Universal medicare: TV is listening; what about Washington?

A reader writes, “What are your thoughts about the statement by Matt Santos, the Democratic presidential nominee on TV’s ‘The West Wing,’ that extending Medicare to all Americans would be an inexpensive and effective way of providing national health insurance?”

My first thought is what Matt Santos might have been reading lately.

It’s possible he was reading one of my old columns, for example, http://www.lansingcitypulse.com/030212/health2/index.html. There I mentioned that both the UAW and General Motors had concluded that national health insurance was the best way to get the auto industry to stop hemorrhaging red ink (and that was well before recent bankruptcies and plant closings).

Or else Santos might have been perusing the recent columns by Paul Krugman of The New York Times, who, I admit, gets a bit more exposure. Krugman has been teaching his readers a crash course in Health Economics 101 and basically saying that no matter how you add up the numbers, some sort of single-payer national insurance makes the most sense.

Finally, ol’ Matt may have been paying attention to the literature put out by the Physicians for a National Health Program. For some years they have been talking about “universal Medicare,” and it’s from them that I picked up the phrase to use in my 2003 column. The thinking is that we need some sort of single-payer national health insurance. But if we call it “Canadian style single-payer,” it’s a non-starter right away in the U.S. political landscape. Medicare, as we have seen in the last couple of years, is extremely popular; even the most-far-right conservatives are afraid to mess with it too much. And it just so happens that Medicare is the closest thing we have in the United States to a single payer system, even though it serves only a part of the population. So maybe “universal Medicare” is the way to get the average Joe on the street to think about it.

What about Santos’ claims that this will save money? Lots of people have done that math too, and it keeps coming out favorably. We continue to believe the myth that the government is inherently inefficient and the private sector is a model of efficiency. The administration of the Medicare program costs about 3 percent of total revenues. The average U.S. private health insurer spends between 15percent and 25 percent of revenues on administrative overhead and bureaucracy. It’s been frequently estimated that switching to a single-payer system would immediately save the U.S. some $150 to 200 billion annually, which is enough to provide good health care for all of those now uninsured.

By contrast, no one advocating a “free market” solution to the U.S. health care implosion has been able to come up with a plan that will both provide universal access and also control costs.

The proof seems to lie in the international experience. The most developed nations of the world all manage to provide high quality care for all their citizens while spending around 8-9 percent of their GDP to do it. All have some sort of nationally-run or at least nationally-coordinated plan, though some, like Germany, are not true single-payer.

The United States is the sole outlier. We leave about 46 million uninsured, or up to 80 million if you count those who lack insurance for at least part of a two-year period. We spend 15 percent of GDP on this boondoggle. And for all that, we get a health care system that on recent international charts ranks around 30th in the world, somewhere around Slovenia’s.

Experts in health policy have been saying this for years. Now the TV politicians appear to be saying it. When are the real politicians going to speak up?

(Howard Brody is a family practice physician and professor of medical ethics at MSU.)