By Dr. Claudia Fegan
Modern Healthcare, July 21, 2017
Now that the Senate GOP’s Better Care Reconciliation Act has crashed and burned, and efforts to repeal the Affordable Care Act appear to have stalled, it’s time to consider another plan: improved Medicare for all.
The American public has demonstrated they want real solutions, not empty promises. Voters are demanding change in both town halls and the halls of Congress.
The same day the Congressional Budget Office released its initial analysis of the BCRA, the Annals of Internal Medicine published a study called “The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?” Based on the study’s findings, the answer is yes. A review of several other studies shows that each year, for every 769 Americans without health insurance, one will die.
Repealing the ACA would mean 32 million Americans losing insurance, according to the CBO, resulting in 42,000 unnecessary deaths. Combined with the 28 million who are currently uninsured, we would see a staggering 78,000 Americans dying prematurely because they are uninsured. That’s more than will die of influenza and pneumonia (57,000) or kidney disease (50,000) each year. Lack of access to healthcare is our nation’s eighth-leading killer, a crisis our leaders can no longer ignore.
During the 2016 campaign, Donald Trump promised voters healthcare reform that would provide more coverage, better benefits and lower costs. None of the proposed GOP bills achieves these goals, and they are widely unpopular among both Democrats and Republicans. Of course the ACA also has come up short in delivering lower costs. And despite the major increases in coverage, about 9% of Americans are still uninsured.
So the question remains: Have our elected officials simply run out of ideas?
Thankfully, not all of them. Rep. John Conyers (D-Mich.) has introduced a bill called the Expanded and Improved Medicare for All Act, a single-payer plan that would provide immediate, comprehensive coverage to all Americans. The bill has gained 115 co-sponsors, with a majority of House Democrats signing on.
How does it compare to President Trump’s healthcare promises?
• More coverage. Like enrollment in Medicare at age 65, all Americans would automatically join a national health plan, regardless of age, employment, income or marital status. Medical decisions will be made by patients and providers rather than insurance companies.
• Better benefits. Medicare for all will cover all medically necessary services, including dental, vision and long-term care. Patients can visit the doctors and hospitals of their choice.
• Lower costs. By eliminating insurance middlemen and their exorbitant executive salaries, advertising and profits, Medicare for all would yield about $500 billion annually in administrative savings. The program would be funded by payroll taxes that will be fully offset by the virtual elimination of premiums and out-of-pocket expenses for patients. Medical bankruptcy would be a thing of the past.
Will it work? Medicare for all isn’t a new or fringe idea. Single-payer systems work in industrialized countries worldwide, and most spend about half of what we do on healthcare, with better results.
Hiding in plain sight is a single-payer system called Medicare, which is universally popular among patients and physicians, providing care to the oldest and sickest Americans with only about 3% in administrative costs.
Polls show strong support for a single-payer program, and healthcare providers agree. Last month the Chi- cago Medical Society asked more than a thousand members to rate competing healthcare plans. Doctors preferred a single-payer plan 2-to-1 over the ACA and 3-to-1 over the GOP House bill, the American Health Care Act. Nearly 90% agreed that healthcare is a human right that should be available to all individuals, similar to police and fire protection.
We became doctors to help others heal and thrive. Instead, we spend hours each day on insurance paperwork and billing, hours that could be—and should be—spent on patient care. Medicare for all is a system designed to serve the needs of patients, not the profit motives of insurance companies.
Dr. Claudia Fegan is national coordinator and past president of Physicians for a National Health Program. She’s also chief medical officer for the Cook County Health and Hospital System in Chicago.