What if I told you there were a way for the United States of America to save, up front, tens of billions of dollars? Access to health care would drastically improve. Individuals, families, and businesses alike would experience less of a financial and logistical burden, and doctors and patients would be empowered regarding the decisions made in the interest of the latter. Other areas tied to health care would also stand to benefit from the reduced complexity of the new system and the relief over who is and who isn’t insured or otherwise cannot afford critical procedures. On top of all this, such a framework is already being used to great success elsewhere in the world. Sounds great, right? We should be jumping at the chance as a nation to implement such a system, no?
In case it were not already apparent, I’m referring to a single-payer health insurance system, which, in this country, would take the form of a Medicare-for-all paradigm. Hmm, are you still as enthusiastic?
I’m guessing there are those of who you aren’t, whether you’re a staunch Republican, a Democratic loyalist, or none of the above. Advocacy for a single-payer public insurance system was one of the cornerstones of Bernie Sanders’ presidential campaign, but it was one of the most commonly assailed elements of his platform alongside the notion of free college tuition for public schools. As was the running theme from his detractors, the idea sounded great, but practically speaking, it had no chance of becoming reality. On some level, I tend to think the plausibility of Bernie’s proposed policies got and still does get conflated with the likelihood of him becoming a finalist, if you will, in a presidential race. However you slice it, Sanders was fighting an uphill battle in capturing the Democratic Party nomination ahead of Clinton. Still, for all those convinced a Medicare-for-all system in the U.S. would be a disaster in the making, might there be more to the story than even these self-professed experts realize? That is, could the concept of a single-payer insurance plan not only have merit, but also be exactly what this country needs?
First things first, let’s discuss what a single-payer health insurance system involves at its most elemental, and then we can better explore the case for implementing such a system nationwide. To do that, we’ll consult Physicians for a National Health Program (PNHP), an organization devoted explicitly to advocacy for a universal, single-payer national healthcare program. PNHP, as part of its work, strives to furnish a more informed debate on how to address health care in the United States, and it offers a wealth of information and resources to this point. According to the organization, single-payer national health insurance is a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private. For those of you who hear “public agency” and start frothing at the mouth, yes, the government would be involved in the administration of a Medicare-for-all program. Before you get carried away, however, let’s directly and immediately address what this entails, and what it does not.
1. Single-payer health insurance does not require steep tax hikes.
As Physicians for a National Health Program explains, indeed, an additional tax will be needed to cover the costs of a national single-payer system, one described as “modest” and based on ability to pay. Now, I see you breaking out your pitchforks and torches there, but hold on a minute, would you? An estimated 95% of households—what I consider to be a significant majority—would ultimately save owing to not having to pay premiums (including co-pays and deductibles), as they do under private insurance plans. In other words, you’d give a little, but get a lot in return.
2. Single-payer is not socialized medicine.
Republican politicians often like to dangle the specter of socialism and vague notions of government overreach to scare voters away from a superior policy option. In this instance, arguments against Medicare-for-all or even the Affordable Care Act are designed to distract from scrutiny of the American Health Care Act, the intended GOP replacement for the ACA and a piece of legislation so flawed no Republican—not even Donald Trump—wants to be associated with by name. Which is, ahem, exactly why it should be referred to as TrumpCare or RyanCare.
With specific regard to a single-payer program, the association with socialized medicine is one that is used to obscure and deflect. Socialized medicine is when facilities are owned by the government, and health professionals are on the public payroll. This is how it works in England, or even with the VA in the States. A Medicare-for-all, national health insurance system only socializes the administration of this insurance, not the care itself. Patients would be able to choose their doctor and hospital, and doctors would be afforded greater autonomy in their own right.
3. Medicare-for-all is not unaffordable.
Double negative, apologies, but I’m most concerned with the underlying concept here. I noted earlier how individuals and companies would benefit by no longer having to fuss around with co-pays and the like, but the American economy stands to gain at large from a single-payer framework. Nearly a third of current health spending in the United States today belongs to administrative expenses. As President Trump has learned the hard way, health care is complicated, and the price tag for billing, marketing, underwriting and other overhead activities is estimated to cost us some $400 billion. A year. Recouping that money alone would be sufficient to cover a Medicare-for-all health care system. So much waste—and so much of it preventable, too.
4. Single-payer insurance does not result in rationed care.
One of the biggest points of the hit piece regularly levied against universal health care is that it rations care. Unbearable wait times! You’ll die before you get to see a doctor! You mean as opposed to the current system in the United States, where you basically have insurance only if you can afford it? That’s rationing too, bruh! Some 30,000 Americans die every year because they can’t afford health insurance, and still more forgo procedures and treatments because of refusals of insurers to cover them. The extent to which delays are experienced in any single-payer system is a function of that system’s capacity and the ability of the associated government to manage the patient load, and as such, long waits are not an inherent condition of universal health care. Besides, and I don’t know about you, but I would rather wait a little longer to be seen by a doctor than, um, die.
5. Approval for a national health care system is not a minority opinion.
Establishment politicians on both sides of the aisle would try to convince you that a national health program isn’t desirable, or in the case of the more conservative ones, bad for business. Poppycock and hogwash, I say! For starters, on the dimension of business, a single-payer system would actually be a boon, as employers would no longer be burdened by administrative tasks related to health care and health insurance, and would thus be better able to focus on their core functions. Irrespective of what a Medicare-for-all program would stand to do for companies and their management, though, doctors and their patients alike see the writing on the wall when it comes to the merits of universal health care. Nearly 60% of Americans support a single-payer health insurance program in the United States, and four in ten Republicans also favor such an approach. This complements a similar percentage of doctors who have been, for close to a decade now, calling for a national health insurance system. This polling data begs the question: if Medicare-for-all/single-payer is so bad, why do so many of us want it?
In trumpeting the support of a majority of Americans who favor a single-payer health insurance format in the United States, it should be duly noted that a good portion of the constituency does not. For some, notably on the Democratic Party side of things and ever mindful of the legacy of Barack Obama, upholding the Affordable Care Act seems to be sufficient. To be sure, in the short term, resisting attempts by Donald Trump and Co. to eviscerate the ACA and elements of the social safety net is important—bigly important, at that. Still, a side-by-side comparison of a proposed Medicare-for-all plan and the current legislation in place regarding health care/health insurance makes the flaws in ObamaCare stand out, and arguably gives Republicans more fodder in trying to convince the public to get behind repealing and replacing it. Once again, Physicians for a National Health Program has a handy guide as to why the Affordable Care Act, though leaps and bounds ahead of the AHCA, yet falls short of being, ahem, what the doctor ordered when it comes to what is ailing health care in the U.S. Here are the salient points from this study of contrasts:
1. The Affordable Care Act still leaves millions of Americans without coverage.
An estimated 30 million Americans will go without health insurance by 2022 if current projections and trends hold. For a nation as affluent as the United States, that’s appalling, and this figure doesn’t even begin to consider the tens of millions who remain underinsured, and as alluded to earlier, intentionally bypass recommended medically necessary procedures because they can’t afford them, or otherwise believe they can’t. Medicare-for-all, meanwhile, offers health care for everyone, as the name implies.
2. Under the ACA, patients are not offered a full range of benefits.
In a seemingly very backward state of affairs, employers and other insurers tend to offer fewer health benefits and yet require higher co-pays and deductibles as we go along. That’s borderline insane. Under Medicare-for-all, all medical necessary services would be covered.
3. In a single-payer system, the country would save money. With what is currently in place, costs would only skyrocket.
To reiterate, with Medicare-for-all, we’d be saving about $400 billion with no net increase in health spending. Over the next ten years, if health care in America remains unchanged, costs would increase by more than $1 trillion. Trillion. Again, craziness, especially if plans offered by insurers are getting more draconian with each passing year.
4. In a single-payer system, patients would be allowed free choice of doctor and hospital. In the current system, denials and limitations of service abound, and networks continue to be restricted.
How often have you heard or experienced situations in which an individual wants to see a specialist or undergo a procedure, but that function or professional is not covered by his or her health insurance plan? Or worse, what about a situation in which a patient, unbeknownst to him or her, is attended by a doctor not included in his or insurer’s network, and is hit with a disproportionate charge on his or her bill as a consequence of this care, the likes of which may be nominal attention at best? These are all-too-common scenarios under the current health care framework, which disempowers both doctor and patient. Within a Medicare-for-all paradigm, patients would be afforded their choice of facility and physician.
5. The Affordable Care Act does not rectify inequality in costs between the wealthy and lower-to-middle classes.
Because funding for a Medicare-for-all system would be based on a progressive tax system that draws revenue from income and wealth taxes, and because premiums and out-of-pocket costs are replaced by these taxes, not only would 19 out of 20 Americans pay less than they do now, but health care administration would run more smoothly and fairly. Currently, health care costs are disproportionately paid by poorer Americans, especially those facing or suffering from acute and chronic illness. Which, honestly, if you’re surprised about, you perhaps suffer from some form of break with reality or a particular condition that yields delusions.
So, single-payer health insurance would save Americans time, money, energy, and grief. It is loads better than the American Health Care Act, and it surpasses the Affordable Care Act, a well-intentioned but structurally flawed bit of policy. Moreover, internationally, there are plenty of successful models from which to choose, including those of Australia, Canada, France, Spain, and Taiwan. A majority of Americans supports it. Why aren’t we progressing faster and further on this issue even at the state level? Well, the potential answers are manifold, but as is so frequently the case, it helps to follow the money. Indeed, understanding resistance becomes that much easier when we consider who stands to lose from the implementation of a Medicare-for-all system, or better yet, who has been profiting handsomely from today’s confusing and fragmented market. The following are some of the key players in the opposition of universal health care:
Insurance companies
When you stop to think about it, it’s kind of a shitty thing for insurance companies to make such heavy profits on something that could very well mean life or death for the health care seeker. And yet they do, and where this revenue stream exists, you’ll usually find a voice against single-payer. Take AARP. You might think an organization devoted to the well-being and empowerment of retirees would support a program that would stand to help a population worth the advocacy and extra protection. You’d be wrong. AARP makes about a quarter of its money via UnitedHealthcare, the largest for-profit insurance company in the nation, and so its support for the Affordable Care Act is about all the Association can muster. Public insurance would almost certainly rein in the health insurance industry to a considerable extent, and to this end, the private insurance lobby has devoted a commensurately large amount of resources to try to keep it down.
Pharmaceutical companies
Not our pharmaceutical companies, forever motivated by the highest ethical and moral standards! That’s right, kids: Big Pharma doesn’t like the idea of Americans importing prescription drugs from Canada at reduced rates, and they certainly do not like the idea of the government negotiating drug prices on behalf of the consumer and buying in bulk so as to make their products more affordable. The entrenchment of the pharmaceutical industry in our everyday lives is apparent from anyone who has watched television for, like, an hour. “Moderate to severe” illnesses. “Possible side effects” include. Shit, that you probably know what to do in case of a four-hour erection just speaks to the tight grip Big Pharma has on this country, as does your likely familiarity with who Martin Shkreli is and the absurd practice of jacking up prices of drugs like EpiPen at a moment’s notice. In the Wild West of the prescription drug market, drug makers see a no-nonsense sheriff looming in Medicare-for-all—and make no mistake, they ain’t fixin’ to stand by and let it try to restore order. No siree.
Conservatives in business and government who bank on “free-market” economics
Conservative Republicans love the theory behind the power of the free market, and hate what they perceive to be government interference in the due course of business. What has aided the GOP in their electoral aspirations and their attempts to dismantle the ACA is the American people’s own distrust of government and pursuit of wealth. As you might expect, there are serious problems with simply allowing health care to take care of itself under the premise that allowing people to make choices without the federal government interceding always leaves consumers better off. Critical to understanding this debate is realizing visions of a “free” market in health care are all but illusions. The peculiarities of this industry are such that consumers rarely possess the sort of content knowledge adequate enough to participate in an informed negotiation with the seller, be that the facility performing the requested service, the pharmaceutical company selling the drugs, the medical equipment company selling the paraphernalia, the private insurance company selling the plan, or some combination therein.
Even assuming end users can reasonably close this knowledge gap, however, there is still the matter of prices being less than transparent and subject to change, not to mention subject to variance across states and dependent on whether people/families can afford to pay. On top of all this, and perhaps most importantly, so much of health care is not based on want, but need. If you need a reasonably complicated form of treatment, or a prescription drug that is fairly expensive to manufacture, you need health insurance, or else you are paying exorbitant amounts out of pocket—and even then you might be out of luck if supply is on the short side and prices shoot up with demand. Breaking this whole situation down to its essential point, we, the consumers, have little bargaining power when it comes to trying to negotiate a fair deal, and as costs get shifted to out-of-pocket expenses, those who genuine lack the ability to pay are more frequently disadvantaged, and the companies and wealthy individuals that have a vested interest in generating profit from health care and health insurance tend to benefit. In other words, free-market principles applied to health care in the United States are fundamentally about redistribution of costs—and in a way that is pretty much guaranteed not to be in your favor.
So far, a number of states have tried to pass some form of single-payer legislation, and in the case of the state of Vermont, it actually went into effect before being repealed a few short years later. In terms of current attempts to enact a public health insurance system on a state level, perhaps the most notable examples are those of California and New York, if for no other reason than they are big states, electorally speaking. As you might expect, though, these initiatives have been targeted by more than their fair share of hit pieces and smear campaigns. In the Golden State, there are scare-tactic specials such as a piece in the Sacramento Bee entitled “The price tag on universal health care is in, and it’s bigger than California’s budget.” Which, technically, is true, but still lower than the current price tag, as author, radio host, and one-time Green Party vice presidential candidate Pat LaMarche explains. In the Empire State, meanwhile, you have the likes of Bill Hammond, director of health policy at the conservative think tank Empire Center, being given a platform by the New York Post to deride New York Democrats’ push for single-payer health care as a “lunatic” endeavor. Well, Gerald Friedman, economics professor and department chair at UMass – Amherst says the Dems’ proposed plan would not only save lives and money over time, but create some 200,000 jobs. Dude’s got a PhD, too, so suck on that, Hammond!
Noting the hurdles faced in individual states to get single-payer plans approved and sustained, maybe it’s just as well that we think bigger as a country and fully get behind Medicare-for-all health care. After all, the legislation is ready and waiting. In the House of Representatives, H.R. 676, the Expanded & Improved Medicare for All Act, was introduced by Rep. John Conyers of Michigan’s 13th District (the Fightin’ 13th!) and referred to the House Committee on Energy and Commerce back in January. Since that time, it has also been referred to the House Ways and Means and House Natural Resources Committees, and 112 representatives have signed on as co-sponsors, a record-breaking number. As for the Senate, three guesses as to who plans to introduce a version of this bill. If you aren’t thinking about a certain senator and unabashed democratic socialist from Vermont, well, you very well may not know your ass from a hole in the ground.
Granted, in the very short term, this means little without Republican support, and to be clear, not one GOP legislator has signed on as a co-sponsor of H.R. 676. We would expect similar treatment in the Senate; if Tom Price’s confirmation as Secretary of Health and Human Services is any indication, Republican legislators will actively try to rig health care to the benefit of moneyed interests. This does not mean that the effort is an unworthy one, however. The more that GOP leaders push a more deeply flawed replacement (AHCA) for an already-flawed health care system (ACA), the more that people understand that single-payer national insurance exists and is effective the world over, and the more single-payer legislation is advanced on a state-by-state basis, the more momentum builds for a credible solution to our health care crisis and politicians who will rise to the challenge of meeting the needs of their constituents. Because it is a crisis. Try telling the families of the people who have died as a result of not having health insurance it’s not.
So, seriously—it’s time for Medicare-for-all/single-payer health insurance in this country. We’ve waited long enough, and in truth, we the people can’t afford to wait any longer.
United States of Joe 