Putting to bed the GOP talking points on Healthcare - for good!
Healthcare is on the minds of many Americans in the preview to the 2020 Presidential election. Many worry about costs, coverage and the death of the private sector. Single-payer, a plan employed by dozens of countries around the world is cheaper, with better coverage, and permits the private sector supplementally. For the health of every American, we must get profit out of health coverage.
Putting to bed the GOP talking points on single-payer healthcare, for good
By: Jordan Shapiro, M.A
Fear is not the only option
In America, we define healthcare with fear. Fear of lack of access, affordability, debt, coverage, more taxes, pre-existing conditions, and the list goes on. Our nation will continue to struggle to build a plan for future human prosperity if many of our citizens have to focus more on whether they can afford their next insulin or dialysis treatment rather than on how they are contributors to the economy and culture.
Today, fear around healthcare shows a new face: fear of change. Bipartisan support widely acknowledges that reform is needed, but, as usual, the methodology is up for debate. Meanwhile, millions of Americans remain uncovered and struggling with healthcare and debt from the current system.
Many policymakers, especially Democratic primary candidates, have a plan for ensuring that every American can access affordable healthcare. Many of these plans build upon Obamacare allowing citizens to elect private plans, public plans, or no plan at all.
Except for Senator Sanders and Senator Warren, crucially, none of these proposals, by default, create universal healthcare. They create a path for all Americans to access healthcare plans. Structurally they continue to give the healthiest, most productive citizens to private insurance companies leaving the government with less bargaining power and a high-risk pool.
Single-payer is universal. It’s one plan, with the most-powerful risk pool the country can manage —every person. It lowers costs for everyone while increasing efficiency and is a tried and tested system that dozens of countries successfully employ across the world.
If Americans want universal healthcare, we need to pick an option that, by its very definition, is a fully comprehensive option.
Ensuring universal healthcare means creating a system of universal healthcare
In America, healthcare falls into three principle categories. State-sponsored healthcare such as the VA, Medicare, and Medicaid. Employer-sponsored healthcare, which you can only receive by working a full-time job. Finally, the public option, which allows Americans to shop the healthcare marketplace and pay for insurance privately.
Anyone working in this system, who has switched insurance, lost coverage, or used the healthcare marketplace knows the choices are overwhelming. Every insurance company has a different policy, plans with different copayments and deductibles, and a whole manner of fees and coverage lists. Reading the fine print that would make a lawyer balk, let alone your average citizen.
Single-payer eliminates confusion from the current system by offering one, overarching plan. This plan would, based on international precedent, be managed by the government or a government-regulated entity. The scheme covers all ailments, medicines, doctor visits, equally, for all citizens.
A typical system requires no payments for a doctor or specialist visit, a long list of drugs and treatments with no out-of-pocket fees.
Medication and medical equipment are expensive, but throughout Europe, governments negotiate universal prices for drugs and equipment to keep costs in check and ensure equity for each citizen.
Sounds too good to be true? It’s not.
In Denmark and France, for less advantaged patients, or patients who need chronic care, their medications are additionally subsidized for affordability. In France, irreplaceable medicines, those that provide significant improvements in a person’s quality of life, are almost fully funded.
The definition of universal healthcare is single-payer. It is the only system that guarantees every citizen to be fully covered, period.
Government-sponsored universal healthcare is too expensive
The National Healthcare expenditure estimates that healthcare per person in America costs about 10,000 dollars, totaling about $3.5 trillion in 2017; this figure leaves out 28 million Americans who are uninsured.
Estimates from the California Health Care Foundation indicate that by 2026, under the current system, per person costs will rise to $16,000 per person.
For many Americans, $10,000 sounds cheap; the average employer-sponsored healthcare costs are around $19,000 per family.
Americans know healthcare is expensive. Fear that those costs could balloon even faster is reason enough to oppose change to the system.
In 2017, OECD average spending, per year, per person for healthcare was $4,000 per person, and in these systems, every person receives equal, complete insurance.
In a recent working paper from the Mercatus Center, Charles Blahous found that in a side-by-side comparison between current US healthcare expenditures and a US single-payer system, the single-payer system would, over a decade, be cheaper.
What the numbers show is that the American system is bloated with inefficient systems: high medical school costs, profits for pharmaceutical companies, and profits for insurance companies.
According to the Association of American Medical Colleges, the cost of attending medical school for four years is $275,596 in addition to debt already accumulated by undergraduate schooling. Doctor wages reflect the need to pay off that debt.
Of the top five insurers in America, Humana (NYSE: HUM), United Health Group (NYSE: UNH), and Anthem (NYSE: ANTM) have seen their stock prices triple in the past five years. Cigna (NYSE: CI) at its highest in 2018 more than doubled over its 2014 price but has fallen by 20 percent since then.
Pharmaceutical companies, too, gain the ire of single-payer advocates. The pharmaceutical companies reported $775 billion in profit in 2016.
A universal insurer can universally cut costs
In the current American system, patients are held hostage by price markups and profits. Critics of single-payer indicate that price variation is healthy market competition.
Any American can shop around different hospitals to find an MRI that costs $500 rather than $1500. Those fees, thanks to the Affordable Care Act, are now public. However, according to the Economist, insurance companies negotiate, privately, with hospitals so while the MRI may cost $1500 for some patients, for others, it may be $750, and those negotiations are private.
This example does not speak to every aspect of the market. It is safe to say that a considerable expense in the American medical system isn’t based on healthy competition. It is based in deal-making and artificial prices designed to benefit insurance providers, not citizens.
Single-payer is the solution.
If on insurance plan covers every American, that insurer has universal leverage to negotiate and set prices. In addition to cutting costs on equipment and drugs, doctors and hospital staff will know what the price of each medication is, universally. Paperwork and administrative tasks, which are currently insurance company dependent, become consolidated into one system.
An MRI will cost the same at every hospital. Life-saving drugs are never beyond the reach of people who need them. Market competition will flourish from companies building the most advanced and efficient systems to win government contracts that insure 350 million Americans.
If everyone is on one plan, will private insurance go away?
A significant critique of Medicare-For-All is that private insurance may become illegal. There is no precedent in the United States to eliminate a private industry. Gerard Anderson, a professor at John Hopkins, reported to Vox that: “Basically, every single country with universal coverage also has private insurance. I don’t think there is a model in the world that allows you to go without it.”
In a health context, the global precedent is to allow private insurers to provide for supplemental care and run, limited, private hospitals. France, Denmark, Australia, and the United Kingdom all have a version of this two-tier system.
The private health sector is an essential component of America’s global health dominance.
The US offers more clinical trials, has the most Nobel Laureates in physiology and medicine, and in 2016 held the title as the most distinguished in global innovation in the healthcare sector.
A public system in America would shift the role of private insurance, not eliminate it. Instead of Cigna offering comprehensive coverage plans, they could provide supplemental plans for cosmetic surgery or non-essential services like teeth whitening.
Importantly, the systems aren’t are not mutually exclusive. It’s true, private insurance would be irrevocably changed. How we fund innovation would have to change; it would no longer be on the backs of ordinary citizens but come from venture capital and government contacts.
The single-payer solution keeps American’s from being profit generators for insurance companies. The private sector provides for supplemental services and supports innovation.
But I like my private insurance…
According to a Gallup poll from late 2018, Americans rate their quality and coverage of healthcare at greater than 50 percent.
America’s healthcare costs are higher than any other country which guarantees it as a right. Insurance companies, expensive universities, system inefficiencies, and pharmaceutical companies created a spiral that has made every aspect of American healthcare, from an MRI to a hip replacement more expensive than anywhere else in the world.
As we move forward into the healthcare transformation process, the more important question we need to ask ourselves is: Do I like my healthcare or am I just afraid of losing it?
The current system leaves thousands in quality-of-life-threatening debt. It balloons American’s healthcare costs more than double what single-payer plans cost in other countries. It leaves 28 million people uninsured, not accounting for folks who are underinsured. We are all bearing the costs of this system, whether your insurance works well for you or not.
A new system is disruptive, it’s scary, and figures about actual costs to each American haven’t been published.
For the average American who pays $19,000 in healthcare premiums, the 28 million American’s who aren’t insured, and for our society as a whole which pays more than double per person for healthcare spending, evidence does not show that the average American will be paying more than they already do for coverage.
Supporting single-payer means we’re saying no to corporate greed, yes to universal coverage, yes to human rights, and yes to a cheaper system as a whole.