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Sunday, February 10, 2019

Medicare For All-An Idea Whose Time May Have Come

With the 2020 Presidential election looming on the horizon and tortuous months of political speeches one thing that clearly sets the Democrats apart from the Republicans, currently in control of the national purse strings, is their vocal promotion of healthcare access and protections for all. Republicans raced into Congress on the anti-Affordable Care Act platform only to learn that voters like their government sponsored healthcare, resulting in their rout in the midterm elections last November. This article reviews the motive, financial implications, and method to assess a national Medicare Plan.
The United States spends 40% to 60% more for healthcare than any other industrialized country and this does not produce improved health or better outcomes than nations spending considerably less per capita. In 2017 the U.S. spent $10,224 per person for healthcare, as tracked by the Petersen-Kaiser Health System Index Tracker. (Cox, 2019) This total is 28% higher than when my book, Unraveling U.S. Healthcare-A Personal Guide was published in 2013. (Winter, 2013) The next closest country in medical spending was Switzerland which still spent 28% less than the U.S. France, whose health system provides family clinics, coverage for all, and high tech services spent $4,902, less than half of the U.S. And Australia spent only $4,543 per capita for their national healthcare system. Canada spent $4,826 per person for their national healthcare program. Everyone of these industrialized nations are capitalistic in terms of business, but they offer healthcare to all of their citizens.

The cost of healthcare in the U.S. is impeding resources that could be used to improve education, rebuild critical infrastructure such as bridges, and improve the quality of life for most families. By refusing to enact and enforce national healthcare policy the nation continues to be overcharged by profiteers who gouge the American public. The government has the domain to negotiate better policies for drugs, medical devices, and reimbursements at the clinic/hospital level. However, only Bernie Sanders from Vermont, had the political will to actively run on a platform for nationalizing healthcare. This phenomenon all changed with the mid-terms and public polls show a size-able majority of the American people want government run healthcare. Families are tired of being forced to spend more on their health insurance than for housing.  Diabetics are forced to skip their doses, because of the high cost of insulin, which has resulted in deaths. Even seniors, who have benefited greatly from Medicare, the Bush Medicare Modernization Act which provided drug coverage, and the Affordable Care Act which closed the doughnut-hole exclusion for drugs are still gouged for the cost of care. A public case could be made that Medicare enrollees are better off in terms of healthcare access and coverage than working class families in the United States. This situation is untenable financially and politically. The 2020 election will give us a chance to see how far the American people are willing to go to reform their expensive and exclusionary health system.
In 2003, I was part of a team of graduate students at the University of Washington School of Public Health and Community Medicine who analyzed a single payer health system. In fact, I published an article on it in this column in 2009.[1] My role, as an MHA student, was to come up with a financing model that was plausible. For a 3% increase in the payroll tax, born equally by employees and employers, which currently funds Medicare and Social Security, we could implement a national healthcare program.
 A second way to fund healthcare is through an income tax increase, which is how most other nations do it. Crucial information which would inform any financing of a citizen’s initiative would include the 2020 census findings. However, Trump and his administration aren’t anxious to conduct this census and are still seeking to restrict access and questions based on citizenship and other factors.
Social programs are consuming a larger portion of the national budget, which is normal for an aging population. Republicans like to brag about defense budget increases yet rail at any increase in spending for entitlements for our residents. Higher taxes are necessary to even meet the current Social Security and Medicare projects, which must be addressed.

U.S. Proposed Federal Budget-2018
Defense, includes security for national nuclear supply, Veterans Affairs, Homeland Security, State Department, Afghanistan, Iraq, Syrian wars; Does NOT include discretionary private contracting which consumes another 10-20%
Social Security- paid through trust fund until 2032@1.046 trillion Medicare-partially funded by payroll tax Medicaid-100% paid from general fund@1.037 trillion
Proportion of Federal Budget
24%+24%= 47%

The federal budget item that is growing the fastest is the national deficit, which the Trump Administration exploded with it’s corporate and wealth tax cuts in 2018. Currently the deficit is 985 billion dollars or 22% of the federal budget. (Amadeo, 2019)
Any healthcare program in the U.S. will include private insurance at some level, as Medicare, the healthcare expansion model currently does. The idea that the behemoth private medical insurance industry will go away is wrong. However, private insurance has a much higher administration cost than Medicare/Medicaid, which uses 6% of cash inflows for overhead as opposed to 15-20% for the private sector. And you can expect that the insurance industry/medical/pharma lobby, which is the largest and most well-funded of the shark infested Washington DC lobbying cabal will be drafting the details, just like they did for the Affordable Care Act. They succeeded in eliminating the Medicare-for-all idea during the Obama Administration, but that was just buying time. The longer the nation waits to draft a sane health policy the costlier it will be for the tax payers.
Many employers would thankfully get out of the medical insurance business. Also, a national health policy which has the same costs everywhere, would create an even playing field for business competition and innovation. It will also greatly reduce regulatory costs, which are the bane of clinical staff everywhere. Efficiency could go up in clinics because the doctors and nurses would have more time to actually see patients instead of processing insurance paperwork.
Finally, with national healthcare policy, we could also fund the scary shortage of primary care providers, by providing free medical education (and maybe forgiveness of school loans) to those who go into primary care, such as pediatrics, family practice, and obstetrics.
End to the Madness
Obviously, we will have to enact some type of policy which will mute the overcharging, take back control of generic drug prices, create true price transparency for services, and quit gouging American families. We can hardly expect the Millennials, whom will have to clean up our mess, to pay higher and higher payroll taxes and not get anything in return. We can start by offering affordable healthcare for all, which won’t happen under the current, reimbursement-based-on-the-prevailing-inflated-cost method of pricing.

And this is the health policy maven signing off encouraging you to learn as much as you can about healthcare systems outside the U.S. so that we can build a better one for our people.

Works Cited
Amadeo, K. (2019, January 21). US Federal Budget Breakdown-The Components and Impact on the US Economy. Retrieved from The

Cox, B. S. (2019, February 10). How does health spending in the U.S. compare to other countries. Retrieved from Petersen-Kaiser Health System

Winter, R. E. (2013). Unraveling U.S. Healthcare-A Personal Guide. In R. E. Winter, Unraveling U.S. Healthcare-A Personal Guide (pp. 31-35). Rowman & Littlefield. 

This article was written by Roberta Winter, a freelance journalist and health policy analyst in the Seattle area.