In favor of Medicare for all

By Ewell G. Scott, M.D.
The Morehead (Ky.) News, July 8, 2016

Despite the Affordable Care Act including the helpful Medicaid expansion, our health care financing system is badly in need of a genuine fix. Deductibles, copays, and escalating premiums are causing financial difficulty for the 95 percent. There is a solution: Medicare for All.

The perfect storm has arrived. Our crumbling health care non-system is about ready to implode in a cloud of dust. Getting sick and staying well are no longer affordable in these United States. But we are unique among the civilized world, and it appears that's the way we want it.

Despite already spending twice as much for health care per capita, we currently rank 30th in efficiency and outcomes. In short, we are not getting value for our dollar.

Any reform effort must be able to do two things. One, the system must be able to lower costs and continue to restrain those costs, and two, financing the system must be progressive.

In plain speak, we all should pay what we can afford, nothing less, nothing more.

Financing health care must be accomplished just as we finance all essential services, such as safe roads or national security. The current system asks Mr. Bill Gates to contribute the same amount as an employee in a fast food restaurant. This system just cannot continue: it is not sustainable.

What is the solution? House Resolution 676 will accomplish these goals by creating a national health insurance plan, thus eliminating the need for private health insurance companies. Discarding the 1,500 for-profit private insurers will save $400 billion per year by eliminating their huge underwriting and marketing expenses.

All of us can be covered without adding more money into the system. Private insurers' overhead is 20 percent whereas in the Medicare program, our single-payer-like plan for seniors, the overhead is 3 percent.

Reliable national polls demonstrate the popularity of a single-payer approach both in the medical profession and among citizens as a whole. A majority of us want such a system. Switching would be simple. We do it for hundreds of thousands of folks each year when they reach 65. Plus, the financing system is already in place.

But there seems to be a serious disconnect between us and our leaders. In 2009, Sen. Max Baucus, then chairman of the Senate Finance Committee, declared discussion a Medicare for All plan "off the table." I wonder why. Could it have been the $3,505,935 he received in contributions from the insurance, health professionals, pharmaceutical, and hospital industries that influenced his thinking? Surely not.

Around the same time, former Indiana Sen. Evan Bayh's wife, Susan Bayh, served on the board of directors of WellPoint (now Anthem), one of the largest private health insurer in the world, where she received a salary of $327,000 a year for attending meetings occasionally. And we certainly would not want to deny CEOs of the five major health insurance companies their combined $73 million compensation packages, would we?

Businesses, large and small, it seems to me, should enthusiastically support a single-payer plan. Administration of the plan would be the responsibility of others; the company could concentrate on its primary business concern. The playing field for the small business person would be leveled, and would make it easier to attract qualified employees. Plus it is a good deal. A better value for funds spent. What else would a savvy business person wish for?

I believe that most of us would think the following scenarios are unacceptable: emergency rooms so crowded with minor illnesses that true emergencies are sent to another facility (diverted), parents are sick and unable to take care of their children, people stay in jobs they hate just for the health insurance, entrepreneurially minded folks are stunted for fear of paying for a serious illness, or having to choose between hunger and buying medicine. To quote Dr. Josh Freeman, "Just as our nation cannot survive half-slave and half-free, or with only half of adults having the vote, we cannot survive with only some of us having access to health care."

If we were to design a national system from scratch, I do not believe we would judge it acceptable if 22,000 avoidable deaths were included each year. We would shout “absolutely not,” and be properly enraged. But that is what we have right now. The Affordable Care Act has not met the goals its name would imply. It has not achieved the goal of affordability, and 35 million of us have no health insurance.

An improved Medicare-for-All plan can accomplish the goals of universal care in an affordable manner. Continuing to rely on our current fragmented, employer-based private health insurance system will not. Despite our politicians telling us a single-payer plan is not feasible we know that it is. Taiwan, just ten years ago, converted its fragmented private insurer system to one patterned after our Medicare program. Canada has had Medicare for All for half a century. It has been highly successful, and has eliminated socioeconomic health care disparities. It can be done.

Medicare for all is the answer. We know it works, it is already in place and very popular with those who are fortunate enough to be enrolled. We hope our politicians have enough integrity to make the right choices.

Ewell G. Scott, M.D., FACP, resides in Morehead. The opinions expressed in this commentary are solely those of Dr. Scott.