By Christine Adams, Ph.D.
Houston Chronicle, Letters, Oct. 13, 2015
Regarding “Medicare for all Americans? Yes, if we want to save a ton of money” (Page D1, Sunday), business columnist Chris Tomlinson is right on the money with his description of the superiority of single-payer. His solution to the uphill political battle to adopt single-payer is a Medicare buy-in option.
However, a Medicare buy-in, as sensible as it sounds, won’t work because it would merely add one more player into our inefficient, dysfunctional, fragmented, multi-payer system of financing health care. It would leave in place the deficiencies that give us very high costs without resulting in medical outcomes substantially better than those of other developed nations, which have national health programs. Keep in mind these nations provide universal coverage and spend half as much as we do.
Christine Adams is a licensed psychologist. She resides in Houston.
PNHP note: The letter above originally appeared under the title “Medicare.” Below is the pertinent article by Chris Tomlinson, business columnist at the Houston Chronicle.
In face of high costs, why not offer Medicare to all Americans?
By Chris Tomlinson
Houston Chronicle, Oct. 8, 2015
One of the constant tensions in any democracy is deciding when a service should be provided by the private sector and when the government should step in.
Firefighting was once a private business, hence the term engine company, but the mess that created led to the creation of volunteer and municipal fire brigades. Health care is an area where the United States maintains a two-track system, unlike most other rich countries, with private insurance for those 64 and under and a single government payer for those 65 and over.
Increasingly, though, the logic of this division is making less and less sense as problems with the Affordable Care Act are revealing. We simply aren’t getting our money’s worth.
Admittedly, as the world’s largest economy with more than 300 million people, the United States has the most innovative health care sector in the world. When it comes to patents, drugs or new devices, the U.S. health care sector is the best, and we compensate innovators quite well.
When it comes to taking care of people, though, we spent $9,225 per person in 2013, almost twice the average of an industrialized country, only to have one of the unhealthiest populations. That’s because not every American has the same access to quality health care, and more than 42,000 a year die from preventable causes.
There are many reasons for these high costs, but one of them is the private health insurance industry, which by law can’t spend more than 15 percent of every dollar on overhead and profit. In comparison, the Medicare single-payer system for seniors spends between about 3 percent on overhead and does not need to make a profit.
Which begs the question, why don’t we have Medicare for everyone?
Having a single-payer system would reduce bureaucracy, standardize costs, cover everyone and potentially save the nation $375 billion a year, according to BMC Health Services Research. The biggest challenge to saving that money and improving our health care is an entrenched industry that uses terms like “socialized medicine” to scare people.
So let’s put that bugaboo to rest. Socialized medicine is when the government owns almost all the health care facilities and employs almost all of the workers. Medicare, which covers senior citizens, collects taxes and pays hospitals and doctors for their services, the same way an insurance company does. That is not socialism, and it works very well.
Medicare is the single biggest spender of health care in the U.S., paying out $585.7 billion of the $2.9 trillion spent on health care in 2013, the last year data is available. Add in Medicaid and other federal programs, and the government pays 60 percent of the health care bills in the nation.
Because Medicare is so big, private insurance companies use Medicare rates as their guide for paying doctors. Medicare’s rules for approving expensive procedures are also a national standard.
For those worried about government technocrats controlling your health care, consider how many layers of bureaucracy exist when you rely on private insurance. Your employer chooses which health care plan you can enroll in, including how much you will pay in premiums, co-pays and deductibles.
The insurance company then decides which doctors and hospitals are inside the plan’s network, and doctors still must ask the insurer for pre-approval before doing anything expensive.
Medicare is financed through taxes, and the vast majority of providers accept it. There is still bureaucracy to prevent fraud, but the cost and fraud is much less in Medicare than in a private health plan.
The majority of doctors surveyed say they would prefer a single-payer system like Medicare, according to the Annals of Medicine, because they hate spending 20 percent of their time dealing with multiple insurance companies.
A majority of employers should support a single-payer system because it removes them from their employees’ health care decisions and reduces labor costs by 10 percent, according to the Business Coalition for Single Payer Healthcare. Imagine writing single federal tax check every year for coverage rather than constantly renegotiating health plans and writing ever-growing premium checks.
Since a switch to a single-payer system is next to politically impossible, and Americans insist on having choices, consider a modest proposal: Allow anyone under 65 to buy into Medicare instead of buying private insurance.
This option was discussed during negotiations for the Affordable Care Act, but insurance companies spent millions lobbying to defeat it because they are afraid of the competition. If insurance companies can provide better health care for less money than Medicate, make them prove it.
Here’s my challenge to the conservatives who are going to call me a socialist: Give me the liberty to choose government-run health care. If it’s as bad as you think, I’ll come running back to private insurance.
Considering Medicare’s consistently high satisfaction rate among seniors, though, private insurers will be the ones scrambling to step up their game.
Chris Tomlinson is a business columnist at the Houston Chronicle.