Many people fear that moving abruptly to a single-payer system, as in expanding and improving Medicare to cover everyone, would be disruptive and might wreck the economy. I believe that the only areas that may face any disruption would be the insurance and pharmaceutical industries.
There is much disruption now in our disorganized, inefficient health care system. We ration health care based on ability to pay, not health need. Millions of people face unaffordable medical, drug and insurance bills. Narrowing provider networks force many to change doctors and travel miles away from nearby hospitals to find one in their network.
Americans switch insurance companies on average 10 times during their working years. Each insurance company has its own bewildering set of plans, forms and rules. Medicare enrollees struggle with confusing and expensive Medigap policies. My brother recently had to pay thousands of dollars out-of-pocket for his heart bypass operation, because he had checked the wrong box while selecting his Medigap policy. Many people with employer-provided health insurance would like to change jobs or start their own business but don’t, for fear of losing their coverage.
The transition to a universal, single-payer system would not only be painless for nearly everyone, it also would be a tremendous relief. Suddenly, everyone would have full insurance coverage, with free choice of private doctors and hospitals, through a reliable and efficient agency with a 50-year operating record. No one would ever again have to worry about switching insurers or picking plans. The adoption of Medicare in the pre-internet 1960s was very smooth, as was Taiwan’s move to a Medicare-like system in 1995.
Contrary to concerns that such a move would expand government, the size of government might actually shrink, as several federal and state agencies would be folded into a universal Medicare unit. Medicaid, the Children’s Health Insurance Program and the medical component of all 50 state workmen’s compensation programs would be absorbed into a single health system. It’s likely that the Indian Health Service and Veterans Administration eventually would be incorporated. The administrative savings by having a single funding agency would far exceed the new costs of universal coverage.
When I hear people say they don’t want to give up their employer-provided insurance, I wonder why they would prefer it, with its limitations and rising cost sharing. Their employers would be freed from the burden of contentious labor negotiations, as well as the unpredictable expense and hassles of providing employee coverage. Wages would probably rise. Everyone would be better off.
The economy likely would improve. Despite paying new taxes to fund this, 95 percent of households should see their net incomes and spending power rise, as those taxes should be less than their current total health care spending. Pharmaceutical company profits would drop, but as lower drug prices are negotiated, purchasers would have more money in their pockets to stimulate the economy.
What about the economic effect of all those lost insurance jobs? It’s estimated that fewer than 2 million such jobs may be lost. While that may sound like a lot, it is close to how many workers are fired each month, with no provisions for job placement or retraining. In our national full-time workforce of some 150 million, this is a small number. Many of these workers could be employed by an expanded Medicare agency. And both of the single-payer bills before Congress (H.R. 676, S.1804) provide funds for job placement and retraining.
We are experiencing severe disruptions and threats to the economy under the present health care arrangement, and they are likely to get worse. Improved Medicare for All would be a great comfort to the millions with limited or no health insurance, to those locked into their jobs in order to maintain coverage and to employers who dread annual labor negotiations over health care. People currently working in insurance administrative positions would likely find more productive and rewarding work. Many nurses and doctors hired away from the bedside to work in managed care would return to their first love.
It’s time that we join the rest of the industrialized world in adopting a commonsense solution to our health care crisis.
Dr. George Bohmfalk practiced neurosurgery in Texas before retiring to spend half of each year in the Roaring Fork Valley. He is active in Physicians for a National Health Program, a physician-driven group advocating for a single-payer health care system.