By Louis Balizet, M.D.
The Pueblo (Colo.) Chieftain, September 4, 2018
Canadians live on average three years more than we do (82 versus 79 years). They pay, per capita, 50 percent less than we do for health care ($4,613 vs. $9,507). How do they do this? It’s fairly simple – their health care system (called ”Medicare”) covers everybody, is publicly funded by an assortment of taxes and delivers medical care largely by private providers. This arrangement produces efficiencies that allow all Canadians to access medical care without fear of financial ruin.
Driven by our persistent health care inequities and relentless cost increases, and faced with the embarrassing comparison with our neighbors to the north, more and more American politicians are backing bills that would convert our health care “system” to one that resembles the Canadian model. Two non-identical bills have been introduced into the current Congress to achieve “Medicare for all”: House Resolution 676, sponsored by Representative Keith Ellison of Minnesota (the stronger of the two, and which most closely duplicates the Canadian system), and Senate Bill 1804, proposed by Senator Bernie Sanders of Vermont.
It is the latter that has attracted ferocious attack by defenders of the status quo – by Ben Shapiro in The Pueblo Chieftain column of Aug. 5, and, more recently, in television ads that target Jared Polis (a co-sponsor of H.R. 676). Both assert that Medicare for all would be prohibitively expensive.
Both draw heavily on an analysis of Sanders’ bill by the Mercatus Center, a right-wing think tank founded by, funded by and run by the Koch brothers. This analysis, which contends that Medicare for all would increase federal spending by $32 trillion over 10 years, is influenced by the center’s anti-government, anti-tax agenda. (Previous Mercatus Center productions denounced restrictions on polluters, questioned climate change and opposed the Consumer Finance Protection Bureau.)
The center low-balls (by $3 trillion) the administrative savings that would accrue from replacing insurance companies’ 13-plus percent overhead with Canada Medicare’s 2 percent overhead. In ignores the estimated $5 trillion saved by providers (hospitals, doctors, pharmacies) no longer having to fund gargantuan billing, coding and collection systems. It miscalculates the savings that would result from the national government negotiating the price of drugs (as all single-payer countries do) rather than allowing drug companies to charge whatever the market will bear (as we do) – a $ 1.5 billion to $2 trillion error.
It assumes a massive surge in utilization under Medicare for all. But the “surge” when Medicare was introduced in 1966 was negligible, and it was minimal when Obamacare opened up in 2014. The Mercatus Center analysis does not recognize the savings by businesses and state and local governments that would no longer have to joust annually with insurance companies over health insurance for employees.
What the Mercatus Center study, and one with a similar conclusion from the Urban Institute, fail to recognize is that while federal taxes would certainly go up (just not by $3.2 trillion a year), money spent on insurance premiums would virtually disappear. The net result for most Americans would be that money would be directed to health care decreases. And for all Americans, getting sick would no longer mean courting financial disaster.
There will be dueling analyses of the cost of Medicare for all in the months and years to come. Relatively few of us are inclined to, or able to, sort through the numbers. But we can all recognize what is real – that citizens of 20-plus countries with national health insurance live longer than we do and pay far less for health care than we do. This is irrefutable and uncontested, even by the Mercatus Center. Why can’t we do the same as these countries? The answer: We can.