^{Posted on October 2, 2004}

Let's Change Medicare into a Plan for the Ages

by Saul Friedman
October 2, 2004

It’s time Gray Matters put up or shut up, instead of merely complaining about what passes for the American health care system. And if one day we get a responsive president and Congress, what is a realistic alternative to the nation’s dependence for its health care on the private health insurance business?

I say “realistic” because presidents at least as far back as Harry S. Truman in 1948 have sought universal health care - but he had to settle for Medicare about 20 years later. In 1992 the Clintons tried with a proposal that sought to satisfy everyone, but it collapsed under its own weight and was killed by the insurance industry.

But the polls and the deepening crisis in health care, including the loss of insurance for millions of workers and retirees, seem to be reviving the imperative for change. And if we can stop the Bush administration from killing our only national health insurance program, Medicare, it could become the vehicle for a politically feasible alternative - a universal, “single-payer” system.

Despite the assaults from the right, Medicare remains the nation’s most popular and efficient health insurance program: 90 percent of eligible beneficiaries participate, and 98 percent of non- pediatric physicians accept Medicare; so do most hospitals. According to polls, younger workers hope to join one day, but doubt there will be enough funds left for them.

Nevertheless, Medicare coverage is incomplete, without a real prescription drug benefit and too many limits to save money. And it pays too much money to private contractors that administer the benefits in each state. More important, Medicare will die of old age or be killed by HMOs unless the program is opened, perhaps gradually, to all Americans. That way, the Medicare risk pool could be strengthened by the young, and the program for the elderly would become the U.S. version of Canada’s single-payer system.

Single-payer is not socialized medicine or anything like the British model, but it is not widely understood in the United States. The best and clearest explanation can be found in a narrative or an animation by Graham Walker, a Stanford University medical student and former staff member of Physicians for a National Health Program. (Look for it at www.grahamazon.com/sp)

Briefly, Walker says, “Socialized medicine is the system in the U.K. - the government owns the hospitals, employs the doctors.” Single-payer is more like the Canadian system, where “the government pays the hospital and pays the doctor, but hospitals and doctors are still part of the private sector.… Everyone cares who their doctor is, but do you really care who pays your doctor?”

If you’re worried that the government can’t do anything right, Medicare, backed by 35 years of expertise, is far more efficient and responsive than your average insurance company. Yet its coverage reaches everywhere. Ask anyone who’s been on Medicare for years whether it works. Ask any caring physician whether he or she has more trouble dealing with Medicare or the HMOs, which doctors and hospitals have had to sue.

“Right now,” Walker says, “we ration care by the ability to pay.…Single-payer rations care by health care need. There would be no more pre-existing conditions, no more hassles to see a doctor.”

Medicare, which covers more than 40 million older and disabled Americans, is dependent on congressional appropriations and is running into financial trouble; its premiums and fees are getting too expensive. How can the United States pay for a similar single-payer system to cover 300 million? “Money would come from employers and employees,” Walker says, “but most of the money is already in the system - it’s just currently going to HMOs [and other private insurers] instead of to a single payer.” He noted that several studies estimated that a single-payer system would save enough money on administration to cover the 45 million Americans who are uninsured.

An estimated $285 billion is spent on administrative and middlemen services that provide not a single aspirin. Says Walker: “The U.S. spends double what most other countries spend on health care, and Americans have shorter life spans and millions go uninsured. Many financing schemes exist.… Put most simply, the money that most businesses currently pay for health care would go to single-payer; this would make up most of the money needed.”

As Sen. Hillary Rodham Clinton (D-N.Y.) pointed out, businesses in Canada and other nations with similar health systems have the edge over the United States. Employers, including government, face increasing costs to cover their workers, as well as retirees. With single-payer, no more would a worker or retiree be left without health coverage by a bankruptcy or budget problems.

A new poll for the nonpartisan Civil Society Institute reports that 67 percent of Americans would support guaranteed health insurance, through a government program or a nonprofit source. Even when called “national health insurance,” it’s supported by 52 percent.

I’m sure any single-payer system will have its glitches and frustrations, and some for-profit hospitals and health care corporations may not survive. Nevertheless, single-payer is worth considering.

Write to Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY, 11747-4250, or by e-mail at saulfriedman@comcast.net.