By Adam Gaffney, M.D., M.P.H.
New York Post, September 21, 2019
The number of the uninsured is rising. Health care deductibles are soaring. Rising drug prices are putting needed medications increasingly out of reach of American patients. Meanwhile, life expectancy is falling. Our health care system, no doubt, is ailing. But is Medicare for All, a single-payer public insurance program that would cover everybody in the country, the right medicine?
A majority of the American public — and of the nation’s doctors — now say yes. After all, Medicare for All is the only health care proposal that can expand and upgrade coverage for everyone in the nation — and at an affordable price.
First, Medicare for All would cover all the nearly 30 million uninsured. Individuals without any coverage are liable to wind up broke if they receive health care — and to wind up dead if they don’t. Tens of thousands of people die a year because they lack health insurance. No other high-income nation in the globe tolerates such barbarity. Neither should we.
But Medicare for All would also solve a second serious problem: “underinsurance.” Americans’ paychecks are increasingly squeezed by health care costs. Health-plan deductibles — the amount you pay out of pocket before insurance kicks in — have tripled over the last decade or so. These high deductibles cause women with breast cancer to delay treatment of their disease. They lead patients with diabetes to avoid needed medical visits — and wind up in the ER instead. They force us to make terrible choices — like deciding to use scarce household funds to pay for rent or for chemotherapy.
They are also 100 percent unnecessary. In Canada, the co-pay for a doctor visit or hospital care is precisely $0 for everyone in the nation, which is how Medicare for All would work here.
Deductibles would go the way of the dodo: We’d all have first-dollar coverage instead.
Third and finally, Medicare for All would deliver the cost savings necessary to cover the cost of such a big expansion in coverage. The colossal greed of the private health-insurance industry leads to equally colossal waste. Consider that for every dollar in premiums a private insurance company collects, it takes some 12 percent for overhead — for profits, executive salaries, administration, marketing and so on. That’s sixfold higher than traditional Medicare — which has around a 2 percent overhead. (Private insurers also do almost nothing to combat health-care fraud, unlike Medicare).
At the same time, health care providers also have big overheads just to cover the cost of dealing with insurers. We waste some $80,000 per doctor in the US just to cover the cost of them wrangling with insurance companies — fourfold higher than Canada. Meanwhile, our hospitals spend twice as much on administration as those in Canada, as well. And that’s to say nothing about all the time and energy patients waste fighting medical bills or on the phone with insurance companies. We could save hundreds of billions of dollars by simplifying the way we pay for health care in this country, which means pushing insurers to the curb.
Admittedly, taking on such a big industry is no easy feat. No doubt, the insurers will go to the mat to undercut Medicare for All with a never-ending stream of lies and propaganda. But that’s no reason to give up. Americans, after all, have taken on big fights in the past to make this a better nation. We can win this one, too.
Dr. Adam Gaffney is president of Physicians for a National Health Program.