By Jessica Schorr Saxe, M.D.
The Charlotte Post, March 8, 2019
Would you like to improve health statistics for African Americans, as well as other residents of the United States?
Americans lag behind other wealthy countries in health, with lower life expectancy and more deaths in infants and in mothers around the time of childbirth. In Charlotte, infant mortality is about five times as high for African Americans as for whites, a statistic that should shock us all.
Almost half of Americans either are uninsured or underinsured, which means that, although they have health insurance, they are at risk for not getting health care due to cost or getting needed care and not being able to afford their bills. And these numbers are worse for minorities.
Fortunately, there is a solution in sight. Rep. Pramila Jayapal filed HR 1384, the Medicare for All Act of 2019 in the House of Representatives on February 27. The true Medicare for All bill, it would improve on current Medicare by adding additional coverage such as vision and dental care; and eliminating the deductibles and co-pays (which result in almost one out of four seniors having cost-related problems getting medical care) and would extend it to everyone.
By eliminating private insurance companies, it would also be simpler for patients and providers because it would eliminate the unending maze of differing eligibility, forms, formularies, prior authorizations, and networks of different insurance plans (which then have to be revisited when a patient changes insurance). The bureaucratic relief translates into savings. Currently 30 percent of health care spending in the US, about $1 trillion, is due to administrative costs, and half of that is wasted. That $500 billion savings could be used to actually deliver health care.
The concept of Medicare for All has now become so popular that we are besieged by imitations, such as the Medicare for All Choice Act and the Choose Medicare Act. Sometimes referred to as the Medicare for More bills, these purport to be more politically palatable because they would be gradual routes to insure more people. However, they have serious shortcomings.
Most are a variation of a public option, which allow some people to choose to buy into Medicare. Choice sounds attractive, but making it an option means it wonāt be universal. We will still have uninsured people who wonāt get adequate routine care. And, though they may feel invincible, they will still be at risk for motorcycle accidents or leukemia requiring a bone marrow transplant. And we will all end up paying for their care, in the most inefficient way.
Secondly, rather than cutting down on bureaucracy, a public option will create its own new bureaucracy with yet a new set of eligibility criteria, forms, etc.
Lacking the simplicity of true Medicare for All, it will maintain the headaches and expense of the current system.
Can our nation afford to implement Medicare for All? The question should be, āCan we afford not to?ā Researchers at the Political Economy Research Institute found that it would reduce health care spending in the U.S. by 10 percentāwhile also covering every person in the nation.
Concerned about those employed by the insurance industry? The Medicare for All Act of 2019 contains funding for job retraining and transition. Those with jobs in the new system will actually have jobs that contribute to delivering health care, not denying it.
Some politicians are concerned that the public will object because they are attached to their employer-based insurance plans or because they fear increased taxes. Surely the public values their choice of doctors and hospitals, which would improve when all are in a single plan rather than fragmented networks, and would not mourn losing high deductibles and surprise medical bills. Surely they would rather see family health spending decrease by thousands of dollars even if taxes went up a little. And surely the public values health. If everyone had access to health care, we could probably live longer and have fewer babies and mothers dying, especially in the African American community.
We should remember we are that public. Call your member of Congress and tell them you want a comprehensive, universal system that saves money for individuals and the economyāand that they should support HR 1384, The Medicare of All Act of 2019, the real deal.
Dr. Jessica Schorr Saxe is a retired family physician in Charlotte and chair of Health Care JusticeāNorth Carolina.
