Medicare for all a poverty solution

By James Besante
Albuquerque Journal, Jan. 12, 2014

Fifty years ago on Jan. 11, President Lyndon B. Johnson declared a “War on Poverty” on behalf of the “many Americans [who lived] on the outskirts of hope.”

His vision embraced an unprecedented expansion of health insurance coverage, which Congress achieved by enacting Medicare and Medicaid the following year.

In the case of Medicare, millions of Americans age 65 and older were given access to health care overnight. The new law went far beyond insuring the uninsured elderly; it reduced poverty by lifting crushing medical debt from the shoulders of America’s seniors and their families.

In the years that followed, Medicare continued to dramatically reduce poverty among the elderly. The scope of benefits expanded, and the health of America’s seniors improved, regardless of race or income.

Congress eventually extended Medicare coverage to the severely disabled, and today the program covers approximately 51 million Americans.

As a third-year medical student, every day I take part in the care of New Mexicans who live on the “outskirts of hope”: An uninsured mother with cervical cancer. An asthmatic who cannot afford his medication.

Their stories and suffering are real. My patients are the victims of physical and financial hardships. They are among the Americans for whom Johnson waged his unfinished war.

On this anniversary, I look back at Johnson’s 50-year-war and propose a simple remedy to address the persistent problem of unequal health care access, a solution supported by the majority of American physicians: a single-payer national health care system, or better known as “Improved Medicare For All.”

But wait. Some critics claim Medicare is “broken,” that it’s “bleeding the American economy.”

It is true the American health care system is hemorrhaging money.

But Medicare, with overhead costs of 2 percent, operates far more efficiently than any private health insurance plan, with overhead costs of anywhere from 15 percent to 25 percent.

The private insurance middlemen are the ones raising the costs of the system, without adding value.

Despite this fact, “free-market” advocates push for further privatization by corporate insurers whose primary goal is to maximize profits for their stockholders by raising premiums, restricting services and denying claims.

But others say, “We can’t afford Improved Medicare For All.” Wrong. The U.S. spends twice as much per person when compared to other developed nations on a dysfunctional health care system built around restricting access to care, rather than providing it. The money is already in the system – it just takes a detour through the private sector, which manufactures complexity, administrative waste and profits.

What does our sky-high health spending – 18 percent of the gross domestic product – get us? The U.S. has the worst health indicators of any First World country. The leading cause of bankruptcy in America is medically incurred debt.

The sad reality is that our current system weighs heaviest on the poor and working class. In the U.S., the poor live sicker and die younger, and the sick die poorer. Illness is both a condition of the poor and a structural barrier, which recreates poverty in America.

Medicare is not the problem, but the solution. The cure for the American health care system and the secret weapon to win the War of Poverty is to expand Medicare to every American: Improved Medicare For All.

Obamacare is not the answer because it relies on an inefficient patchwork system of private health insurers who are the cause of our current troubles.

At the end of each day, I ask myself: “How would this day have been different if my patients had Improved Medicare For All?” Perhaps appropriate cancer screening would have saved the life of the mother with cervical cancer. Maybe asthma medication would have prevented the hospitalization of the asthmatic.

America can win the War on Poverty. We can fix our health care system. A streamlined, publicly financed program, like “Improved Medicare for All,” is the answer.

James Besante is a resident of Albuquerque.