Single-payer system is only way to keep health costs down

By Bernie Fetterly
Ithaca Journal, Jan. 17, 2013

To “fix the debt,” we should focus on fixing the economy. Investment in jobs and growth will reduce the costs of high unemployment raise more revenue and reduce the debt burden.

Why should fairer taxes from the rich be allowed only if accompanied by less health care for the old or vulnerable?

Cuts to Medicare are aimed at the wrong target. We don’t have an “entitlements” problem; we have a broken health care system. If nothing is done to that system, the rising cost of health care will cause Medicare and other publicly funded health care programs to consume an even larger portion of the budget.

The real problem is runaway health care costs, driven by the entrenched corporate interests — the drug and insurance companies and the private hospital complexes — that have made our health care the most expensive in the world.

Since vouchers are out, conservatives have another strategy to weaken Medicare: raise the age of eligibility and eliminate benefits for 65- and 66-year-olds.

Denying Medicare to 65- and 66-year-olds will actually cost more money than it saves. The best estimate is that $5.7 billion in projected federal savings in Medicare will end up forcing individuals, states and employers to pay an additional $11.4 billion for health care. If the overall U.S. health care system controlled costs as well as most European countries, both Medicare and overall health care costs would be fully affordable.

To do that, you have to take on the drug companies, insurance companies and hospital complexes that drive up costs. Cutting benefits — or eliminating them for 65- and 66-year-olds — doesn’t control costs. It simply shifts the costs from the public budget to individual seniors or their families. Medicare is more cost-effective than private insurance because Medicare uses its leverage to keep doctor and hospital rates in check. “Improved Medicare for all” would be best because it would bargain for lower drug prices and “Medicare for All” would have a very large risk pool. So why would we want to push more people into the private health care system?

Hospitals under an “improved Medicare for all” system would be nonprofit and financed by global budgets. That alone would eliminate a huge problem of hospital complexes and greatly improve efficiency.

Today, more than 50 million older Americans and people with disabilities have access to health care thanks to Medicare. But Medicare can be improved if we apply it to cover every American. If conservatives succeed in raising the Medicare eligibility age, many 65- and 66-year-old retirees will find themselves uninsured. Others will try to stay at work, adding to their employers’ health care burden while limiting job opportunities for younger workers. Employer health insurance costs will rise as a result. Still others will seek coverage through the new health insurance exchanges — if they can afford it.

Two-thirds of people 65 and 66 (3.3 million people) would face an average of $2,200 more each year in premiums and cost-sharing. Medicare itself would be weakened, with fewer people in the program and less leverage to reduce health care costs. Such short-sighted conservative “reform” will result in chaos in the lives of people making the transition from work to retirement — and it would end up increasing the costs to our overall health care system.

To bring down Medicare costs, we need to make our health care system as cost effective as other nations that deliver more coverage and better care at lower cost. There is only one way to do that and that would be a system of “improved Medicare for all.”

If means-testing became law in Medicare, it would change Medicare from a universal program that serves all Americans into an underfunded health care program that serves only the elderly poor.

Medicare would be even more cost-effective if Congress — in the pocket of big drug companies and the rest of the medical industrial complex — hadn’t forbidden Medicare from negotiating with big drug companies or paying fair prices for a variety of health care goods.

If you consider private health care premiums as a tax, because under the Affordable Care Act you will be mandated to buy or have private insurance, you will be required to pay much higher taxes under the ACA than if you had “improved Medicare for all” — a single-payer system.

Do the math: We cannot afford the ACA or the hardship it will bring. What we need is a single-payer system. Insist on it — demand it. We will have several progressive organizations across the nation working together on this issue. Our local, state, and federal politicians need to support single-payer policy and not the ACA. What we do now is crucial.

Fetterly is the director of the Tompkins County Health Care Task Force.