By Doug Henwood
Jacobin, December 26, 2018
How much will universal health coverage cost? The Mercatus Institute, a Koch-funded free-market think tank at George Mason University, recently put it at $32 trillion over the next decade. That sounds like a lot, but is it?
Well, the study also estimated that the cost was $2 trillion less than it would cost to do just the same thing as we are now — which is surprising considering the source, but much less interesting to mainstream reporters.
But the Political Economy Research Institute at the University of Massachusetts has its own estimates. Its long and rigorous study shows we could cover everyone in the United States with no copays and cut overall health spending by almost a fifth. Lead author Robert Pollin, professor of economics at the University of Massachusetts and co-director of PERI, recently spoke with Doug Henwood for his Jacobin podcast Behind the News.
Doug Henwood: You’re projecting over the long-term that US health care expenditure would stabilize around 15 percent or 16 percent of GDP. Which is still well above what we see in Canada and Britain, and quite above also Germany and France, who spend more than Canada and Britain.
We’re talking about a difference of a trillion or more dollars, which is enough to save the climate and have enough left over for dessert. Why can’t we get down to those levels?
Robert Pollin: Very good question. We really wanted this study to be really heavily peer reviewed. One reviewer was Jeffrey Sachs, who was extremely active and very helpful, and was quite critical in some points. This was his main question. “If we’re going to do all of this, we end up with a system that is going to cost 16 percent of GDP. Why can’t we do better, if Canada and the others are 11 percent, 10 percent, 9 percent?”
Some of the other reviewers I have were pushing on the other side, saying, “You can’t make these cuts. It’s unrealistic to think you’re going to get this level of savings.” On balance, this is where I think is realistically we can get to.
Henwood: We have this coalition now developing in Congress of Democrats opposed to any idea of single-payer, so not obvious at this point.
Pollin: Well, not obvious. But 70 percent of the population says they’re for it.
The argument was for a long time, “Yeah, you may be for it, but you don’t know what the hell it is and you can’t pay for it.” I hope that my study and other people’s studies have demonstrated that that simply isn’t true. It was obvious all along that it wasn’t true — other countries are paying a lot less, and they have some equivalent to Medicare for All.
But in the US case, now we have these various studies, including ours, that make it blindingly clear that this is completely practical, and the financing works. It works way better for almost everybody in society. It relieves people of all the anxieties they have about how they cover themselves when they have health problems. It’s a much better way to run a health care system.
On the other side, you have people making tons of money off of a bad health care system. That’s what we are going to struggle over.
U MASS PERI Analysis:
Reviewer Assessments, including that of PNHP’s Woolhandler, Himmelstein, and Gaffney:
By Don McCanne, M.D.
Those passionate about single payer have been energized by the expanding public support for Medicare for All and by recent policy studies such as that by U MASS-Amherst Professor Robert Pollin and his colleagues, and also particularly by the fact that legislative models are in development on both the state and federal levels. But there are disputes about both policy and process.
Once you exclude those who oppose a government role in ensuring health care for all, the primary disagreement on policy is whether we want to build on our current dysfunctional model of financing health care or if we want to move forward with Single Payer Medicare for All. There is really no contest since the single payer model wins out based on effectiveness, efficiency, accessibility in a system that is both affordable and equitable. Building on the current system by measures such as adding a public option or Medicare buy-in doesn’t come close; lack of insurance, underinsurance, impaired access, and financial hardship would be perpetuated. There are still some differences of opinion regarding details of the single payer model, but this can be worked out cooperatively. What is clear is that expanding the current system is not adequate.
What about process? Above all we need to work with legislators and their staffs and others in the policy community who will be providing input into the legislative process. But in our passion it is essential that we not forget about the importance of civility.
Before Pollin’s team released their analysis, they had it reviewed by several other noted individuals from the policy community (link above). Although not all differences were resolved, the various opinions were advanced for consideration by the community at large. This process includes the crucial ingredient of civility. Without it, the process breaks down, as our highly polarized members of Congress demonstrate repeatedly.
When the legislation needs to be protected against flawed or harmful policies, working together with our colleagues to educate the legislative staffs will get us much further than bombarding them with what appears to them to be the product of uncooperative dissidents. Again, when we are clearly in the right, civility will pave the way.
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