A Single-Payer Healthcare System for All Americans
For most of us, getting healthcare in this country is way too hard, as the video at the end shows. So to those in Congress who would make it even harder, I say, “Keep It Simple, Stupid,” with a single-payer system providing universal coverage and healthcare for all.
Because so few people know what single-payer is, Will Fisher uses jelly-beans to explain it. To begin with, single-payer is NOT where the government employs the doctors and directly provides the care. That would be single-provider care.
Will’s jelly-bean analogy shows how we currently Pay for care and the savings from a single-payer system. But read on to see why even Bernie Sanders’ Medicare-for-All plan, doesn’t go far enough to achieve the far greater savings potential I so often write about.
UPDATE: Be sure to read my latest article on Why American Healthcare is So Expensive.
TOP REASONS FOR SINGLE PAYER
Isn’t single-payer just another way to pay for care with nothing to improve care delivery or reduce the need? It does set the stage for more-effective reforms, but this question is why I say, Medicare-for-All is Not Enough.
EFFICIENCY – Medicare administrative overhead is extremely low, at 2% versus >20% for private insurers. Medicare also has no profit motive, shareholders to satisfy, or exorbitant executive salaries to pay. Compare that to an insurance industry that profits from charging ever-higher premiums as the cost of providing care goes up. They have a financial incentive to deny coverage but not to contain overall healthcare costs. Reducing the number of payers can both reduce administrative waste and strengthen bargaining power and public oversight of public health benefits.
COVERAGE – With a nationwide insurance pool for basic health care, everybody is in and nobody’s out. Such a system can replace welfare programs like Medicaid and CHIP. Basic health care would be universal, even for members of Congress; but just like Medicare today, people could still buy supplemental insurance for expanded coverage.
PREVENTION – Wellness programs have been popular in employer-funded health insurance plans, but insurers can’t justify investing in such programs when people change jobs or insurance providers frequently. Because that’s not an issue with Medicare, the incentive is to improve focus on wellness, prevention, and worker productivity.
SIMPLICITY – Yes, a single-payer system complies with the KISS principle – it’s simpler. You can choose your physician and not be limited to your payer’s network. And common sense budgeting can offer fair reimbursements applied equally.
WHERE’S THE VISION?
I responded to an article in The Guardian that critiques Democrats’ healthcare arguments, and another article in The New York Times that criticizes Republicans. The NY Times article described a structural flaw in modern capitalism, where tremendous income gains have gone to those at the very top while prospects have diminished for those in the middle or bottom.
Both polarized political parties seem to lack a clear vision for America, and without a strong vision, Republicans have been separating themselves from traditional conservative policy. Even the term “compassionate conservatism” has vanished. I voted for Bush, but without compassion and goals I can believe in, I can no longer call myself a Republican.
As a consumer advocate working to Help Others, rather than myself, I must oppose policies that seem to be, “for us to win, you must lose.” That mean selfishness is why I now call myself a Progressive. It’s why I founded Modern Health Talk five years ago, why I voted for Obama, why I supported the Affordable Care Act (ACA), and why I still advocate long-term for a single-payer universal healthcare system like Medicare-for-All. It’s also why I endorse a public option as a path toward that objective, which is exactly what Bernie has suggested.
Unlike modern Republicans (and many Democrats), I have a vision for America where government and citizens cooperate in a functioning society and share both responsibility and benefits. We collectively invest in public education, public defense & safety, public infrastructure, public utilities, and a skilled, healthy and productive workforce to drive innovation, profit, and GDP. You see, like Republicans, I value capitalism, but I also see benefits in public-sector organizations and initiatives. And I know that no individual or company “makes it” on their own. With that in mind, one of my first articles here described a hybrid public/private healthcare system that recommended blending the best of socialism and capitalism.
MY ADVICE FOR DEMOCRATS
I like most of the populist message of Bernie Sanders and Elizabeth Warren, but I worry that they may be too far to the left and could scare away moderates. They may not completely share my vision for America, because their rhetoric seems to blame wealthy corporations and individuals, and capitalism, and their plans seem intent on punishing the rich with high taxes and strong regulation.
Sure, Progressive policies and tax reforms are needed, but the Democrat’s message needs to be simpler, gentler and more inclusive in my view. Make the case that we as a nation must share both the responsibility and benefits, and invest strategically – i.e. work together.
As for healthcare, quit complaining about Republican efforts to repeal & replace Obamacare. Because that’s what they campaigned on, your arguments are landing on deaf ears. And quit trying to save Obamacare as it stands with its known flaws. Republicans seem intent to sabotage it, because they’ve been unable to replace it with anything suitable.
Take the high road, and the initiative, by reaching across the aisle with a better plan – a plan that has broader objectives that both sides can support, like saving over $1.5 trillion every year in overall healthcare costs, while also improving outcomes and developing that skilled, healthy, and productive workforce.
MY ADVICE FOR REPUBLICANS
You had 7 years to step back, ask the right questions, and work with stakeholders to craft a workable Obamacare replacement, but you didn’t do that. But you could claim victory and satisfy your campaign promises by replacing the Affordable Care Act with a system like Medicare-for-All. Just don’t call it Socialized Medicine, because polling shows that your framing would determine whether it’s viewed positively or as a negative.
Medicare-for-All could gain support among Republicans if you avoid lies, misleading claims, and rhetorical “slight of hand,” like you did when calling the Affordable Care Act “Obamacare.” Make it clear that, as a government-run health “insurance” program for the elderly, Medicare is only about how care is paid for, not how it’s delivered. As for efficiency, this government insurance program is proven to be more efficient than private insurance for several reasons.
- Medicare Has Controlled Costs Better than Private Insurance;
- Medicare Has Lower Administrative Costs;
- Medicare is Publicly Accountable while Private Plans are Not; and
- Medicare has No Profit Motive.
I find it ironic that you Republicans still claim to be the party of fiscal responsibility but have failed so poorly to see the immense savings potential of a single payer (oops, I mean Medicare-for-All) system. There’s still time to change course, knowing that your own hastily & secretly prepared plans are opposed by over 80% of the nation.
MEDICARE-FOR-ALL
As the latest Republican attempts to repeal Obamacare failed, Democrats like Bernie Sanders and Robert Reich argue that basic healthcare should be a right and guaranteed for all Americans. They too support a Medicare-for-All system, so it should be easy for Republicans to reach across the aisle and get their help.
OUR IMMENSE HEALTHCARE SAVINGS POTENTIAL
The U.S. now spends over $3.5 trillion/year on healthcare – in total, including insurance premiums, deductibles, out-of-pocket expenses, government subsidies, and more, as represented by Will Fisher’s colored jelly bean analogy. That’s more than 17% of GDP, and it’s going up with 11,000 people turning age 65 every day and needing more care in old age.
The big savings potential is because our total spending is twice as much as what the other advanced nations pay, yet we still live sicker and die younger. Those other nations also struggle to constrain rising costs, but they have simpler and more-efficient single-payer systems that make coping with aging populations easier. And their incentives better align with goals.
To reach our savings potential, politicians must go beyond single-payer healthcare. Medicare-for-All is not enough — it’s just another way of paying for health care. Although it’s far more efficient than any private health insurance, it doesn’t reduce the need for care in the first place. For that we need to focus on health, wellness and prevention, because as Benjamin Franklin said 250 years ago, “An ounce of prevention is worth a pound of cure.”
To better understand what can be done to save our broken healthcare system, I encourage you to watch Escape Fire: The Fight to Rescue American Healthcare. This documentary film examines the powerful forces that maintain the status quo in a medical industry that’s quick to treat, not prevent, and to profit, not care for.
TECH INNOVATION WILL ACCELERATE PROGRESS IN CARE DELIVERY
“Moore’s Law and the FUTURE of Health Care” is an article I wrote from the perspective of a retired IBM technologist and futurist. It looks at the convergence of information science (processors & networks), biology (chemistry, genes & proteins), cognitive & neuroscience (neuron signaling), and nano technology. Combined with the growing need, the ability of disruptive technologies and business models to satisfy the need is what makes me guardedly optimistic about the future of healthcare in America. On the other hand, there’s our divided politics.
SPECIAL INTEREST LOBBYING WILL SLOW PROGRESS
I worry about misaligned incentives that encourages a medical industry to profit from disease management rather than health & wellness. And I worry about the unlimited funds spent by special interest lobbying. In his TIME Magazine report, “Bitter Pill: Why High Medical Bills Are Killing Us,” Stephen Brill describes the Medical Industrial Complex that spends 3-times as much on lobbying as the military industrial complex. [I use a different term: medical cartel.] They obviously don’t want to lose $1.5 trillion/year in revenue and will surely oppose any of the reforms I suggest.
THE EMPLOYER PERSPECTIVE
A new survey of employer benefits from the Kaiser Family Foundation shows that we’re getting ripped off.
For 2019, the average price of health insurance is expected to rise above $20,000 for families that obtain their coverage through work, with both employers and workers getting a tax break. The cost of health insurance continues to go up faster than inflation and is up 5% for the second year in a row. Workers will only $6,015 of that, with the rest being a largely hidden part of worker compensation.
Employers like their tax-subsidized ability to offer health insurance instead of higher wages. They especially like it when there’s no protection for people with preexisting conditions. That’s because those workers are locked in with little leverage to demand higher wages. Workers with a health condition find it difficult to just quit and find other work or start businesses of their own. That applies to family members too. They could die.
Follow the money: It doesn’t take a rocket scientist to know why so many employers oppose Medicare-for-All.
WHAT DOES U.S. HEALTH CARE LOOK LIKE ABROAD?
“The American health care system is — to put it mildly — totally perplexing, an exercise in patience and a test of financial resilience. And that’s for its participants. So imagine what the system must look like to people from other countries, especially those with universal health care, where citizens don’t live in fear that the next bout of the sniffles might somehow lead to bankruptcy. … Their reaction? Astonishment, horror, anger and disgust.”
Beyond their reactions, pay attention to how much less they pay, compared to us, and how long they live on average. One would think spending more would yield better results, but the opposite is true here.
WHAT DOES CANADIAN HEALTH CARE LOOK LIKE TO SOME IN THE U.S.?
Universal Health Care doesn’t deserve a bed reputation. In this satirical video, American mountain man Gus Porter gets mauled by a bear, but he won’t let the “socialist” Canadian health care fix him up. He’d rather hike back to America because of his misguided ideology, which eventually costs him his life.
WHAT IF AIR TRAVEL WORKED LIKE U.S. HEALTH CARE?
This second satirical video makes fun of our overly complex healthcare industry, looking at what the airline industry might be like if it worked the same way.
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 3RD PARTY ARTICLES:
MEDICARE MANIA – Not as Important as Extreme Inequality (NY Times, 10/28/2019) I agree with this editorial and see fixing our politics as a prerequisite to fixing our broken healthcare. Extreme Inequality and outsized political influence from wealthy special interests underlies not just healthcare but every other important issue facing society. That includes climate change, immigration, gun control, infrastructure, voting rights, foreign policy, and more. It’s my top issue.
The Battles Ahead: Meet the Biggest Opponents of Single-Payer – WOW! This excellent piece is part of Fighting for Our Lives: The Movement for Medicare for All.
The doctor’s strike that nearly killed Canada’s Medicare-for-all plan (Vox, 3/29/19) Building a single-payer system is hard, but not impossible. Just ask Saskatchewan.
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.
‘Single-Payer’ Healthcare Isn’t Necessary — But Single Pricing Is – Great explanation, stats & chart in FORBES
Medicare-for-All Isn’t the Solution for Universal Health Care – This article on The Nation explores single-payer options of other nations
Trump betraying all his health care promises is the biggest Trump scandal of all – According to Vox News, It’s out in the open. And it’s a huge deal.
Excellent side-by-side comparison of Obamacare and the GOP’s replacement plan (LA Times)
Democratic Ideas On ACA Improvements – If Republicans reach out for help recovering from their Manufactured Crisis, the Dems have plans ready. This article includes More From CBO On BCRA Medicaid Cuts.
Unpacking The Sanders Medicare-For-All Bill (Health Affairs Blog) This is a thorough early analysis of Bernie Sanders’ Universal Medicare Program (UMP) bill. While problem areas still exist, it seems to provide an excellent ACA repeal-and-replace framework that, unlike prior Republican attempts, could actually provide universal coverage with better health care and lower overall costs, even with increased taxes.
President Carter: Lack of Universal Healthcare Should Be a ‘National Scandal’ (TIME) “In a country as rich as the United States, blessed with talented medical professionals, world-class hospitals and research institutes, and an almost unparalleled capacity for technological innovation, the lack of universal health coverage should be a national scandal.”
Republicans are arguing that Medicare for All will undermine Medicare (Vox)
Pig-headed Republicans are pushing America toward government-run national health care (USA Today, 12/16/2018) “New Texas ruling is the latest example of Republican efforts to kill Obamacare. But while the GOP is winning on tactics, it’s losing hearts and minds.”
My baby was in an ambulance, and I was panicked (March 2019) Will Fisher ran for Congress in my district in 2016. He didn’t win then, but he has my support if he runs again. He understands the issues families have with our healthcare system and strongly supports Universal Healthcare. During his campaign he created a viral video that effectively shows the benefits of a single-payer System like Medicare-for-All. It’s featured prominently in this article on Single Payer.
Ex-CBO director: Obamacare is ‘working’ and we’ve ‘wasted a decade’ trying to dismantle it (April 2019) I certainly agree that a sudden switch to a single-payer system would be disruptive, that the ACA has worked, and that it needs improvement rather than repeal. But I also support Universal Healthcare, a public option like Medicare buy-in, and programs that emphasize wellness, prevention, and more efficient healthcare delivery, not just more efficient insurance payment.
Medicare for All’s’ rich benefits ‘leapfrog’ other nations (May 2019)
The Business of Health Care Depends on Exploiting Doctors and Nurses (NY Times, 6/8/2019) Think of how the workload problems identified here could be affected by a single-payer system like Medicare-for-All. Then act holistically and address problems systemically.
On the positive side, paperwork and administrative overhead would be significantly reduced if there wasn’t a need to deal with so many insurers or fight so hard with them to get paid. On the negative side is the potential for overuse. Today, many people forgo doctor visits due to cost, but if every visit were free for everyone, doctors could be overwhelmed by increased demand.
“Who knew that healthcare reform was so complicated.” Yes, and to get it right, we must understand the many perspectives and “Why American Healthcare is So Expensive” to begin with.
The Democrats who are still undecided on Medicare-for-all, explained (Vox, 6/12/2019) The fact that Dems are exploring alternative pathways to universal health care is refreshing, helpful, and in stark contrast with nearly 10 years of Republican efforts to repeal-and-replace, or sabotage, our healthcare system without any public hearing. The chart showing the various Medicare-for-All proposals is especially helpful.
RELATED MHEALTHTALK ARTICLES:
Health Care Reform – Progress and Next Steps, by President Barack Obama
Escape Fire: The Fight to Rescue America’s Healthcare – Features an EXCELLENT documentary film that won several awards at the Sundance Film Festival, and was described as “An Inconvenient Truth for the healthcare debate.”
Searching for a Healthcare Unicorn – Healthcare is not the same as other markets. Capitalism and free-market incentives don’t work in healthcare. And fixing it is not as simple as shifting who pays. It’s like we’re searching for a magic Healthcare Unicorn.
Bitter Pill: Why High Medical Bills Are Killing Us – In his 38-page TIME magazine special report, Steven Brill dives into our health care system to understand why things cost so much. Unfortunately, this important article is now behind a subscriber paywall, so I posted a summary and video introduction by the author.
Ask the Right Questions about Healthcare – There’s still time for Congress to replace Obamacare with real health reform that saves over $1 trillion/year and satisfies President Trump’s campaign promise to make sure every American has access to health care that’s better and more affordable than what is available today, but they’ll need to ask the right questions.
US Healthcare System has Cancer. Can Trump Fix it? – It’s my hope that Trump will recognize the need to treat our healthcare system’s “cancer” aggressively, naturally and holistically. But will he? Can he? Here are the challenges he faces.
Why Republicans Want to Repeal Obamacare – Former Labor Secretary Robert Reich dives into what is driving repeal efforts, but he fails to mention the demographic shifts that threaten GOP political control, and how allowing tens of thousands of people to die without health care would benefit them.
Universal Healthcare Opposition – What’s REALLY behind universal healthcare opposition? It seems to be an ideological fear of helping “LOSERS”.
Why Medicare-for-All is Not Enough – 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 NEED for medical care in the first place, with incentives that focus more attention on overall health and wellness.
Influencing Healthcare Policy – Lobbying, Incentives & Insurance – Healthcare reform, whether it’s Obamacare or Trumpcare, seems to be influenced largely by these three factors to maximize profits.
Chipping Away at Healthcare Special Interests Yet? – Revenue growth in the healthcare industry, driven largely by the corrupting influence of political lobbying, is unsustainable. Real health reform needs to resolve the conflicting motives of the public sector and private sector.
HEALTH or SICK Care? – Unfortunately, fee-for-service healthcare incentives caused medical schools to focus almost entirely on diagnosing and treating illness and injury, not preventing it. Prevention goes against the business model of profiting from each patient’s visit, test, prescription and procedure – a model with the perverse incentive to do more and more, and charge more.
The Unbreak Campaign – This MD-driven Declaration Of Independence seeks answers to the same questions I ask in the above editorial. One of the leaders of this movement is ZDoggMD, probably the ONLY healthcare speaker/rapper ever, who uses his gift of sarcasm to educate the public on important issues.
Disrupting Healthcare with Functional Medicine 2.0 – Healthcare is shifting from a Blockbuster’s bricks & mortar model to a Netflix on-demand, anytime/anywhere model. What we desperately need is a new “operating system” for healthcare that is predictive, preventive, personalized and participatory.
Wealth Inequality, Healthcare and the Economy – People, including Congressional Republicans and Democrats, have little real understanding of how wide the wealth gap has become and it’s impact on healthcare and the economy, so this article features an excellent video infographic on the topic and other statistics.
Corporate Behavior and Rising Health Care Costs – The aging population adds to healthcare costs but is a global problem, so what makes our healthcare system the most expensive in the world by far and without the positive outcomes to justify it? I see problems with our politics, special interest lobbying, and societal beliefs. And I find it telling that public health officials can accurately gauge one’s average weight and BMI by zip code, and that longevity in poor neighborhoods can be over 20 YEARS LESS than in affluent neighborhoods on the other side of the same town.