Steve Orlik: Is it time for Medicare for All?
December 4, 2018
Harry Truman announced a vision for single-payer health care more than a quarter of a century ago, a vision that the government would pay all costs. Bernie Sanders would like to achieve Truman's vision by enacting a single-payer system under the banner of "Medicare for all."
The idea is now rather popular. When polled, according to The Economist, nearly 75 percent of Americans declared a favorable view.
Similar percentages can most likely be found here in Nevada County.
This idea of "Medicare for all" seems to have become a litmus test for progressive voters seeking candidates for 2020. Its popularization is largely owed to Sanders' evangelizing during the 2016 presidential primaries, although Hillary Clinton described the idea as unworkable. Since then, five likely 2020 Democratic presidential contenders — Elizabeth Warren, Kirsten Gillibrand, Kamala Harris, Sanders and Cory Booker — have endorsed "Medicare for all." Should one of them win, there is enormous expectation that this mantra would be enacted.
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First, though, Democrats need to decide what "Medicare for all" actually means. The details of health policy are daunting and extremely complicated. Notwithstanding our current president's promise to reform our nation's health care system, a plan has yet to be revealed. The appeal of a slogan is that it's easy to gloss over the mind-numbing details required to formulate a plan, let alone make law.
Some Democratic politicians have put forward modest proposals which include: allowing more people to qualify for Medicaid (government-provided insurance for the poorest); lowering the age requirements for Medicare; and introducing a so-called public option, i.e. a state-run insurer to compete with existing private ones. None of these proposals has received as much attention as the detailed plan put forth by Sanders, in which Medicare would become the single-payer of all insurance claims. It would be free at the point of use. Premiums, deductibles and other payments would be nearly eliminated. To fund all this, federal spending would need to increase by an estimated $32.6 trillion over 10 years, according to The Economist. In Sanders' home state of Vermont, the proposal stalled once it became clear that a surtax of 11.5 percent on payrolls and premiums up to 9.5 percent of income would be needed to fund single-payer insurance.
The problems identified by Sanders are nonetheless real. America stands alone among large, developed countries in lacking universal coverage. America's average life expectancy is ranked seventh, according to the Organisation for Economic Co-operation and Development, sandwiched between the Czech Rep and Hungary. Government-run health programs can reduce costs by eliminating administrative costs, private profits and using their dominant position to keep prices low. But none of the European systems that Sanders draws his inspiration from are purely single-payer. Many use a mix of public programs and supplementary private insurance to ensure universal coverage; a cost-sharing approach may also offer government subsidies to those who cannot afford coverage.
Democratic candidates and constituencies must get to work on the details. Otherwise, they may find themselves in the unenviable position that has befallen the Republicans, whose health-care reform position has been one of either interference or obfuscation.
In spite of controlling the House, Senate and the presidency, Republicans spent two years trying to remove or greatly damage the Affordable Care Act with no success. Their obsession to dismantle the ACA cost Republicans control of the House, as well as the loss of several Republican state governorships. A Nov. 8 (Reuters/Ipsos poll) asked respondents to list the top three priorities for Congress to address in the 2019-20 session. So happens number one regardless of party is to address the U.S. health care system. From health care costs outpacing inflation, concerns about preexisting conditions and the escalating cost of prescription drugs.
Aspiring Democratic candidates will need a pragmatic agenda focused on boosting competition in health-insurance exchanges and reversing the cuts, regulatory changes and work requirements imposed by the Trump administration. This will take a lot of legislation. If Democrats accomplish that, consumers could then be eligible to buy Medicare coverage from the government (i.e. the non-coercive, "public option"). The difficulty with this agenda is that it does not fit onto a bumper sticker or a cap. The advantage is that it might one day get through Congress.
At best, the health care discussion provides both parties an opportunity to work together to provide a new version of "Health Care for All" that would bring America to parity with the other wealthy western nations. At worst we continue down the road of useless political promises and rhetoric. Let's hope the future demonstrates that each party can set aside differences to find solutions to this most important public policy issue. Our collective health hangs in the balance.
Steve Orlik lives in Nevada City.
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