By Joseph Sparks
Sparks Remarks Blog, March 23, 2016
Medicare-for-all advocates should rejoice. You are winning the debate. No one has refuted the benefits of this proposed single-payer health care system. The arguments that have been presented against Medicare-for-all have been wrong, misleading, and disingenuous. Even the haggling over cost is not much of a dispute. This issue is not whether Medicare-for-all will save money—it will—it is just a question of how MUCH will be saved.
The benefits of Medicare-for-all include: one, it covers everybody. No more time needs to be spent figuring what insurance to buy or what your policy covers.
Two, it eliminates co-payments and deductibles, making health care affordable and accessible to all. No more worrying about whether you can afford medical care or whether the co-payments and deductibles will cause bankruptcy.
Three, it covers more benefits than most current insurance. For example, Medicare-for-all covers vision and dental, benefits that many insurance policies lack.
Four, it provides the freedom to choose any hospital or medical professional. Under Medicare-for-all you can choose any physician you want, and you can stay with that doctor no matter how many times you change jobs. No longer will your choice be limited by the insurance companies’ ability to get the best rate without regard to quality.
Five, it allows the physician to determine the best course of treatment based on need, not based on whether your insurance policy covers the treatment or whether you can afford it.
While no one disputes the benefits, many are engaged in misstatements about Medicare-for-all that make egregious errors, including a major media outlet. The Washington Post said this:
“Health-care costs have been moderating in recent years, a fact the Sanders plan relies on to balance its books. However, a major reason for that cost containment has been the rise of high-deductible plans of precisely the kind Mr. Sanders wants to eliminate; cost-sharing encourages people to avoid unnecessary tests and other wasteful expenses.”
There are at least three errors in the above statement. First, there is very little, if any, evidence to support this statement. Second, in recent years, medical costs have been moderating in most developed countries, even the ones that have no co-payments or deductibles. Third, if high-deductible plans are necessary to contain costs, then how do they explain that countries with single-payer systems that lack co-payments or deductibles, such Canada and England, have substantially lower costs than the U.S.? On a per-capita basis, we spend twice as much as Canada and more than 2.5 times what England spends on health care. If high-deductibles were necessary to keep health care costs down, then both England and Canada should have much higher health care costs than the U.S.
The best response to the claim that people would overuse health care if it were free was this comment, “Gee honey, I have nothing to do today. I think I’ll go get a colonoscopy.”
High-deductible plans do achieve one result. They cause people to forgo needed medical care because they cannot afford it, aggravating the continuing problem with underinsurance.
An often-stated misleading and possibly disingenuous statement about Medicare-for-all is that it is unclear whether you can keep your health care plan if you want. Since insurance is unnecessary under a Medicare-for-all system, no plan is needed. Generally, people want to keep their plans because they can use the doctor they want and/or the out-of-pocket costs are affordable. A Medicare-for-all plan, as already mentioned, allows you to choose any doctor and eliminates out-of-pocket expenses, something that almost no health insurance plans match.
A statement that is definitely misleading and disingenuous is that Medicare-for-all will raise taxes because it neglects to mention that it will save money for a substantial majority of the population. Gerald Friedman, an economist who has studied single-payer economics for many years, estimates that Medicare-for-all will save or reduce health care costs for at least 95 percent of the population. For example, a family that makes $50,000 per year will pay an extra $466 in taxes, but the savings from no premiums, no deductibles and no co-pays produces a net saving of $5,807.
Now there has been some debate about how many people will save from a Medicare-for-all plan. Kevin Thorpe, a Health Policy and Management professor, argues that Friedman’s savings estimates are too high, but even Thorpe concedes that more than 70 percent of working families will save money.
And this brings up to the final issue: cost. Thorpe argues that Friedman’s estimates of the savings are too high. However, Thorpe’s analysis is flawed for a variety of reasons, and his current analysis contradicts some of his previous work that was more in line with Friedman’s numbers.
Another misleading and disingenuous argument is put forth related to cost; it will increase government spending. Certainly, if we went to a Medicare-for-all system, the government would spend more on health care, but it is money that will be spent anyway. In 2014, we spent more than $3 trillion. Does it matter if that burden is paid almost all by the government, or by the government and insurance companies? Yes, because if we move to Medicare-for-all, we save at least $600 billion per year along with all the other previously mentioned benefits of a single-payer system, especially ending the individuals’ financial burden of health care. As one economist, lawyer, and expert on the federal budget said, “[W]e cannot afford not to do so.”
For all these reasons, Medicare-for-all advocates are winning the debate.
Joseph Sparks is a freelance journalist who resides in Washington, D.C. He covers health care, politics, and technology.