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.
Motive
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.
Means
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
|
20%
|
24%+24%= 47%
|
$4,407,000,000,000
|
$892,700,000,000
|
$2,083,000,000,000
|
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)
Method
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
Balance.com: https://www.thebalance.com/u-s-federal-budget-breakdown-3305789
Cox, B. S. (2019, February 10). How does health spending in the U.S. compare to other countries. Retrieved from Petersen-Kaiser Health System Tracker.org: https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-start
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.
