By Robert Weissman
Port Charlotte Sun, December 29, 2019
By almost every relevant metric, we do the worst or nearly the worst among all rich countries. We are the only country to permit tens of millions to go uninsured, far more people in the United States report skipping care because of cost issues than other countries, our infant mortality rate is atrocious and our life expectancy trails other nations and is actually dropping.
There’s no excuse for any of this in such a rich nation. We can solve all of these problems — by expanding coverage, eliminating underinsurance and co-pays and improving health care and health outcomes — with “Medicare for All.”
Medicare for All would cover everyone, and end the outrage of a system that permits 27 million Americans to go uninsured.
Medicare for All would solve the problem of underinsurance, which affects three in 10 adults. It would eliminate high deductibles that lead many to skip care.
And here’s the most overlooked fact about Medicare for All: It would improve coverage not just for the uninsured or underinsured, but for everyone, even those with the best health insurance plans now available. Medicare for All would eliminate co-pays and deductibles, provide for dental and vision care, and cover long-term care, including care in homes and nursing homes. With Medicare for All, every doctor would be “in network,” and you could use a doctor of your choice. That’s far better even than existing “Cadillac” plans.
Can we afford a system that would improve care for every single person?
We can expand and improve Medicare at no additional cost compared to what we currently spend.
Leaving aside the very significant economic benefits — not just human health, but economic gains — that will come from improving the national health system, we can eliminate upward of $500 billion annually in spending wasted on bureaucracy, inefficiency and excessive corporate profits.
Thanks to price-gouging exploitation of patent monopolies and other government-granted market exclusivities, the United States spends outrageous sums on prescription drugs. By negotiating drug prices and ending Big Pharma rip-offs and price gouging by middlemen, we could conservatively save $200 billion every year.
Even bigger savings would come from eliminating the wasteful spending by the health care sector on administrative costs. The key would be to move away from per-treatment billing and instead rely on global budgets. Hospitals and other medical providers would receive an overall payment based on the patients they serve and the treatments they provide, and then they could get on with the business of providing care. The arrangement would be no different than the ways police stations or public libraries are funded; libraries don’t send a bill to the city treasurer each time a person checks out a book. The potential available savings are tremendous:
- Administrative costs consume an astounding 25% of U.S. hospital spending, far above most comparable countries, due largely to the costs of billing. If hospital administrative spending were brought in line with more efficient countries, the United States could save more than $150 billion each year on hospital spending alone.
- Researchers have found that American medical practices spent almost four times more money than Canadian doctors on dealing with payment issues — $82,000 per physician annually compared to $20,000.
- Processing bills, coupled with expenses for collection of unpaid bills, accounts for half or more of medical practice’s administrative costs — between 50% and 60%, according to a 2005 study published in Health Affairs.
A Medicare for All system would also be able to rationalize spending on expensive renovations and health care technology. By requiring separate budgets for the purchases of expensive medical equipment and other expansions, Medicare for All would ensure that such purchases are warranted by a community’s needs and would thus reduce unnecessary spending, both on the capital expenses themselves as well as on spending for related services.
Critics of Medicare for All have it wrong. They suggest that Medicare for All would bring rationing. But it’s the current system that imposes rationing as a shocking one in three Americans skip care because of costs. The critics say doctors or hospitals won’t be paid enough, ignoring that their costs will plummet because they won’t have to waste so much money on billing and administration. And they scream that quality of care will decline _ even though the evidence is plain that, under the current system, we have the worst health indicators among rich countries, by far.
We absolutely can afford Medicare for All. What we can’t afford is to continue with our current failed system. The time is now for Medicare for All.
Robert Weissman is president of Public Citizen.
By Don McCanne, M.D.
It seems appropriate to end this year and begin the next with a clear statement of what our cause is all about. Public Citizen’s Robert Weissman provides that statement for us. It’s up to us to bring his words to fruition. As he says, “The time is now for Medicare for All.”
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