Our friends at the Washington Post are waging a brave campaign against Medicare for All.
By Adam Gaffney, M.D.
Jacobin, June 20, 2017
Over the weekend, the Washington Post editorial board took a bold stance: they argued that universal health care with single-payer financing is simply beyond reach.
That the Post felt the need to issue the editorial at this particular moment is a testament to single payer’s rising fortunes. From coast to coast, activists are on the march: against the widely loathed, upward-wealth-redistributing, health-care-stripping abomination known as Trumpcare, for sure — but also for real universal health care.
Yet the Post’s frail arguments should be confronted, because they repeat a number of common talking points that rest on flawed assumptions and that could do real harm.
The Post editorial board begins by briefly conceding that single payer does have “some strong advantages.” It notes that single payer would be less of a hassle for many people (a good point), that it would get employers out of the messy role of providing health-care benefits (reasonable), and finally that it would facilitate cost-effectiveness research by government investigators (fine I suppose, although this is unlikely to galvanize the average person).
At the same time, however, the Post entirely neglects any of single payer’s actual “strong advantages”: the elimination of uninsurance (28.6 million uninsured in 2016), the ending of underinsurance (most single-payer proposals and bills say that care will be free at point-of-use), or the expansion of health-care benefits (for example, long-term care and dental care).
After neglecting to mention the benefits that actually animate most single-payer advocates, the Post proceeds to critique what it views as single payer’s “astonishing” price tag. It notes that while single-payer proponents point to the much less expensive public health-care systems of other nations, public health-care spending in the United States is already quite high:
The public piece of the American health-care system has not proven itself to be particularly cost-efficient. On a per capita basis, US government health programs alone spend more than Canada, Australia, France and Britain each do on their entire health systems. That means the US government spends more per American to cover a slice of the population than other governments spend per citizen to cover all of theirs.
At first glance it seems here that the Post is making something of an argument for single payer, arguing — as colleagues have put it — that we are already “Paying For National Health Insurance — And Not Getting It.” But they aren’t. They are contending that US public health-care spending is inefficient relative to international comparators, so making the whole system public wouldn’t bring costs in line with other nations.
Now they are right that transitioning to single payer would not reduce US health-care spending, as a percentage of GDP, to the levels seen in the United Kingdom (nor would we want it to: the UK is currently spending too little on its National Health Service).
Nonetheless, the underlying logic of the editorial board’s argument is still very flawed. The Post fails to acknowledge a widely known fact: Medicare is run at a far lower rate of overhead as compared to private insurers, while a single-payer system would produce additional efficiencies throughout the system via reduced spending on administration and billing. Even if we didn’t reduce overall health-care spending through Medicare for All, there would still be enormous savings from the transition that we could use to cover single payer’s costs: more than $500 billion annually, by one estimate.
After essentially dismissing this as a source of savings, the Post proceeds to assert that if single payer is to wring any real savings out of the system, they will be by necessity painful and divisive. Here it engages in a divide-and-conquer approach which we will likely see more of in coming days: doctors will have to be paid less, rural America will have to give up its “expensive medical facilities that serve relatively few people,” and “patients would have to accept different [i.e. worse] standards of access and comfort.”
This is nonsense. Canadian doctors get reimbursed perfectly well for their labor. Rural areas might actually be better served, not worse, under a national health program (NHP) that consciously plans the construction of new health-care capital. And the whole point of single payer is to improve access for all patients: as we replace insurance networks with “one big network” of NHP providers, and eliminate uninsurance and underinsurance, barriers to care — financial and otherwise — will decline.
The editorial concludes by noting that “universal coverage” and controlling costs should still remain the goal, albeit within the edifice of the “Obamacare system.” Yet they neglect to demonstrate how any incremental reforms would actually take us to universal coverage.
The fact is, the major added cost of single payer is the price of covering the uninsured and expanding coverage for the rest of us. So if universal health care is “too expensive” with single-payer financing — with its widely agreed upon efficiencies and capacity to substantially reduce drug prices — it would be absolutely too expensive to attain without it.
It’s Washington Post editorial board writers — not single-payer proponents — that are selling snake oil.