Why Fiscal Conservatives Should Love Medicare-for-All
Good, Old-Fashioned U.S. Socialized Medicine
By CAROL MILLER
CounterPunch
June 29, 2009
Call me old fashioned, but a true conservative is someone who conserves, dislikes wasting money and is offended by endless corporate bailouts by hard-working taxpayers. A fiscal conservative like me. As a public health professional, I want to see health dollars used to keep people healthy through public health and wellness programs, as well as provide medical care when it’s needed.
We have a health care crisis in the United States. Nearly 50 million people do not have health insurance, and they are our family and neighbors.
There are 500,000 medical bankruptcies every year. Most of these half million families had health insurance; at least they thought they did because every month they paid for insurance. Millions of people have learned the hard way that for-profit sickness insurance does not prevent financial ruin during a health crisis.
One of the worst lies thrown around every time Congress debates health care is that the U.S. will end up with socialized medicine. Socialized medicine is when the government owns and operates health facilities as well as pays the salaries of the doctors, nurses and the rest of the healthcare work force.
Let me say as clearly as possible — President Obama and the Congress are not discussing, introducing or enacting socialized medicine.
Good old-fashioned U.S. socialized medicine
Today, the U.S. already has socialized medical systems serving more than 20 million people. The current U.S. socialized medicine systems are very popular. The largest in terms of numbers of people is the Military Health System. The largest in terms of numbers of facilities owned and operated is the Veterans Administration health system. Two additional smaller U.S. socialized medical systems are the Indian Health Service and the federal Bureau of Prisons.
Despite being socialized medicine, the VA is ranked the highest in a national survey of patient satisfaction by the University of Michigan. U.S. taxpayers own the 155 VA hospitals and 881 clinics; we employ 289,000 people working in the VA including 16,000 doctors and 42,000 nurses.
Even the bastion of capitalism, Fortune magazine, is impressed by VA health care, stating, “The seamless integration of science, information, and compassion is the dream of modern health care. Scenes like these are not fantasies, however, but daily realities at the Veterans Health Administration.” (Fortune, May 2006.)
Let me repeat, President Obama and the Congress are not discussing, introducing, or enacting socialized medicine. Unlike the socialized system military and veterans enjoy, most health care services are provided through a private delivery system. All reforms will build on the existing private delivery system.
2009 health reform debate
So now that we all agree that the President and Congress are not expanding socialized medicine in the U.S., what are they proposing? There are two basic options and neither creates a nationalized or socialized health care system.
Medicare for all: The first choice expands Medicare eligibility beyond its current limitation to elderly (over 65) and disabled individuals of any age. This is the most conservative, least-disruptive and cost-effective way to cover more people; it only takes a simple change to an existing, very popular program. Every time the Congressional Budget Office scores the cost of Medicare-for-all type programs, they pay for themselves through two key business principles, the power of bulk purchasing and administrative savings though the elimination of waste in the system.
Mandated insurance: The second choice forces taxpayers to buy for-profit insurance despite a wasteful administrative cost of $1 billion a day. Yes, a trillion dollars every two and a half years just for paperwork, not a penny of that for health care. As a fiscal conservative, I do not want to pay a secret corporate bailout so that greedy CEOs make bonuses based on how good they are at rationing care to sick people.
In this expansion of the current failed system, the U.S. spends more than twice as much per person than any other country and the excess cost does not result in better outcomes. The U.S. is about 37th in the world for life expectancy, infant mortality, and other indicators of health status.
We have to walk away from corporate rationing to create a seamless system with the highest quality services for the best price. The easiest way to hold down costs is to have the largest purchasing group possible to get bulk prices — this is the single-risk pool.
Especially in this economic downturn it is essential to help people get access to health care. Being creative now gives us the chance to create a brand-new system, an All-American plan.
False conservatives will parrot the corporate line and continue to bail out the failed sickness insurance system. True fiscal conservatives who want to eliminate waste, hold down costs and improve outcomes will support Senate Bill 703 and House Bill 676. All the other bills transfer tax dollars first into needless paperwork and corporate profits and then dole out whatever is left for medical bills.
The choice is clear. We keep our doctors and hospitals in the current private delivery system but let one public insurance plan handle the paperwork and pay the bills.
Carol Miller is a New Mexico public and rural health expert. She has public service in Washington, D.C., in both Republican and Democratic administrations, including the Clinton White House. In 1994 she was the health reform policy adviser for the National Rural Health Association and the New Mexico Secretary of Health. Miller, a former Commissioned Officer in the US Public Health Service, has used both the uniformed services and veterans health care systems.