repeal Obamacare without a replacement plan in hand. 
 
 “Non-starter. There will be uncertainty in the insurance markets. Premiums will rise,” Sen. Bill Cassidy (R-La.) said on “Fox News Sunday.” “I think it’s wrong; I think it betrays President Trump’s campaign pledges.” 
 
 Mnuchin also backed Cruz's and Lee's amendment despite opposition from moderates, amplifying the party's internal discord. 
 
 “I’m very hopeful that his plan and his changes will get supported,” Mnuchin said of Cruz on ABC’s “This Week.” 
 
 Cruz and Lee, a Texan and Utahn, are an imminent problem for McConnell. They worked alongside leadership for months but now are demanding a more conservative approach than the GOP’s initial draft. Conservative groups and the Trump administration now support their addition, highlighting a clash among Republican senators with differing health care ideologies. The bill almost certainly would fail without Cruz and Lee's support. 
 
 The duo spent the break advocating for their Consumer Freedom Act, which would allow the sale of cheap, deregulated health care plans alongside Obamacare-compliant plans with protections for pre-existing conditions and other minimum benefits. They argue that allowing more diversity in insurance plans would reduce premiums, but critics say the approach would shift sick people into one risk pool and healthy people into another, a recipe for a market meltdown. 
 
 Lee will vote against any bill that does not include their amendment or something similar that guts regulations, his office said. 
 
 "Sen. Lee has been flexible and consistent from Day One. Americans need regulatory relief from Obamacare, and he will not vote for something that does not provide that relief. [The Consumer Freedom Amendment] is that bare minimum relief,” said spokesman Conn Carroll. 
 
 But Republican senators like Chuck Grassley of Iowa and Susan Collins of Maine argued against such an amendment over the recess. Grassley warned that it could be “subterfuge to get around pre-existing conditions.” 
 
 Cruz said on ABC’s “This Week” that Grassley was borrowing his talking points from Schumer, a serious charge in GOP circles. 
 
 “The Consumer Freedom option is the key to bringing Republicans together and getting this passed,” Cruz said. “What’s being repeated [by Grassley] is what Chuck Schumer said this week.” ||||| (CNN) Progressives and Republicans have found something in common amid the raging health care debate: They all love talking about single-payer insurance. 
 
 No, they haven't bridged any of the divides on health care policy, and a Canadian-style single-payer plan -- the left prefers to call it "Medicare for all" -- remains implausible in the current Congress. 
 
 But both sides are beginning to see a political benefit in bringing it up. 
 
 Progressives have long held universal health care as a marquee public policy goal and increasingly see opportunities to push for a radical overhaul as President Donald Trump and Republicans on Capitol Hill face headwinds in their efforts to roll back Obamacare. 
 
 Vermont Sen. Bernie Sanders, an independent, is readying a bill proposing a single-payer system, and is expected to file it once the Senate finishes considering the GOP effort to repeal and replace former President Barack Obama's signature law. And more Democratic senators are publicly endorsing such a system. 
 
 Last week, New York Sen. Kirsten Gillibrand, who began her career as a moderate "Blue Dog" member of the House, backed single-payer. Massachusetts Sen. Elizabeth Warren, meanwhile, told The Wall Street Journal, "now it's time for the next step. And the next step is single-payer." 
 
 For Republicans, the calculation is different, but simple: Obamacare is politically more popular than the legislation Republican leadership is pushing on Capitol Hill. The danger of undercutting many of its provisions, including barring insurance companies from rejecting customers or hiking rates due to pre-existing conditions, is clear. For senators from states that accepted and have benefited from Medicaid expansion under the law, the vote is even trickier. 
 
 But single-payer health insurance, or "Medicare for all," is a much more divisive proposition. A recent Pew Research Center poll found that while 52% of Democrats support it, that number drops to 33% when the field expands to include Republicans. 
 
 In the White House and on Capitol Hill, GOP officials are now floating the prospect of a single-payer future -- rather than the survival of Obamacare -- as the likely alternative to a successful repeal process. 
 
 "If we have to negotiate with Chuck Schumer and the Democrats, we're going to be looking down the barrel of a single-payer system because that's what they want to see happen," Sen. John Thune, R-South Dakota, said on "Fox News Sunday." 
 
 Trump's deputy press secretary Sarah Huckabee Sanders brought up single-payer health insurance -- without being asked -- at the White House press briefing on Thursday. 
 
 "The other bill out there that's gained the support of a majority of House Democrats is the Bernie Sanders single-payer plan that would cost the government $32 trillion over the next decades. One hundred and thirteen House Democrats, including the DNC vice chair, have signed on to this approach," she said, referring to Rep. Keith Ellison of Minnesota, the deputy chairman of the Democratic National Committee. 
 
 "The President believes that it's completely unaffordable and creates a one-size-fits-all government approach to health care," she said. "That bill and others like it on the other side that have been proposed are clearly deal-breakers." 
 
 Progressives are also seeking to make use of Obamacare's rising popularity -- and the threat of its undoing. After years spent criticizing the law from the left, they have rallied to protect it in the face of repeal. 
 
 "Right now the goal is defeat this terrible piece of (Republican) legislation and then regroup and go forward doing what every other major country on Earth does and (pass) Medicare for all," Sanders told CNN last week. Days earlier, he and organizers from MoveOn.org, the liberal advocacy group, were barnstorming Pennsylvania, Ohio and West Virginia, rallying opposition to the GOP bill. 
 
 But even as Sanders railed against Trump, tallied Obamacare's achievements and warned about the dangers facing those who might lose coverage, the mention of "Medicare for all" still triggered the heartiest outpouring of applause at already boisterous events. 
 
 "If Democrats retake power, the idea of a public option and Medicare for all are going to be a much easier sell because they stood shoulder-to-shoulder in the fight today," MoveOn's Washington director, Ben Wikler, said as protests swirled on Capitol Hill ahead of the July 4 recess. 
 
 The real test, though, will come when Sanders releases his new single-ayer bill later in the summer. 
 
 The 2011 edition had zero co-sponsors . This new legislation figures to arrive with more support from Democrats, including potential 2020 hopefuls like Gillibrand and Warren, and to greater fanfare from Republicans, who sense both opportunity and danger. 
 
 In both cases, the one sure bet is that both sides will be eager to chat about it. ||||| Assembly Speaker Anthony Rendon’s abrupt decision Friday to sideline a bill that would have established single-payer healthcare in California roused a swift and fiery backlash from the measure’s supporters, who accused the Democrat from Paramount of unilaterally blunting the effort for sweeping overhaul of the state’s healthcare system. 
 
 Their anger was captured in a tweet by California Nurses Assn. leader RoseAnn DeMoro with an illustration of California’s iconic bear flag bearing the slogan “Healthy California” — and a knife with the name “Rendon” on the blade in the grizzly’s back. The tweet, and a similar Facebook post, was shared hundreds of times. 
 
 https://twitter.com/RoseAnnDeMoro/status/878997176843608065 
 
 Backers of the single-payer measure also made their displeasure known by stuffing Rendon’s office voicemail boxes, fuming in social media posts and canvassing Rendon’s southeastern Los Angeles district to tell his constituents about his action. 
 
 But the move to shelve the bill — and the ensuing fury — led other powerful Democrats, including Gov. Jerry Brown and leaders of Planned Parenthood of California and major labor unions, to applaud Rendon for slowing down a measure that was long on enthusiastic supporters but short on key policy specifics — most significantly, how to pay for it. 
 
 “Often we fine-tune a bill when it goes from one house to another through the committee process. This was so grotesquely beyond that,” Rendon said in an interview Monday. “This was essentially a $400-billion proposal without a funding source. That's absolutely unprecedented...This was not a bill, this was a statement of principles.” 
 
 The measure, Senate Bill 562 by state Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego), envisioned a dramatic reshaping of how Californians would receive health coverage. 
 
 You asked, we answered. Here are some of our readers' questions on California's proposed single-payer plan » 
 
 The state would cover most health costs for all California residents, regardless of immigration status. The system would do away with premiums, copayments and deductibles. Ostensibly, the program would have been financed by tax increases, although a specific source of tax revenue was not identified in the bill. 
 
 Progressive activists, led by the measure’s sponsor, the nurses’ union, have rallied around single payer as a way to ensure universal, comprehensive healthcare coverage. The issue has particularly resonated with supporters of Sen. Bernie Sanders’ (I-Vt.) presidential campaign, which was centered on a promise of “Medicare for all.” Sanders weighed in Saturday, saying he was “extremely disappointed” with Rendon’s action. 
 
 California won't be passing a single-payer healthcare system any time soon — the plan is dead for this year » 
 
 But even as the bill advanced through the state Senate, it was apparent that it would have to overcome several obstacles to succeed. Legislators, who voted this year to raise taxes on gasoline, were wary of backing additional taxes. The proposal hinged on approval by voters and the federal government. 
 
 Just hours before the Senate approved the bill in early June, it was unclear whether the measure would come up for a vote at all. Several Senate Democrats, who asked to remain anonymous to speak about internal caucus discussions with The Times, said legislators balked at being asked to take up a bill with uncertain financing. But they ultimately decided to advance the measure to keep the discussion alive — and to avoid alienating the party’s base. 
 
 The bill’s progress alarmed some interest groups that saw crucial questions go unanswered. Laphonza Butler, president of the statewide council of the Service Employees International Union, said her union was eager to discuss the single-payer proposal but worried that specifics about implementation, namely how it would be integrated with care programs offered by county governments, were going unaddressed. 
 
 “We expected the Senate would take amendments, have thoughts about the financing and the structure,” said Butler, who released a statement Friday afternoon backing Rendon’s decision to hold the bill. 
 
 Rendon said he had multiple conversations with Assembly Democrats about how to handle the proposal. 
 
 “A lot of the members of our caucus saw this bill as something that the Senate dumped at our doorstep without much thought or consideration about what was in it,” he said. 
 
 The move to shelve the bill is the type of legislative maneuver leaders have historically used in Sacramento to shield their members from politically thorny votes. 
 
 “By him holding it, he is basically putting himself in the position to take the hit on behalf of everybody instead of putting his members in a precarious position,” said former Assembly Speaker John A. Pérez, a Rendon ally. “I think that's actually the job of a leader.” 
 
 But proponents were livid at the sudden announcement, delivered late on a Friday afternoon via news release. 
 
 What would California's proposed single-payer healthcare system mean for me? » 
 
 “This is such bad form,” said Bonnie Castillo, associate executive director of the California Nurses Assn. “He did not even notify us, the sponsor of the bill, of what he was intending to do.” 
 
 Castillo scoffed at the notion that Rendon’s actions guarded his members from a fraught decision. 
 
 “I don't think he has protected anyone, and mostly he hasn't protected anyone in the state of California by denying them the opportunity to have comprehensive healthcare,” Castillo said. “Yes, it's hard. It takes leadership. Every other industrialized nation has been able to do this. It's not impossible.” 
 
 The nurses’ union noted that there was nothing stopping Assembly members from making their own modifications to the bill. 
 
 “We were fully expecting to complete this legislative process in the Assembly,” Castillo said. 
 
 But Rendon countered it was the bill authors’ job to make such drastic changes to the legislation. 
 
 “I didn't kill the bill,” Rendon said. “I'm telling the Senate to do their job, which is to come up with money.” 
 
 Single-payer backers jammed phone lines to Rendon’s Capitol and district offices over the weekend. Volunteers with the nurses’ union knocked on doors in his district, and rallies are planned at his Los Angeles and Sacramento offices later this week. Although one popular hashtag among supporters urged #RecallRendon, single-payer proponents are not actively seeking to oust him at the moment. Instead, they’re focused on pressing the speaker to change his mind. 
 
 Rendon’s backers say the outrage is misplaced. 
 
 “If they think Anthony Rendon is their problem in California, they need to open their eyes,” Pérez said. “They're more concerned with creating orthodoxy around a concept than actually improving the lives of people.” 
 
 melanie.mason@latimes.com 
 
 Follow @melmason on Twitter for the latest on California politics. 
 
 You asked, we answered. Here are some of our readers' questions on California's proposed single-payer plan 
 
 What would California's proposed single-payer healthcare system mean for me? 
 
 Updates from Sacramento ||||| Democrats are increasingly committing to support single-payer healthcare, amid Republican attacks on ObamaCare and pressure from their party’s left-wing base. 
 
 What was once considered only a progressive talking point has gained traction as more Democratic candidates have been willing to embrace government-funded healthcare on the campaign trail and more House members have been signing onto the idea. 
 
 Single-payer isn’t just being discussed in liberal enclaves of the country like California, where a single-payer measure recently fell short in the state Assembly. It’s a hot topic in Speaker Paul Ryan Paul Davis RyanOvernight Health Care: Trump calls for crackdown on surprise medical bills | Trump officials give religious exemption to foster care program | Uninsured rate at highest level since 2014 | Juul hires former Harry Reid chief of staff As new Congress begins, federal-state connections are as important as ever Trump once asked Paul Ryan why he couldn’t be ‘loyal': book MORE’s (R-Wis.) Republican-leaning district, where all the Democratic candidates running in the primary have supported it. 
 
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 The idea hasn’t won universal appeal in the party, but the spotlight has been shone on the concept of a government-run healthcare system as concerns mount over the Senate GOP’s plan to repeal and replace ObamaCare, which would lead to 22 million more Americans without insurance. 
 
 Sen. Bernie Sanders Bernard (Bernie) SandersSanders poised to announce presidential campaign: report On The Money: Trump agrees to end shutdown without wall funding | Senate quickly clears short-term funding measure | House to vote tonight | Federal workers could get back pay within days | Dems take victory lap Shutdown ends without funding for Trump’s border wall MORE (I-Vt.) championed the idea of universal healthcare during his insurgent presidential campaign, and he’ll introduce his single-payer plan once the debate over ObamaCare ends. 
 
 Other senators — such as Elizabeth Warren Elizabeth Ann WarrenSen. Warren misses the mark on the living wage debate RNC votes to give Trump 'undivided support' ahead of 2020 A crowded 2020 presidential primary field calls for ranked choice voting MORE (D-Mass.) and Kirsten Gillibrand Kirsten Elizabeth GillibrandRNC votes to give Trump 'undivided support' ahead of 2020 Hickenlooper 'leaning' toward joining 2020 race in next few weeks Poll: Biden leads among Dems in 2020 primary field MORE (D-N.Y.), two potential 2020 contenders — are getting on board with a Medicare for All proposal. Sen. Tammy Baldwin Tammy Suzanne BaldwinWhy does the bankruptcy code discriminate against disabled veterans? 116th Congress breaks records for women, minority lawmakers Kyrsten Sinema swears in to Congress using copy of Constitution instead of religious book MORE (D-Wis.), who faces a tough reelection in a state won by President Trump, said she’s a “maybe” on Sanders’s plan but “anticipates” supporting it, according to The Capital Times. 
 
 In the House, Rep. John Conyers Jr.’s (D-Mich.) Medicare for All bill has already netted 113 co-sponsors — nearly double the number of co-sponsors the legislation garnered last congressional session. 
 
 Key names are noticeably absent from the list, including House Minority Leader Nancy Pelosi (D-Calif.) and Minority Whip Steny Hoyer (D-Md.). But other members of leadership, including Democratic Caucus Chairman Joseph Crowley (D-N.Y.) and Assistant Democratic Leader James Clyburn (D-S.C.), are co-sponsors of the bill. 
 
 “It’s nice to see many senators … and a variety of people in the House publicly stating for the first time on record that a single-payer system is the way of the future that we need to be working toward,” Shannon Jackson, the executive director of the Sanders-aligned group Our Revolution, told The Hill. 
 
 Warren has publicly encouraged Democratic candidates to campaign on the idea in 2018 and 2020. But even though the Democrats in Ryan’s likely safe GOP district are supporting it, other Democratic candidates in red states and districts have been more cautious about endorsing single-payer. Rob Quist, the Montana Democrat endorsed by Sanders, was the only candidate in this year’s House special elections to run on that platform. 
 
 “I think that the politicians who choose to run on a campaign that states and embodies that pillar of our platform will be successful and they will be able to connect with the people,” Jackson said. 
 
 A Kaiser Family Foundation poll shows a modest increase in Americans’ support for the concept, with 53 percent of the public supporting all Americans getting their coverage through a single government plan. 
 
 That’s up from 2008 and 2009, when about 46 percent of the public held this position. A majority of the uptick in support has come from independents, Kaiser noted. 
 
 But in practice, Democrats haven’t been able to muster enough votes to pass a single-payer plan. In California’s state Assembly, moderate and progressive Democrats couldn’t agree on the proposal. While it passed the state Senate, California Assembly Speaker Anthony Rendon (D) ultimately tabled the proposal in his chamber. 
 
 “It’ll tend to be an issue that more left-leaning Democrats are willing to embrace,” said Dan Mendelson, president of consulting firm Avalere Health. 
 
 “In order to embrace that concept, you’ll have to be willing to defend the efficiency and effectiveness of a fully run government system, and there are many Democrats who are not going to do that and there are some who are.” 
 
 For Democrats, the increased talk about single-payer offers an alternative message to oppose the Senate GOP’s bill to repeal and replace ObamaCare, he said. 
 
 Under a single-payer system, all Americans would have health coverage, whereas the nonpartisan Congressional Budget Office estimates 22 million people would become uninsured under the Senate GOP’s healthcare plan. 
 
 “I think what you see is the Democrats on the Hill are searching for a single unifying message to unite in opposition to what is happening presently in the Congress,” Mendelson said. “And that’s really what they're looking for.” 
 
 Republicans have taken note, seizing on Warren’s request for Democrats to campaign on single-payer in an attempt to play offense in the healthcare debate as Republicans struggle with their unpopular plan. 
 
 But Republicans are seeing an advantage in Democrats’ embrace of single-payer, too. The National Republican Senatorial Committee (NRSC) is running auto-play Facebook ads that seek to tie the 10 Democratic senators up for reelection in states Trump won to Warren and government-run healthcare. 
 
 The Senate GOP’s campaign arm and the Republican National Committee have pointed to studies that say Medicare for All could cost as much as $32 trillion over a decade. 
 
 “I think that the idea that this is becoming our central focus is mistaken and one that our opponents are trying to put forward so they don’t have to talk about their age tax,” said a Democratic strategist with ties to Senate races. “What unites Senate Democrats is opposition to this disaster of a Republican bill.” 
 
 Some Republicans don’t see single-payer becoming a toxic issue for Democrats, arguing that those kinds of attacks are more of a “deflection tool” from the GOP’s own healthcare bill. 
 
 “It almost seems like it’s too wonky and not enough red meat to really make something catch fire,” a Republican operative in Washington told The Hill. “It’s hard to attack Democrats over single-payer healthcare when we can’t get our act together on repealing ObamaCare.” 
 
 Despite increasing talk of single-payer, Democrats haven’t agreed yet on a healthcare message for the 2018 midterms, in part because that will depend on whether Republicans manage to repeal ObamaCare. 
 
 "The [GOP] Senate bill is almost designed to make healthcare top-tier issue in the next elections,” said Larry Levitt, a Kaiser Family Foundation senior vice president. 
 
 “If the repeal and the replace bill is enacted and signed into law, Democrats will face a challenge as to what their healthcare message will be in 2018 and 2020,” Levitt said, adding that “it’s very likely that many Democrats would turn to single-payer as the next step.” ||||| Looking for news you can trust? 
 
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 Single-payer health coverage is back in the news these days. But what is it, anyway? Here’s a very brief primer on the five basic forms of health insurance: 
 
 Socialist: The government owns the hospitals and directly employs the doctors. Britain’s NHS is the best known example. In the United States, VA health care works on this model. 
 
 The government owns the hospitals and directly employs the doctors. Britain’s NHS is the best known example. In the United States, VA health care works on this model. Single-payer: Doctors and hospitals are mostly private entities, but are paid exclusively by the government. Canada is single-payer, with each province acting as the sole source of payment to doctors and hospitals. In the US, Medicaid and traditional Medicare are single-payer. 
 
 Doctors and hospitals are mostly private entities, but are paid exclusively by the government. Canada is single-payer, with each province acting as the sole source of payment to doctors and hospitals. In the US, Medicaid and traditional Medicare are single-payer. Multi-payer: Same as single-payer, but doctors and hospitals are paid by multiple sources: the government, regulated sickness funds, regulated insurers, etc. There’s a continuum in multi-payer systems, from those that are almost single payer (France) to those where other payers play larger roles (Germany, Belgium, the Netherlands, etc.). This is the most common form of universal health care, and its advantage over single-payer is that it offers a little more flexibility in coverage. In the US, Medicare Advantage is basically multi-payer. 
 
 Same as single-payer, but doctors and hospitals are paid by multiple sources: the government, regulated sickness funds, regulated insurers, etc. There’s a continuum in multi-payer systems, from those that are almost single payer (France) to those where other payers play larger roles (Germany, Belgium, the Netherlands, etc.). This is the most common form of universal health care, and its advantage over single-payer is that it offers a little more flexibility in coverage. In the US, Medicare Advantage is basically multi-payer. Subsidized private: People are required to be covered by private insurance, but the government provides subsidies to make coverage affordable. Switzerland uses this system. In the US, this is the Obamacare model. 
 
 People are required to be covered by private insurance, but the government provides subsidies to make coverage affordable. Switzerland uses this system. In the US, this is the Obamacare model. Private: In the rich world, this is used only in the United States. Employer health care in America is essentially entirely private, although government is involved indirectly via the tax code, which allows employees to receive health coverage free of taxes. 
 
 All of these except the last are universal health care systems. They differ only in how they deliver services and pay for them, and they can all work well. France, often cited as the best health care system in the world, is technically multi-payer, but really only a hair’s breadth away from single payer. In practice, this is a semantic distinction for most of us, since there’s usually little difference between universal single-payer and universal multi-payer. Because of that, in America we tend to refer to all universal systems as single-payer. 
 
 None of these systems cover literally every dime of health care coverage. Canada, for example, is single-payer but doesn’t cover all prescription drugs. Different provinces have different rules. In most countries, it’s possible to purchase supplementary insurance to cover the gaps in the national system, something that’s necessary because they all have various copays and exceptions: 
 
 You can put all this together to get a single number that represents how generous a national health care system is. For example, Switzerland covers about 65 percent of all medical costs. Canada covers about 70 percent. France covers about 78 percent. Medicare in the US covers about 80 percent. Denmark and Germany are the most generous, covering about 84 percent. 
 
 UPDATE: I originally used the wrong OECD table above. The correct one for our purposes is the table for “basic” care provided by tax-funded health coverage or compulsory social health insurance. The more expansive table, which I used initially, includes coverage from supplementary policies purchased by individuals. Sorry. ||||| As the United States grapples with the future of the Affordable Care Act, the notion of a single-payer healthcare system to simplify and expand coverage is being discussed more and more. According to a recent poll by the Morning Consult and Politico, 44% of Americans favor a single-payer healthcare system. 
 
 But what exactly is single-payer healthcare? 
 
 Single payer—or Medicare for All, as it’s sometimes referred to in the U.S.—is a system in which all healthcare financing is provided by one entity, such as (but not always) the federal government. All residents receive core coverage regardless of income, occupation, or health status. 
 
 The U.S. is one of the only countries in the developed world that does not have such a system in place, but in other countries, like Canada, the care itself is still provided by private organizations and doctors, or a combination of public and private organizations, like Spain and Australia. In the United Kingdom, care is accessed through public providers, but additional private care can be purchased. But that care—everything from hospital visits to prescription drugs to mental health care—is covered for all residents by the state, via taxes determined by the state. 
 
 In recent years, the idea for a single-payer plan in the U.S. has been discussed, most notably by Vermont Senator Bernie Sanders during his 2016 presidential campaign. Under his plan, co-payments, deductibles, and other cost-sharing measures would disappear. 
 
 Around 95% of households would save money under this system, according to Gerald Friedman, an economics professor at the University of Massachusetts at Amherst and one of the architects of Sanders’ plan. In 2013, Friedman’s research found that a single-payer plan would save the U.S. about $592 billion in 2015 with savings growing over time, largely by cutting administrative billing costs and reducing pharmaceutical prices. 
 
 How It’s Different from the Current System 
 
 Healthcare financing in the U.S. is an often complicated web of hospitals, doctors, and other care providers, middlemen like insurance and pharmaceutical companies, and public programs like Medicaid, Medicare, and state-run marketplaces. As many Americans know, it’s incredibly confusing and expensive for most parties involved. (According to Friedman’s report, Americans spend nearly four times as much on billing and insurance-related activities as doctors in Ontario do, where a single entity is in charge of billing and repayments.) 
 
 And if you’re under 65, your health coverage is largely dependent on your, your parents’, or your partner’s employment status, though the Affordable Care Act has made it slightly easier to gain independent coverage. 
 
 courtesy of Morning Consult/Politico 
 
 Single payer would simplify all of this by largely cutting out the insurance and pharmaceutical companies and untethering coverage from your job. The losers are those middlemen, like private insurance companies, that make the current system so frustrating to navigate and politically fraught. Also, much to the dismay of the wealthiest households, their taxes would increase the most of any group. 
 
 But the working middle class—people who make too much money to qualify for Medicaid or the Affordable Care Act coverage subsidies—would benefit greatly, as would an employer’s HR department. “Employers spend a lot of money processing information for the insurance industry, identifying insurance plans, and negotiating,” says Friedman. “And that would just disappear.” Instead, the government (or the individual states, depending on how the logistics shake out) would negotiate prices, set plans, and deal with the paperwork. 
 
 Everything from dental care to long-term care is covered for everyone under single payer, equalizing treatment between the affluent and less affluent. If this sounds familiar, it’s because there is already a fairly successful public medical financing system in the U.S.: Medicare, which all seniors over 65 can qualify for. Proponents of single payer point to Medicare, which is fairly popular, as an indication that a generalized universal program could work here. 
 
 How It’s Paid For 
 
 Federal funding currently earmarked for healthcare, including spending for Medicare, Medicaid, and the Children’s Health Insurance Program, which totals in the trillions of dollars, would be used for the new system. 
 
 Following Sanders’ plan, that leaves about 30% of the needed funding unaccounted for, says Friedman, which would need to come from new or increased taxes. He advocates a progressive tax system, i.e., the wealthiest households would pay significantly more, through an increased personal income tax and taxes on unearned income, like capital gains and dividends. 
 
 But he notes you can also raise money through less progressive means, like a consumption tax, or a tax on goods and services. “If Trump came out in favor of single payer, then I suspect he would fund it with a consumption tax,” he says. That would still impact wealthier households more than lower and middle class households. 
 
 How It’s Done Elsewhere 
 
 Despite being lumped together under the single payer moniker, healthcare systems in other developed countries differ, but have some commonalities: They provide universal coverage, and provide a baseline of care. 
 
 The National Health System in the United Kingdom, for example, covers everything from routine screenings to long-term care to end-of-life care. In Australia, there is a universally available public healthcare option and a private healthcare system. But all residents in both countries have insurance, as do residents in other countries across Europe. 
 
 Jonathan Oberlander, a professor of social medicine at the University of North Carolina in Chapel Hill, argues that advocates of the system in the U.S. typically point to the Canadian system as a good model, “where all legal residents in each province or territory receive coverage from one government insurance plan for medically necessary hospital and physician services.” You can buy supplemental insurance if you wish, but there’s a minimum, fairly comprehensive plan for everyone. This is similar to Medicare, but covers an even larger percentage of the costs than Medicare does for American seniors. 
 
 It’s not a perfect system. “All countries struggle with tensions among cost, access, and quality; at times, Canada has grappled with fiscal pressures, wait lists for some services, and public dissatisfaction,” writes Oberlander. “Yet its problems pale in comparison to those in the United States.” 
 
 Still, he writes the single-payer model faces an uphill battle here: Political pressure, the unpopularity of tax increases of any kind, and robust business interests have long hampered its implementation. 
 
 Correction: An earlier version of this article misstated that the United Kingdom’s health care is provided by private companies. ||||| It's no secret that the cost of failure in the GOP healthcare reform effort will be that Obamacare remains on the books indefinitely. 
 
 Last week, Senate Majority Leader Mitch McConnell hinted that he might be willing to pay that cost. He said that Republicans would work with Democrats to produce a bill that would "fix" Obamacare's exchanges if they're unable to agree on a repeal-and-replace plan. 
 
 But if Sen. Bernie Sanders, I-Vt., is to be believed, the stakes may be even higher. In an interview out last week, Sanders said that he would be waiting in the wings with a single-payer proposal of his own, if the Senate GOP's healthcare reform bid falls apart. 
 
 Single-payer systems have endangered lives and reduced access to quality care everywhere they've been implemented. If Republicans needed any additional motivation for repealing and replacing Obamacare, Sanders's single-payer threat ought to do the trick. 
 
 Proponents of single-payer assume that patients would be better off if government bureaucrats controlled all of our nation's healthcare resources. They'd ensure that everyone had insurance coverage. They'd dictate spending levels and pay healthcare providers. And they'd eliminate all the supposedly wasteful spending that insurance companies devote to administration and marketing. 
 
 That would be a herculean task. Health care amounts to one-sixth of the U.S. economy. Managing it without the aid of market mechanisms like price signals would require bureaucrats to properly allocate trillions of dollars in resources and the labor of millions of American workers. Indeed, the estimated cost of the single-payer proposal Sanders offered in the 2016 election campaign was a whopping $32 trillion over 10 years. 
 
 It's far easier to just declare a global budget for health spending, and then ration care to ensure that spending stays below that ceiling. That's exactly what every other single-payer system does -- and how nations with single-payer systems can keep health spending lower than the United States does.
– Senators are back at work Monday, and their No. 1 priority remains trying to craft an alternative to ObamaCare. The problem is that Mitch McConnell's task of getting the necessary 50 votes seems to have gotten only more difficult over the holiday break, and that's raising a slew of stories about what happens if the GOP bill fails. Shoring up ObamaCare is one possibility, but another is the controversial idea of some kind of single-payer system. The long-shot concept, anathema to conservatives, is surfacing more and more in stories: Definition: Under a single-payer system, "doctors and hospitals are mostly private entities, but are paid exclusively by the government," explains a primer at Mother Jones. "Canada is single-payer, with each province acting as the sole source of payment to doctors and hospitals. In the US, Medicaid and traditional Medicare are single-payer." Tax hikes: Everybody would get core coverage regardless of income, job, or health status, explains Money, and people would no longer get insurance through their jobs. But paying for it would surely require new tax increases of some kind. Sanders, and others: The concept is gaining traction among Democrats, reports the Hill. Bernie Sanders promises to introduce a bill when debate ends on the GOP ObamaCare alternative. Sens. Elizabeth Warren and Kirsten Gillibrand back the concept, and in the House, a "Medicare for All" proposal by Rep. John Conyers has 113 co-sponsors. Warren, specifically, told the Wall Street Journal last month that "now it's time for the next step, and the next step is single payer." Please, no: Putting bureaucrats in charge of health care isn't the answer, writes Sally Pipes at Forbes. "Single-payer systems have endangered lives and reduced access to quality care everywhere they've been implemented," she notes, citing "deplorable care" in Britain and Canada and arguing that if Republicans needed any incentive to make progress on their health bill, the prospect of a single-payer system should do it. California: A bill to shift to a single-payer system stalled last month in the California Assembly, and the Los Angeles Times reports that a main reason is that it was "short on key policy specifics—most significantly, how to pay for it." Partisan divide: A Pew Research Center poll finds that 52% of Democrats support the single-payer idea, but the overall percentage in support drops to 33 when Republicans are added, reports CNN. For that reason, both sides seem to love talking about it, notes the story. Senate GOP plan: It's not dead yet, though the positions of conservatives and moderates within the GOP seem to have hardened in the last week, reports Politico. That makes McConnell's quest for a compromise acceptable to enough senators exceedingly difficult.