By George Bohmfalk, M.D.
The Aspen (Colo.) Times, October 11, 2018
(Part 6 of 6. Read parts 1, 2, 3, 4 and 5.)
Many people are hesitant to adopt a government-run, universal, single-payer health insurance in one fell swoop. They ask about incremental reform, and retaining a role for private insurance companies. They wonder why this can’t be tested in individual states, like legalization of marijuana and same-sex marriage, before taking it on nationwide.
Are these valid options?
The financial keys to universal health care are the administrative savings inherent in a single-payer system and a single risk pool. If we were to offer a public-option system and retain employer-provided and private insurance, billions of dollars will still be squandered on administration in those private systems. The primary goal of for-profit insurers is profit, rather than paying out health benefits. They are skilled at attracting younger, healthier enrollees while directing older and sicker applicants to public programs.
It’s likely that, with an arrangement of such distorted competition, the public system would become overweighted with high-cost enrollees and be destined to fail. If everyone is in the same boat, there will be plenty of funding to provide excellent care to all, and political pressure to guarantee it.
Some countries, such as Germany, France and Japan, do involve private insurance companies in their systems, but these are highly regulated, nonprofit companies that administer the universal programs in those countries in lieu of a government agency like Medicare. Administrative overheads are lower in countries that use a government agency, like Canada, South Korea and Taiwan.
Sen. Bernie Sanders’ Medicare for All Act (S.1804) proposes a transition over a period of several years. While this may seem like a reasonable phase-in process, it’s completely unnecessary and would be doubly detrimental. Such a drawn-out transition would allow years of expensive administrative waste to continue. Millions of Americans would be deprived of needed care and exposed to unaffordable medical costs in the interim. There’s just no need to waste several years and billions of dollars on a phase-in, as Taiwan demonstrated just over 20 years ago with their smooth immediate transition.
What about letting individual states test universal health insurance?
In order for individual states to enact a single-payer system, they must obtain Congressional waivers to redirect federal funds, such as Medicare and Medicaid, to state agencies. These waivers are extremely difficult to obtain, particularly from a Congress disinclined to support any more federal involvement in health care.
Failed efforts in many states, including Vermont, New York, California and Colorado, have demonstrated not any weaknesses of a single-payer system, but only the near impossibility of enacting one in a single state, for this and many other reasons. This is an issue that can only be done nationwide.
Several proposals have been offered for halfway steps to universal health care, some of which disguise themselves in Medicare for All phrasing, such as the Center for American Progress’ (CAP) Medicare “Extra” for All plan. Colorado’s Sen. Michael Bennet and Virginia’s Tim Kaine offered Medicare Part X, and several proposals call themselves Medicare Part E.
While all of those might provide some relief to some Americans, they all fall far short of providing universal, complete coverage. There is simply no reason, other than fear, not to take the commonsense approach and move in a single stroke to a well-designed single-payer system that would benefit everyone, as described in H.R. 676.
As you read about alternative proposals to Improved Medicare for All, determine whether they accomplish three critical aspects. Do they:
Guarantee universal coverage to all Americans?
Protect against unaffordable deductibles and copayments that delay care?
Eliminate hundreds of billions of dollars in wasteful administrative overhead?
Any proposals that fail to accomplish these three goals are inadequate.
Some say the political will to fully improve and expand Medicare simply isn’t there, so we need to compromise on an achievable policy. Our choice is between a good policy, which has been proved to work in every other industrialized nation, or halfway measures that may chip at the edges but leave us as the world’s most expensive health care system and with the worst results. We must insist on the best policy, and change the politics. It’s just the common sense, correct thing to do.
Dr. George Bohmfalk practiced neurosurgery in Texas before retiring to spend half of each year in the Roaring Fork Valley. He is active in Physicians for a National Health Program, a physician-driven group advocating for a single-payer health care system.
