Obstacles to Medicare for All
Two primary obstacles are:
- The for-profit private healthcare insurance companies, hospitals, and big pharma will fight Medicare-for-All to the bitter end. They have everything to lose and nothing to gain.
- People who are covered through their workplace are generally “satisfied” with their coverage, because many who have never had to use their health insurance “benefits” beyond a limited extent, don’t know that even people with health insurance can go bankrupt because their insurance is inadequate.
Physicians for a National Health Program (PNHP), Dr. David U. Himmelstein, M.D. said: “For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, copayments and deductibles that illness can put you in the poorhouse.” (more)
Reasons for Optimism
Despite the complacency of people who “like” their existing health insurance and the fact that health insurance companies will fight tooth and nail against Medicare-for-All, there are reasons for optimism when it comes to changing to a single payer government-run system.
There are at least a few reasons for optimism: Two other major players in the healthcare system—doctors and companies that offer healthcare to their employees—are not adamantly opposed to Medicare-for-All as the insurance companies would have you believe..
In a recent survey, almost 50% of physicians support Medicare-for-All (more) despite knowing that they may earn less under such a system.
There are no surveys as yet of CEOs who support Medicare-for-All, but there are individual CEOs who have spoken up to support a single payer healthcare system. They cite the advantages of a portable healthcare insurance and the burden of being responsible for the ever increasing cost of offering healthcare to employees—which often means they can’t offer pay raises. And they say that a single payer system will relieve them of the huge administrative responsibility of managing an employee healthcare insurance program. (more)
All in all, there are reasons to believe that the obstacles can be overcome and all major healthcare players—with the exception of for-profit healthcare companies, hospitals, big pharma—can be persuaded.
After all, surveys show that currently (2019), 70% of Americans support Medicare-for-All. (more).
Medicare-for-All Can Take Many Forms
Medicare -for-All can take many forms. And, because the U.S. has been so mired in a complex system of healthcare in which for-profit companies and the government have been jointly involved, unwinding the entangled system will not be easy. In any case, Western European democracies, the UK, and a number of other countries such as Taiwan, all have universal health care, but each has its own unique characteristics.
UK System: Single Payer System administered by national government. The health care system in the United Kingdom, the NHS (National Health Service) is the oldest, having started right after WWII. These are the primary characteristics of UK’s universal health care system:
• Only one medical authority that pays for and administers the system—the National Health Service—through taxes paid to the national government. The national government owns and operates hospitals.
• Relatively comprehensive coverage—includes dental and vision and virtually all necessary prescription drugs.
• Doctors are government employees and are paid directly by the national government
• The only private insurances companies allowed are ones that cater to mostly high income people who would like more extras such as shorter waits for elective surgeries and bells and whistles. About 10% of affluent citizens have private health insurance.
• Pros: Per capital health care costs are quite low (at $4246 per capita in 2017—it is the lowest among developed countries), much lower than in the U.S.(at $10,224 per capita in 2018—it is the highest among developed countries), and most basic healthcare services are adequate. Prescription drug prices are significantly lower than in many other developed countries, mainly because the NHS negotiates aggressively with drug companies and since NHS is the only buyer, drug companies have little choice but to sell at a lower price. Reason for the pros: If there are no for-profit middlemen insurance companies squeezing out profits, care can be much cheaper even when doctors are paid quite well as in the UK
• Cons: Sometimes the waits are long, especially for elective procedures.
Canadian System: Single-Payer System but administered by Provinces. Coverage not as good as UK’s.
• The national government collects taxes for healthcare and then distributes it to the 14 entities (10 provinces, 3 territories, and the military) that administers and pays for healthcare costs in their region. There are national guidelines that must be met.
• The provinces that receive national government money, own and operate hospitals.
• Doctors, dentists and midwives are NOT direct employees of the government. Physician organizations negotiate directly with provincial administrators over rates for services.
• Coverage does not include vision, dental and prescription drugs. So, about 30% of healthcare costs are not covered by the government.
• 65 to 75% of Canadians pay private insurance companies for supplemental care. Poor families, seniors, and some minors receive government subsidies for supplemental care. But there are limits on how much private insurance companies can charge.
• Pros: Fairly good coverage, healthcare costs are much lower than in countries like the U.S. where private insurance companies play a much more significant role and can siphon off substantial profits. Prescription drug prices are among the highest compared to other developed countries.
• Cons: Complaints about wait times and the fact that vision, dental, and prescription drugs are not covered by the government. Prescription drug prices are lower than in the U.S. but much higher than in other countries. That’s because unlike in the UK, prescription drugs are NOT covered by national healthcare dollars even though the provinces do try to negotiate for lower prices with the drug companies.
So, there are many ways that Medicare for All can be structured.
From the above glance at the UK and Canadian systems, it seems that the cheapest and most comprehensive system is a Medicare-for-All system that not only has a single payer (national government) but offers more comprehensive coverage (includes, prescription drugs, vision, dental) as in the UK. Ironically, a more comprehensive system (UK) will cost less than one that has less comprehensive coverage (Canada).
Again, the worst and most expensive system in developed countries is America’s, where many are uninsured, private insurance coverage is often inadequate, healthcare outcomes are relatively poor, and costs are very high. This is primarily because private for-profit health insurance companies play a major role and their goal is profits, not good healthcare.
But there should be the option of private insurance for people who want shorter waits, access to particular specialists, etc. In the UK only 10% have private health insurance on top of their government coverage. Even these affluent Brits use government services for most of their basic medical needs. (more)
Doctors for Medicare for All.
Businesses will Benefit from Medicare for All
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