By Ed Weisbart, M.D.
Common Dreams, March 18, 2021
Just days after passage of the American Rescue Plan, Rep. Pramila Jayapal (D-WA) is introducing an updated version of the Medicare for All bill in Congress.
Is Medicare for All still relevant? Yes, and now more than ever. But I’m glad it was not included in the American Rescue Plan.
The American Rescue Plan is astonishingly important for its life-saving value. Quick passage means Covid vaccinations will roll out more broadly, schools will be more quickly able to reopen, and on and on. Health insurance premiums will plummet or disappear for millions of us.
But despite this landmark legislation and all of the good it will do, our healthcare system remains fundamentally flawed. Medicare for All should be the next step.
Employer-based insurance seldom provides adequate coverage. Even those of us with insurance continue to be plagued by high copays, high deductibles, medical bankruptcies, limited choices of physicians and hospitals, and other insurmountable barriers to care.
The commercial insurance industry is a particular failure at mental health. Despite most having insurance, 57% of Americans with mental illness, 73% of youth with depression, and 90% of those with substance abuse disorders cannot access treatment. 80% of counties outside of core metropolitan areas have no psychiatrists.
Many patients simply give up. We need better access to insurance, and we need far better insurance.
Our nation remains vulnerable to the next crisis. If there’s one thing we should be learning from the pandemic, it’s the danger of linking access to healthcare with employment. Imagine if we made that linkage for drinking water, fire insurance or national defense. These are things we each need, not optional commodities to be traded for the latest stock price. If you have more property, you probably want more property insurance. That just doesn’t make sense when it’s human lives on the table. Health insurance is—and should be considered—something vastly different from personal property insurance.
Despite its life-saving importance, the American Rescue Plan continues to protect bloated corporations with our public dollars. I am deeply happy that many more of us can access health care but diverting our tax dollars into blindly supporting unfettered premiums is the most wasteful solution.
The American Rescue Plan does virtually nothing to make healthcare more affordable for the nation. There are no new restrictions on insurance company overhead and no new pathways for efficiency. The law further subsidizes the commercial insurance industry, a model that is astonishingly ineffective at controlling costs. Between 2008 and 2018, the average cost of commercial insurance increased more than twice as quickly as did Medicare’s costs (53% vs 21%). By age 64, commercial health insurance premiums on ACA exchanges are north of $13,000 per year—more than double the per capita spending for Medicare at age 65.
Late last year, the non-partisan Congressional Budget Office published one of the most detailed explorations of Medicare for All and clearly concluded that universal coverage through Medicare for All can be affordably achieved with expanded benefits copays all but eliminated.
Despite the urgency of adopting Medicare for All, I’m pleased that it was not included in the American Rescue Plan, and here is why.
Covid has set our houses on fire, and we need this rescue immediately. Including Medicare for All would have demanded a slower legislative process; it was wise to not delay the fire engines.
I’m happy to have my tax dollars contribute to making sure everyone can get healthcare, but I’d be much happier if we were prudent about it. Instead of paying corporations their 10-15% overhead, we should take advantage of Medicare’s 2% overhead. Instead of a complex system with Byzantine bureaucracies blocking health care, we should simplify our system with one reliable payer. And instead of struggling to stay ahead of the next crisis, we should include everyone in Medicare and take that problem off the table.
Insurance companies will never have our best interests at heart. No other industrialized nation exposes healthcare to the whims of an employer, the fluctuations of the marketplace, or a national catastrophe like a pandemic.
One of the largest barriers to Medicare for All has been a distrust of the competency and efficiency of our government. By starting to rebuild that trust, the American Rescue Plan may have truly earned its name.
Dr. Ed Weisbart is a family physician and chair of the Missouri chapter of Physicians for a National Health Program.