By Johnathon Ross, M.D., M.P.H.
Cleveland Plain Dealer, October 3, 2021
Many physicians and nurses have experienced the increasing complexity, waste and injustice of our current healthcare system. Many, including myself, have long worked for reform by supporting an improved and expanded Medicare for all.
For decades, the Commonwealth Fund has tracked U.S. healthcare system performance vs. other rich nations. In 2021, we are again ranked last in performance and highest in cost. With Medicare for all, we can do better.
In December 2020, after congressional hearings, the nonpartisan Congressional Budget Office (CBO) published a working paper that estimates that Medicare for all would save over $400 billion in administrative waste annually — dollars that could be applied to universal coverage and care.
Even eliminating copayments for patients while maintaining current average payments for doctors and hospitals, national health expenditures would still fall by $40 billion annually. Compare this to our current system, which leaves 31 million uninsured and half of Americans fearful they cannot afford an unexpected medical bill.
Surveys of U.S. physicians find that 80 percent spend more than five hours weekly on administrative tasks; 30 percent spend more than 20 hours. The simplicity of universal coverage and a single fee schedule without copays would slash billing- and insurance-related costs, while increasing caregiversā time for patient care.
The CBO estimates annual administrative savings of about $10,000 per physician and $20,000 per nurse. The cost of malpractice and workersā compensation premiums, half of which cover care for injured parties, should be substantially lowered with universal coverage.
Patients gain comprehensive coverage without deductibles or copays, complete choice of provider, elimination of surprise bills and reduced fear that care will be unaffordable. Modestly reduced provider payments would allow universal long-term care coverage without increasing national health expenditures.
Public opinion shows about 60 percent support for Medicare for all, increasing to 70 percent when people understand that health care would become a right and commercial insurersā administrative waste would be eliminated. Ninety-three percent of Americans feel patients should be treated equally but only 16 percent believe this is currently the case.
Physicians and patients have similar goals for reform: Everybody covered, better cost control, improved quality of care and a reduction in the burgeoning healthcare administrative bureaucracy.
Half of physicians already support Medicare for all, but many fear reduced compensation, which CBO suggests is unlikely with universal coverage, all-payer rates and office administrative savings.
In 2020, the American College of Physicians and the Society for General Internal Medicine announced support for improved expanded Medicare for all as a possible solution. Physicians for a National Health Program, Students for a National Health Program, the American Medical Students Association and National Nurses United, along with a dozen other healthcare organizations, support Medicare for all — and support is growing.
Medicare for all will save lives and improve caregiversā and patientsā satisfaction by eliminating administrative waste and hassles. Public financing also would bring needed public accountability and transparency to our underperforming healthcare system.
In 1857, abolitionist Frederick Douglass said, āIf there is no struggle, there is no progressā and that āpower concedes nothing without a demand.ā
If we want healthcare progress, it will be a struggle against vested interests and their profit-seeking behavior. If we want healthcare justice, we must demand it. It is not affordability but injustice that stands in our way.
Guest columnist Dr. Johnathon Ross is a past president of Physicians for a National Health Program. He has practiced and taught primary care in poor rural and urban communities, but it was his experience inside the health insurance industry that convinced him of the logic and need for a national health insurance program.