Universal Health Care for the United States?

[4/18/19] U.S. health care system is being destroyed by insurance and drug companies (letter to the editor)

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PAEONIAN SPRINGS, Va. — Conservatives and progressives agree that everyone should be able to get health insurance and have access to quality health care. But the divide over how to accomplish that goal is wide and deep.

Progressives believe the government should make decisions about allocation of the resources in our health sector while conservatives believe these decisions should be controlled by individuals and families.

The sales pitch for Medicare for all is appealing — universal coverage, free access to doctors and hospitals, and no insurance premiums, copayments or deductibles.

But then come the tradeoffs: Washington bureaucrats would decide what services are covered and how much doctors and hospitals would be paid.

Everyone would be required to give up the coverage they have now — including 173 million American who get health insurance at work — and taxes would be much higher to finance $32 trillion in added government spending over the next decade. For comparison, federal revenues last year totaled $3.4 trillion.

“If you look at polling data, it’s great until you tell them taxes would double and they’d have to give up their employer coverage,” Sen. Bill Cassidy, R-La. noted recently.

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In Canada, everyone in the country is guaranteed access to health care by the government.

The same is true for France, the United Kingdom, Germany, Netherlands and every other country that we think of as comparable in terms of levels of wealth, democracy and economic development.

In spite of providing universal care, these countries also all spend much less on health care than the United States.

In Canada, per person spending is 60 percent what it is in the United States. In Germany spending per person is 56 percent and in the United Kingdom just 42 percent of what we spend.

And these countries all have comparable outcomes. People in other wealthy countries not only have longer life expectancies and lower infant-mortality rates, they also have comparable outcomes when looking at more narrow health issues, like treatment for cancer or heart disease.

The basic story is that we spend roughly twice as much per person as people in other wealthy countries and we have pretty much nothing to show for it in terms of better health.

This is the context in which critics of Medicare for all are telling us it is not possible.

If the argument is that it won’t be easy, the critics have a point. The reason we spend twice as much for our health care is that big actors in the industry get twice as much money here.

Drug companies get away with charging us twice as much for drugs as they do in other wealthy countries. The same is true for medical equipment companies who charge far more for kidney dialysis machines and MRIs than in France and Germany.

And our doctors and dentists get paid twice as much, on average, as their counterparts in other wealthy countries.

In addition, we spend more than $250 billion a year paying insurance companies to administer our chaotic system.

Doctors’ offices, hospitals and other providers spend tens of billions more on administrative personnel who have to deal with the paperwork and issues that are caused by having a range of insurers, each with their own payment rules and practices.

These interest groups will use all of their political power to protect the income they get under the current system.

The pharmaceutical industry will fight measures to rein in their profits in the same way the tobacco industry fought public health advocates who sought to curb smoking.

The same is true for the medical equipment industry.

And doctors and dentists will fight like crazy to preserve a pay structure that puts most of them in the top 1 percent of wage earners.

This will also be true of insurers faced with a more efficient system that will put most of them out of business.

While a well-designed pathway can get us to Medicare for all, even we can’t do it all at once.

For beginners, we can look to lower the age of Medicare eligibility from the current 65 to 60 or even 55 in an initial round. We can also allow people of all ages to have the option to buy into a public Medicare-type system.

We can also look to start getting our costs down. This means lowering drug prices, both by negotiating in the same way as other countries, and directly funding research so that newly developed drugs can be sold as cheap generics.

We should do the same with medical equipment. And we can subject our doctors and dentists to the same sort of foreign and domestic competition that workers in other professions face.

These steps can get us on a path to Medicare for all, on which we will quickly be extending coverage to millions of people, while substantially reducing the cost of care for everyone.