By Paul Y. Song, M.D.
Huffington Post, September 7, 2017
Last week, Senator Kamala Harris boldly announced that she would co-sponsor Senator Bernie Sanders’ upcoming Medicare-for-all legislation and Senator Elizabeth Warren just agreed to do so as well. As the dust settles after yet another failed GOP attempt to repeal the Affordable Care Act (ACA), it is vitally important for everyone to understand why simply preserving the ACA is not good enough.
By now, many of us are aware that despite spending twice as much per capita on healthcare as any industrialized nation, we still have a healthcare system where 29 million Americans are uninsured, tens of thousands of people die each year simply because they lack coverage, and medical illness remains the top cause of bankruptcy.
Even more shocking however, is the 30+ million insured Americans who continue to have such high out-of-pocket costs and deductibles relative to their incomes that they are considered underinsured. Due to this dynamic, one out of three people with insurance will delay seeking care, leading to more advanced disease and poorer outcomes.
Because the ACA was largely written by the private insurance and pharmaceutical industries, it did not regulate insurance rates or address skyrocketing/unaffordable drug prices. As a result, a 2017 Kaiser Family Foundation study revealed that 37% of insured Americans reported difficulty paying their monthly premiums, up from 27% two years ago. For 2018, individuals who purchase coverage without subsidies are expected to get walloped once again with double digit increases in their premiums. And according to a recent study by Prescription Justice, 45 millions Americans did not fill their prescriptions last year because they could not afford to.
Staggering healthcare obligations are also having a negative impact on US business competitiveness. Prior to the bailout, General Motors spent more on healthcare than it did on steel to make cars. Each year, escalating premiums consume more and more of company budgets that could otherwise be used for capital improvements, R&D, and higher wages. With no end in sight, large employers report that health plans will cost more than $14,000 per employee in 2018. And a recent Kaiser Family Foundation study found that companies are shifting more and more of these costs to their employees. Despite stagnant wages, workers’ contributions towards their employer sponsored health insurance premiums rose 83 percent from 2005 to 2015, and the amount employees had to pay for deductibles increased 255 percent from 2006 to 2015. All of this leads to far less take home pay and disposable income. Money that could otherwise be used to help families and our economy is instead going into the pockets of insurance and pharmaceutical executives.
And while the Medicaid expansion was transformative in increasing coverage to many of our poorest disadvantaged communities, very low reimbursements have hindered the ability of these patients to find providers willing to treat them in a timely fashion. This lack of access has had a detrimental effect as many curable diseases are often caught too late.
Meanwhile, despite contributing over $12 billion in taxes each year, undocumented immigrants have been mostly excluded from all federal health programs, leading to more uncompensated care. Hospitals have then used this as an excuse to grossly inflate basic costs of good and services leading to higher liabilities that are passed onto all of us one way or another.
In 1972, the late Shirely Chisholm wrote:
“We have never seen health as a right. It has been conceived as a privilege, available to only those who could afford it. This is the real reason the American healthcare system is in such a scandalous state.”
Sadly, these words continue to ring true over four decades later, but the time is now to finally fix our broken and immoral healthcare system.
Instead of making drastic inhumane cuts or throwing good money after bad with incremental changes that maintain a broken status quo, we must demand bold action to establish a Medicare-for-all program where we no longer treat healthcare as a commodity.
It is the only comprehensive solution that can adequately address all of the significant issues listed above by removing the gross inefficiencies of a bloated fragmented system while controlling costs of premiums, pharmaceuticals, medical procedures, and medical devices through bulk purchasing and fair cost controls. At the same time, it will strengthen and enhance the current Medicare system by greatly expanding the risk pool with younger and healthier individuals.
Establishing Medicare-for-all is no doubt a daunting and complicated task, but not an impossible one. Every other industrialized country in the world covers all of their people at a much lower cost with better health outcomes.
We can too, but it will take serious time, effort, and commitment coupled with real political will.
Representative John Conyers has introduced H.R. 676 for the past 14 years, but for the first time has 118 sponsors. Along with Senator Sanders’ much anticipated Medicare-for-all bill, this will put forward a solid framework from which we can begin to finally have a serious discussion and earnest attempt to bring about the the type of healthcare system we truly deserve, but are just not getting.
Critics will say that we cannot afford this right now. They will point to an earlier Urban Institute study estimating the cost of such a plan at $32 trillion over 10 years. The reality is that we already spent $3.4 trillion on healthcare in 2016, and this is projected to increase an average of 5.6% per year per decade and cost $49 trillion over the next 10 years without addressing any of the serious problems discussed. And besides taxpayers are already paying for two-thirds of every dollar spent on healthcare
Support of Medicare-for-all is at an all-time high and what we cannot afford is to continue the same status quo. We must demand that the rest of our legislators follow Senator Harris’ lead and put their constituents’ health security before corporate interests once and for all.
Paul Y. Song, M.D., is a Board Member of Physicians for a National Health Program and Co-Chair for Campaign for a Healthy California.