Medicare for All should be the goal

By Eve Shapiro, M.D., and Richard Wahl, M.D.
Arizona Daily Star, July 21, 2015

Medicare, one of our nation’s most valuable and popular social programs, turns 50 on July 30. Medicare is a federal health insurance program that covers 55 million Americans — those over 65 and younger people with permanent disabilities, currently 17 percent of the population.

It was originally conceived as a first step toward covering everyone in the United States under a national health insurance program. Medicare has been a success — it has sharply reduced poverty among seniors and has reduced health disparities related to race, ethnicity and socioeconomic status.

Patients in Medicare can go to the physician and hospital of their choice. It is also economical — overhead costs are about 2 percent compared with 12 to 20 percent for the private insurance market and even higher for the individual market.

Medicare costs are going up due to an aging population and the higher costs of healthcare, including pharmaceutical prices. These higher costs can be easily met by an upturn in the economy, generating greater tax receipts, and tweaks to the payroll tax, which has not increased in 30 years.

In comparison to Medicare, the health insurance options for all other Americans are problematic. Despite the improved access to care with the Affordable Care Act and the recent U.S. Supreme Court decision affirming people’s access to federal subsidies, the Congressional Budget Office estimates that 27 million Americans will remain uninsured.

In addition, many more Americans are feeling the effect of the cost shift to employees in the form of higher deductibles and copays. This creates underinsurance, defined as out-of-pocket costs more than 10 percent of income, which now faces more than 21 percent of adults. In addition, more than half of all bankruptcies in the U.S. are due to overwhelming health care costs.

What’s the solution? We need Medicare for All to ensure universal, comprehensive coverage with no copays and deductibles. This would include freedom of choice of one’s doctor and hospital, the ability to negotiate for more competitive drug prices, and the elimination of the approximately $400 billion administrative costs in our current system.

This system would be financed by a progressive tax that would cost the average family far less than they are paying now in health care costs. This is not “socialized medicine” because doctors would remain in private practice. Only the financing would change. It would not introduce rationing but would prevent the rationing we have now based on ability to pay.

A pipe dream? No. There is legislation in Congress, The Expanded and Improved Medicare for All Act, HR 676, which would put such a single-payer system in place. All other developed countries in the world have such a system, and provide for coverage for their citizens at a cost far lower than ours and at least equal in quality. Canada, for example, has had a system in place since 1971. Since then, they have spent far less than us on per capita health care costs (close to half), while living longer.

Let’s enable all Americans to take advantage of a single payer system, not just the elderly, and enact HR 676.

Eve Shapiro and Richard Wahl have been pediatricians in Tucson for many years and are members of Physicians for a National Health Program.