By Marc Sapir, M.D., M.P.H.
San Francisco Chronicle, April 11, 2019
New Medicare for All legislation (House Resolution 1384) reached the floor of Congress with 107 congressional co-sponsors, and has since added one more. Immediately, a widespread counterattack against Medicare was launched, incessantly calling it idealist, leftist, pie-in-the-sky, outrageously costly and guaranteed to increase your taxes, raise the national debt, take away your right to private insurance, cut doctor’s incomes and, in short, branding it as nothing but disastrous socialism. The anti-Medicare campaign originates with conservative think tanks such as Heritage and American Enterprise (policy foundations attached to insurers and Big Pharma), some policy gurus in academia defending private insurers and politicians receiving lobbying support from insurers.
They aim to block the one practical solution to the health care crisis Americans face.
None of these arguments is new, as health policy researchers Drs. Steffie Woolhandler and David Himmelstein document in their essay, “Medicare for All and its rivals,” in the April 2 issue of Annals of Internal Medicine.
It’s the same story we’ve heard repeatedly since Medicare began in 1965 coming from ideologues protecting hugely profitable insurers on Wall Street. Their cause is misanthropic; people suffer. They leveled the same attack against LBJ, Ted Kennedy, Hillary Clinton, and now against Bernie Sanders and Alexandria Ocasio-Cortez.
Here are the facts:
In a socialist health care model (similar to much of our Department of Veterans Affairs services), medical doctors are salaried government employees.
Medicare, in contrast, leaves the private-health-care-system intact, eliminating only the profit-driven insurance companies, which are self-serving and restrict care. Simplifying financing provides everyone 100 percent full access, plus dental, vision and long-term care. A Medicare credit card bills Medicare, not the patient.
The talk that Canadians are not happy with their Medicare is anecdotal fraudulence. Repeated surveys reveal that Canadians are far happier with their Medicare than are Americans with our chaotic system. With a half-million personal bankruptcies yearly in the United States from health debt, and early deaths from denied care, that’s not surprising.
When Medicare was proposed by President Lyndon Johnson, he wanted everyone covered but could only get coverage for seniors because of fierce resistance. Despite repeated attempts to undermine and privatize Medicare, it’s done a better job for seniors than the private insurers could or would. For example, my family’s supplementary private insurance would not allow my wife to go to the best reputed surgeon performing parathyroid surgery because he was not on its panel. We decided to go to that specialist in San Francisco anyway and pay 20 percent of the cost, knowing that Medicare pays the other 80 percent of the bill. And, because Medicare determines how much the surgery is worth, our 20 percent was far less costly than if Medicare was not involved (our cost share was in the hundreds, rather than thousands, of dollars).
Under HR1384, Medicare would be improved, broadening coverage and eliminating the 20 percent share payment. Everything is paid for. But how?
If it worries you that you might have to pay a payroll tax, consider this: Medicare for seniors is funded by a payroll tax.
And because care for seniors (who need more care than younger patients) is funded that way, any added payroll tax would add less than what you pay right now in Medicare payroll tax and any other taxes that are implemented. (In return, we would have the right to go anywhere we want for care — to stay with our familiar doctors, clinics, hospitals or not.)
But where does the claim of prohibitive costs to the economy come in? In a word, it’s a ruse.
We now pay more than twice as much per capita for health care as other rich countries (and yet our health outcomes are worse). In a study funded by the Bill and Melinda Gates Foundation, the United States ranks 29th among all nations for access to and quality of health care (after most of Europe, Australia, Japan, New Zealand, Singapore and South Korea).
U.S. government spending alone on health care (Medicare, Medi-caid and other programs) could fund the entire health care systems of almost all countries in the world. That means Medicare for All, which will lower health care costs, won’t inflate the deficit nor cost individuals more than they currently pay.
The main issue is how to best capture the money currently spent on health care and direct it into one Medicare fund. It won’t be hard.
Dr. Marc Sapir is a retired East Bay primary care physician and the former medical director of the Center for Elders’ Independence. A long time member of Physicians for a National Health Program (PNHP.org), he currently serves on the steering committee of the organization’s California division.