By Nick Estes
Albuquerque Journal, Feb. 27, 2016
Bernie Sanders is right to call for “single-payer” national health insurance; basically, Medicare for all. It makes lots of sense.
This is no slam on Obamacare. The Affordable Care Act was a tremendous moral and political achievement. Under the ACA over 30 million people have obtained health insurance coverage – most for the first time.
Insurance carriers can’t deny people because of pre-existing conditions, annual and lifetime caps on benefits are not allowed and young adults can stay on their parents’ policies until age 26. However, America could do much better for its citizens by joining the rest of the advanced countries in adopting a true national health insurance program.
This is not “socialized medicine.” Doctors and hospitals would not become part of a national system. Sanders only wants to take Medicare, a payment system with 50 years of successful experience, and extend it to everyone.
Overall there is little doubt that this would be cheaper to society than the present system that relies in large part on private health insurance.
Single-payer would save several hundred billion per year in the unnecessary administrative costs and profit that now go to private health insurers. It takes huge costs to administer a system that requires each company and each provider to determine which costs are covered – depending on the patient’s particular plan, on which entity provided the service, what type of service was provided, and under what circumstances.
A single government payer also would be in a better position to bargain for reasonable rates from providers, drug companies and medical equipment manufacturers.
We pay twice as much for medical care as the rest of the advanced countries, so there is a lot of room for savings. We could use the money from both these savings pools to cover the 30 million people who still have no health insurance.
I don’t advocate this out of antipathy to the health insurers. It’s just that the economics of health care are completely different than the economics of most other goods and services.
With most products and services we leave it up to the consumer to decide whether he or she wants the item enough to pay for it. In most cases that allocates goods and services efficiently to those who want them the most and can afford them.
That’s not the way we allocate health care. A humane society believes that everyone should get high-quality care when they need it. For the most expensive treatments, we are usually talking about life or death, or at least a decent future life versus living with a terrible disability.
Health care is thus like police and fire protection: We try to supply good quality service to everyone without charging people at the time of the service or requiring them to sign up and pay for a personal protection plan. We all pay for this protection through our taxes.
Medical care is similar. Individuals usually don’t know whether they are going to need expensive treatments some day. Some people die of a sudden heart attack, others die of a disease that required years of treatment. Regardless, an ethical society provides the necessary care.
Even the other necessities of survival – food, clothing and shelter – are different from health care. Like health care, they are needed for life, but they come in vastly different quality and expense levels.
Government rightly provides a basic survival level to everyone (for example, in food stamps), but the free market provides anything people want and can afford above that level.
That doesn’t work for health care. It is not ethical to deliberately withhold necessary health care from anyone for whom it is appropriate, regardless of how expensive the diagnosis and treatment may be.
That is why we adopted Medicare and Medicaid 50 years ago.
But this logic is not limited to senior citizens and the poor. This is why all other advanced countries combine a system of mostly private providers with a form of universal health insurance ultimately supported by taxes.
This approach makes sense for the United States, too, and Bernie Sanders is correct to insist that the idea be laid before the American people.
Nick Estes is retired University of New Mexico counsel.
PNHP note: Physicians for a National Health Program (PNHP) is a nonpartisan educational organization. It neither supports nor opposes any candidates for public office.