By Theresa Hash and Ellen Kaczmarek, M.D.
Mountain Xpress (Asheville, N.C.), Letters, May 4, 2021
The COVID-19 pandemic shines a bright light on the inadequacies of our current health care system. Affordable health insurance does not mean guaranteed health care. What has become painfully clear is that we need a health care system that provides services regardless of income, background or job status.
The best use of tax dollars (our money) is to adopt a single-payer improved Medicare for All (M4A) health care system like every other major industrialized country. They cover more people for less money and have superior average health outcomes compared to the U.S. In 2017, the U.S. spent $3.3 trillion on health care. This equaled about 17% of U.S. gross domestic product, spending of about $10,000 per person. By contrast, peer countries spent between 9 and 11% of GDP on health care, averaging $3,400 to $5,700 per person.
We pay more and get less.
Twenty-two studies, from conservative to liberal, have documented that M4A would significantly reduce overall health care spending. M4A can only save money with a two-prong approach ā cutting wasteful insurance industry bureaucracy and negotiating prices with hospitals, medical equipment companies and drug companies. Plans such as subsidizing COBRA, shoring up the ACA or adding a public option only add to the bureaucratic insurance industry, do nothing to decrease costs and do not guarantee care ā a big waste of our tax dollars.
How do we pay for M4A? While details are negotiable, with the proposed M4A Sanders bill, employees would pay a flat 4% payroll tax and employers a 7.5% payroll tax, with the first $1 million being exempt. The remainder would be funded by closing tax loopholes and adding progressive taxes on corporations and the wealthy. Ninety-five percent of American families would pay less than they do now for insurance, deductibles and out-of-pocket costs. Average savings per employer is estimated at $8,850. We would pay less and get more health care.
According to the Chamber of Commerce, 96% of establishments in the Asheville metro area have 50 or fewer employees. With the first $1 million in payroll being exempt from proposed M4A taxation, our small businesses and local economy would benefit greatly with M4A. Local businesses would have a more level playing field and compete for talent on wages, quality and service.
M4A would inject a new dynamism into the local economy. Workers could go where their skills and preferences best fit the job. Entrepreneurs, gig workers, artists, farmers, young people, part-time employees and retirees would all have health care. Wages and job quality would be boosted by employers redirecting health care costs. There would be no medical debt bankruptcies, drug rationing or skipped doctor visits, and continued coverage during job loss.
M4A would also help eliminate racial inequities in health care and could be a beneficial part of Ashevilleās reparations planning. Reimbursement rates under M4A could also be adjusted to incentivize providers to deliver services in communities with unmet medical needs, particularly in our rural and low-income urban areas. Asheville-area workers and families ā regardless of race, gender or job status ā would become a healthier, more financially secure local workforce.
What about local government? Health coverage, the source of most labor disputes in this country, would be off the table in union negotiations. Rising health insurance costs would no longer be passed onto employees, and M4A would eliminate future funding payments (other post-employment benefits) for retiree health benefits that are a huge financial strain on all government levels. Local governments will have more funds available for wages, infrastructure, capital improvements and public health.
Medicare for All makes economic sense for WNC. Our tax dollars should pay for actual health care, not insurance.
Theresa Hash and Dr. Ellen Kaczmarek are the co-chairs of HealthCare for All WNC.