By Margot Sanger-Katz
The New York Times, July 3, 2019
The “Medicare for all” bill written by Senator Bernie Sanders would cover not just standard medical services, but also vision, dental and long-term care. It would offer more health benefits than the world’s leading universal health care systems.
But as some politicians who support the plan are quick to clarify when asked, that does not mean it would “abolish all private health insurance.”
The next thing they may say includes something about “a role” for private insurance or “supplemental coverage.”
The example of supplemental insurance Mr. Sanders typically mentions is coverage for cosmetic surgery.
To clarify: There is no private market for cosmetic surgery insurance.
“We are not aware of any,” said Adam Ross, a spokesman for the American Society of Plastic Surgeons, the leading professional group for plastic surgeons. “Not for cosmetic procedures.”
“No one would sell a cosmetic surgery plan, since the only ones buying it would be people expecting to need cosmetic surgery,” said Linda Blumberg, a fellow at the Urban Institute.
Mr. Sanders’s bill is so expansive that it’s actually quite hard to imagine many health care services that private insurance companies would be able to cover. While the bill doesn’t explicitly ban private insurance, it makes it unlawful to “sell health insurance coverage that duplicates the benefits under this act.”
“You have to really rack your brains to think of anything that would not be covered,” said Cynthia Cox, a vice president at the Kaiser Family Foundation, a health research group.
You might think that Democratic politicians who endorse the Sanders plan would embrace the bill’s comprehensiveness as a virtue. And, in some ways, they do. But some also appear nervous about saying that they will do away with an entire industry. Public opinion surveys suggest that voters are skeptical about plans that will take away their private coverage. Some co-sponsors of Mr. Sanders’s bill now say they are more comfortable with optional plans that would not bar duplicate coverage. Some others have embraced the “supplemental coverage” line.
“In order to create a role for private insurance in any of those ways, you need to weaken the main system,” said Adam Gaffney, the president of Physicians for a National Health Program, which supports a very broad single-payer plan along the lines of Mr. Sanders’s bill. He said the effective abolition of private insurance was a strength of the proposal, which doesn’t require insurance for financial or benefit gaps.
By Don McCanne, M.D.
Why are so many politicians and others obsessed with protecting the private insurance industry when our goal is, or should be, to protect patients from financial hardship while ensuring access to appropriate health care? With high premiums, ever higher deductibles and other cost sharing, exposure to out-of-network medical bills, and exposure to costs of care not included as plan benefits, the private insurers fail to provide the financial protection that the single payer Medicare for All model is specifically designed to do.
Our current health care financing system is highly fragmented and extremely complex. That has not only caused it to be very expensive while falling short on efficiency and effectiveness, its complexity has also made it impossible to repair its inherent defects by merely adding to the system more complexity such as a public option which can only make modest adjustments in the numbers insured but not in the other flaws in the system.
Contrast that to a system that is specifically designed to include everyone, to provide all essential health care benefits, to eliminate financial barriers to care, and to make the system affordable to society as a whole by eliminating hundreds of billions of dollars in administrative waste. Protecting and perpetuating the private insurance industry by merely adding one more insurance option, even if public, to the current quagmire will only leave on place the current personal financial hardships and impaired access to care.
As PNHP president Adam Gaffney says, “In order to create a role for private insurance… you need to weaken the main system.” Flipping that statement to a positive, in order to strengthen the health care financing system, you need remove the role of private insurance. Abolition of private insurance is a strength of Medicare for All, not a weakness.
It is nonsense to suggest that we should open up other ways for the insurers to tap our health care dollars to benefit their own industry. They have been a very expensive monkey wrench thrust into our health care system. We need to pull the wrench out, repair the damage as we rebuild the machine, and then get on with providing comprehensive, high quality, affordable health care for everyone.
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