Breakthrough editorial in The San Diego Union-Tribune

Medicare for all? Let's copy what works with health care in other nations instead

By The Editorial Board
The San Diego Union-Tribune, September 5, 2017

It’s now clear that creating a single-payer health care system is the top priority of the Democratic Party and millions of Americans.

In California, Assembly Speaker Anthony Rendon, D-Lakewood, made the right call in June when he pulled the plug on a bill creating a state single-payer system. He did so because the measure, Senate Bill 562, didn’t explain how to cover its estimated $400 billion annual cost — triple the state’s general-fund budget. This reasonable decision led to national blowback. Now Rendon plans to hold hearings to discuss how to get to universal health care.

In Washington, the “Medicare for All” bill that Sen. Bernie Sanders, I-Vermont, plans to introduce this month is picking up support, including from Sen. Kamala Harris, D-California. It’s hard to imagine any Democrat winning the party’s presidential nomination in 2020 without backing single-payer.

But it’s time that Republicans started thinking big about health care as well — and stop equating any expanded government role with socialism. According to a study by the American Journal of Public Health, taxes already pay for 64 percent of U.S. health care. The study found that, “At $5,960 per capita, government spending on health care costs in the U.S. was the highest of any nation in 2013, including countries with universal health programs such as Canada, Sweden and the United Kingdom.”

It’s a stunning statistic. Here’s another: A 2015 Commonwealth Fund study found the U.S. spent per capita at least 47 percent more of its gross domestic product on health care than 12 other wealthy, First World nations — yet had among the worst health outcomes, with the exception of treating cancer. The U.S. had the lowest life expectancy.

Any CEO would look at this picture and say the U.S. must do better. Republicans must do the same. Instead of tinkering with — or gutting — the Affordable Care Act, the Trump White House and congressional GOP leaders should consider setting up a commission to examine how to emulate other nations which deliver better outcomes at a lower cost.

Some answers are obvious. In 2009, journalist T.R. Reid chronicled how 20 percent of U.S. health spending goes to “marketing, underwriting, administration and profit,” compared with 4 percent in France and 2 percent in Taiwan. This bloat is created both by the profit motive in insurers’ provision of essential care — which Reid says is unique in the developed world — and the vast complexity of U.S. health care, with dozens of government systems and hundreds of private systems. Simple is better.

“Given our remarkable medical assets ... the United States could be, and should be, the best [at health care] in the world,” Reid argues. “To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.”

Amen. This is why Democrats who want universal health care should look for inspiration from the rest of the world, not embrace “Medicare for all.” The same holds for Republicans who don’t like how much U.S. health care costs and who think Obamacare is a clunky mess. Americans’ national pride shouldn’t include reverence for a flawed, costly and eminently improvable health care system.



By Don McCanne, M.D.

This is a truly remarkable editorial considering the conservative heritage of The San Diego Union-Tribune. Although the editorial board adheres to its conservative roots by dismissing the label, “Medicare for all,” it makes the case for abandoning our highly dysfunctional health care financing system and turning to models used successfully in other nations - universal systems in which governments play significant roles.

It is a breakthrough acknowledgment that Americans’ national pride shouldn’t include reverence for a flawed and costly system with the vast complexity of the dozens of government systems and hundreds of private systems. “Simple is better,” they state.

It is time that we quit arguing over labels and get down to seriously considering health policies that actually work. An honest assessment will lead to those policies included in the Physicians’ Proposal for Single-Payer Health Care Reform. We’re willing to negotiate changing the single-payer Medicare for all label; we just won’t negotiate exchanging beneficial policies for detrimental ones.

The Physicians’ Proposal:

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