Why Medicare-for-All is Not Enough
Doctors Prescribe Single-Payer Health Care Reform
Well before Bernie Sanders entered the presidential race, a nonpartisan group of 39 leading doctors set out to fix the glaring problems in the Affordable Care Act (ACA, or Obamacare). They proposed a single-payer plan that has since been endorsed by over 2,000 physician colleagues and published in the American Journal of Public Health, according to this article in Huffington Post. But I argue Medicare for All is not enough.
The HuffPost article generated lots of reader comments, and I just had to respond because this is the sort of debate I love to jump into. It brings together many different perspectives, especially those of consumers who too often aren’t heard from by politicians. Here’s a summary of my responses and answer to the question, “Is Medicare-for-All enough?”
Medicare-for-All is Not Enough
As a consumer advocate and founder of Modern Health Talk, I whole-heartedly endorse the idea of a single-payer national health care system, as proposed by these doctors and by Bernie Sanders, but I think we need to go even further, and maybe not as fast.
Beyond just improving the efficiency of how healthcare is paid for and adopting the exceptionally efficient Medicare system for everyone, we need to address the PRICE of medical care and the NEED for it in the first place. To further reduce the costs of providing medical care, we also need incentives that focus more attention on overall health and wellness — prevention versus treatment.
Even Benjamin Franklin knew, “an ounce of prevention is worth a pound of cure,” but our medical schools primarily teach new doctors how to diagnose and treat illness. That further encourages today’s fee-for-service business model that pays doctors to do more, test more, prescribe more, and treat more symptoms to keep patients as paying customers. Wellness education and incentives, however, go against that perverse profit model, so they often aren’t part of the curriculum.
Medicare-for-All would be a good step in the right direction, and it would likely lead to other reforms that emphasize wellness, because doing that dramatically lowers costs, and because it removes the incentives to artificially pump up profits for shareholders of healthcare stocks.
Who would oppose Effective Health Care Reform?
What’s at stake if we actually cut US health care costs to the average of what other advanced nations pay? Beyond the positive impact on lives and suffering, what might we do with the $2+ Trillion/YEAR in savings? Would we lower taxes? Pay off the national debt? Help people out of poverty? Make strategic investments in education, research, and infrastructure? Who could be against that?
Steven Brill addressed that question in 2013 with a 32-page TIME Magazine special report, Why High Medical Bills Are Killing Us. He described a medical industrial complex (hospitals, insurers, drug companies, testing companies, and equipment providers) that keeps its costs secret and spends twice as much on political lobbying as the military industrial complex — all to protect their perverse profits from treating illness and injury.
Any reforms that cut healthcare costs in half also mean they’d lose half of their revenue, possibly impacting jobs and shareholders. So with Citizens United and the corrupting power of big money in politics, true health care reform seems futile without a major political takeover by concerned citizens, and that’s the sentiment that Bernie Sanders has tapped into.
Corporate Behavior and Rising Health Care Costs
Sadly, the first duty for insurance companies, hospitals, and other corporations is to the shareholder, not the patients or doctors. To understand how corporations work and why they so often behave as sociopaths, watch The Corporation, a Canadian documentary.
Protecting Practitioners
Most doctors and nurses I know got into medicine to help people, not to become wealthy from their illness or injury. As we focus more on prevention, we need to help them develop new skills to fit that goal and their personal goals.
One of the comments on HuffPost article suggested subsidizing medical education. I too can endorse offering more medical education options, even for free to those who qualify and are willing to serve and public assistance in paying off (or forgiving) student debt for new docs. One of the many benefits of that would be to give us more influence over what is taught in medical school, including more emphasis on health and wellness and less on treating symptoms.
Practitioners may also need help in learning how to support the greater efficiencies of new technologies that are being applied to telehealth video calls, remote sensor monitoring, health data analytics, and medical tourism.
A government-provided, single-payer health care system should make it easier to promote these tech innovations and to encourage wider use of electronic medical records. That’s because the financial incentives today discourage Hospital-A from sharing records with Hospital-B, because they fear losing the patient/customer. Likewise, Hospital-B does not really want test results from Hospital-A, because without them they can charge for retesting. Single-payer makes so much sense to me as a long-term objective. And Medicare as a public option makes sense as a non-disruptive way to get there.
Long-term Objectives and Short-term Goals
We must apply measured reason to health reform and not rush into disruptive changes that may have unintended consequences, meaning don’t change too much at once.
Medicare-for-All is not enough, although it’s a good long-range objective. As a public option for anyone who wants it, Medicare seems reasonable as a way to transition with less risk. It could be promoted wherever market forces aren’t working, such as in rural communities, states with just one insurer, and for people over age 50, thus leaving private insurers with younger and healthier customers. That should help drive down premiums for those still buying private insurance.
Developing a Healthy and Productive Population
The goal of lowering the administrative cost of medical care delivery is one thing, but shouldn’t the real objective be to develop a healthier and more productive population and workforce? Doing that would avoid much of the need for medical care in the first place, and a single-payer system can then lead to and facilitate this second objective.
Imagine the impact that a healthier and well-rested workforce would have on absenteeism and worker productivity, profits, wages, GDP, and global competitiveness. With that perspective, I can envision other public policy changes that improve health, including environmental pollution, the food supply, and addressing poverty. In my view, it’s all about getting the incentives right and making sure they match our goals, without undue influence from wealthy and self-serving special interests.
By the way, what exactly ARE our goals as a nation? Think of that question as you cast your votes this November.
Efficiency Advantages of a Public, Non-Profit Health Insurance Plan
When just looking at the administrative efficiencies of public and private health insurance, the Institute for America in 2009 proposed A New Public Health Insurance Plan to reduce costs and improve quality. Here are some highlights:
- Medicare has controlled costs much better than have private health insurers over the last 25 years.
- The private health insurance market is highly consolidated and needs competition from a public insurance plan to lower skyrocketing premiums.
- Administrative costs are dramatically lower under public health insurance plans, resulting in enormous savings to the system.
- Bargaining power of public health insurance plans significantly reduces provider costs.
- In a head-to-head competition, the public Medicare plan is much better at containing costs than private Medicare Advantage plans.
- Independent analyses show substantial savings can be achieved from a public health insurance plan that competes with private insurance plans.
- Quality and effectiveness innovations occurring under the public Medicare plan show that public health insurance plans have greater potential to drive the quality revolution than do private plans.
- If Congress wants to drive value in the health care system, it can design a new public health insurance plan offered in an exchange that will be best positioned to lead these efforts because public health insurance plans [have no profit motive and] increase choice, competition and accountability.
ABOUT THE AUTHOR
Wayne Caswell is a retired IBM technologist, futurist, market strategist, consumer advocate, sleep economist, and founding editor of Modern Health Talk. With international leadership experience developing wireless networks, sensors, and smart home technologies, he’s been an advocate for Big Broadband and fiber-to-the-home while also enjoying success lobbying for consumers. Wayne leans left to support progressive policies but considers himself politically independent. (contact & BIO)
A Public Option Isn’t Good Enough (I commented) …
To support Libby’s strong argument for Single-Payer, let me share Will Fisher’s excellent “jelly bean” video, which simplifies the exploration: https://www.mHealthTalk.com/single-payer/.
CAUTION — Single-Payer is not the panacea it’s made out to be. We must not divert from the objective of matching or bettering the other advanced nations that pay half as much for better outcomes. Doing that would save well over $1.5 trillion/year befor even considering the benefits of improved productivity from a healthier workforce. But that also means the medical industrial complex will fight like hell to preserve theperverse profits from patients viewed as paying customers.
BIGGER PICTURE — A recent VoxCare comment wants us to FIRST provide housing and food as basic rights. I can’t disagree but see them connected.
There’s a direct relationship between poverty and obesity, and between obesity and healthcare costs. According the HBO’s documentary, The Weight of our Nation, 21% of our annual medical spending, goes to obesity-related illness, because weighing too much increases your risk for chronic diseases such as hypertension, type 2 diabetes, high blood pressure, coronary heart disease, asthma, sleep apnea, and other serious illnesses. And then there’s the impact on worker productivity as obesity-related job absenteeism, causing many companies to off-shore jobs to avoid rising health costs. This too contributes to our economic decline.
Public health officials can accurately predict obesity and longevity rates by zip codes. One inner city example had an average lifespan of just 64 years versus 90 years for a wealthier neighborhood 8 miles away. (https://mhealthtalk.com/cazitech/obesity/)
Disadvantaged communities are at higher risk for many preventable health conditions, including obesity, diabetes, heart disease, asthma, HIV/AIDS, viral hepatitis B and C, and infant mortality. That’s partially due to the lack of fresh and nutritious food at affordable prices and the lack of sidewalks and parks that encourage exercise. Pressures from Job, Money, Divorce, Violence, and Homelessness cause a vicious cycle of Stress = Obesity = Stress = Rising Healthcare Costs.
Would Bernie Sanders’ Medicare-for-all save Americans money?
QUESTIONABLE MOTIVES — Be very suspicious of articles and ads like this, promoted by an industry that profits so perversely from treating illness and injury but has little incentive to prevent or cure it. Watch out, because this industry has an incentive to mislead and a history of paying doctors to publish academic papers with half-truths that appear credible but hide their true intent.
WHAT’S AT STAKE? Well over $1.5 trillion/year if disruptive reforms are able to cut spending by half to match other advanced nations with their better longevity and outcomes. That estimate is based on the fact that we spent almost $3.65 trillion last year. What might we expect from the medical industrial complex with so much at stake?
OVERUSE — Sanders stretches the truth too, with a motive to get elected. His generous benefits and the elimination of cost-sharing would cause overuse and likely would not pass, but most of his other arguments are sound.
EFFICIENCY — Compared to private insurance, Medicare has immense negotiating power, far more efficient claims processing, and no profit motive; so extending that single-payer model makes good fiscal sense. But it alone won’t cut costs in half. For that we must go beyond how we PAY for care and also improve delivery and other parts of the system, including hospitals & clinics, drug companies, testing companies, and medical equipment providers.
HOLISTIC VIEW — We must address the entire system and know “Why American Healthcare is So Expensive” to begin with. (https://mHealthTalk.com/expensive/)
HERE I AGREED — “There is really only one certainty when making big changes to the health-care industry: There will be unintended consequences. Medicare-for-all would involve disruption in the health-care market much larger than what the United States experienced with the implementation of the Affordable Care Act, Medicaid or the original implementation of Medicare.”
Industry insiders see that disruption as bad, because it threatens their jobs and perverse profits. The rest of us see it as good, because we imagine how our nation might use $1.5 trillion/year in savings. We also know a healthier workforce would increase workforce productivity, company profits, wages, GDP, and global competitiveness.
RELATED ARTICLES:
Medicare-for-All: We read Democrats’ 8 plans for universal health care. Here’s how they work. (Vox) ““Medicare-for-all” has become a rallying cry on the left, but the term doesn’t capture the full scope of options Democrats are considering to insure all (or at least a lot more) Americans. Case in point: There are half a dozen proposals in Congress that envision very different health care systems.” None of them go far enough to cut healthcare spending in half and match what other advanced nations spend (per capita or GDP percent).
Beyond the Affordable Care Act is the proposal of Physicians for a National Health Program, a single issue organization advocating for a universal, comprehensive single-payer national health program.
Medicare-for-All Isn’t the Solution for Universal Health Care (The Nation) — The health-care debate is moving to the left. But if progressives don’t start sweating the details, we’re going to fail yet again.
A Single-Payer Healthcare System for All Americans — Isn’t single-payer just another way to pay for care, with nothing to improve care delivery or reduce the need? This question is why I say, Medicare-for-All is Not Enough, although it sets the stage for effective reform.