Medicare-for-All

In October, 2015, The Week ran an article entitled “Why Republicans are hellbent on destroying Medicare”. The short answer is that Medicare is the ultimate form of the dreaded “socialized” medicine. And while it is beloved by those who use it, to everyone else, Medicare is the scapegoat for all that is wrong with the U.S. healthcare system. There’s a good reason for this: in the U.S., we are so entrenched in capitalist ideology that we see health as a commodity to be bought and sold. And, as with all products, the very best is reserved for those who can pay exorbitant amounts. But Medicare is actually the most successful healthcare system in the world.

In 2008, President Obama made healthcare one of his central issues, and upon entering office vowed to bring about substantial change. Six years ago, The Patient Protection and Affordable Care Act, fondly referred to by some as Obamacare, passed through Congress. However, through the process, the bill got so watered down that the change it actually brought still doesn’t bring the U.S. anywhere close to what was promised. As Reid (2009:251) explains, the U.S. healthcare system still has the largest amount of inequality of coverage, the most complex system, and the most expensive system in the world. And this is after Obama and other Democrats fought tooth and nail to get this monster of a bill passed. Luckily for advocates of health care reform, the dark horse of the 2016 election cycle, Senator Bernie Sanders, is bringing back the fight for universal healthcare. Sanders is once again making health care reform a central issue of his campaign, and forcing Americans to address the question “what is wrong with our healthcare system?”

For some, the answer may be “nothing”. Because, in theory, healthcare is not a basic human right and our government is under no obligation to make sure that we all get the care that we need. We all know the rhetoric of the American Dream: our country was built on the hard work of our ancestors and predecessors, those who fought for our freedom and allowed us all of the opportunities we could ever want. Because of this, we tend to shy away from “big government” and “handouts” as if there’s something wrong with our elected representatives fighting to make sure we all have better access to basic resources. But other Americans (myself included) would eagerly admit that there are a lot of things wrong with our healthcare system. In fact, Reid (2009) claims that it’s not even a real system; it’s a marketplace – with products, and bargaining, and little regulation. A fundamental problem with seeing healthcare as a marketplace is that everyone has different goals – the sellers want to make a profit, and the buyers want to get the best product possible at the cheapest possible price. And when we’re actually talking about life and death situations, that’s a real problem. A 2009 Harvard Medical School study found that 45,000 people die each year because they don’t have insurance. This number seemed so astounding that the reliable factcheck.org immediately jumped on this and found that maybe that number is accurate. The fact-checkers couldn’t say for sure, and the most reassuring conclusion they could come to was something along the lines of “well, the death rate goes down when those people actually get health insurance”.

But let’s take a step back and think about this for a minute: insurance companies exist to sell coverage that will hopefully never need to be used. However, they also need to sell to enough people so that if someone actually needs something covered, they’re still making a profit. And, unfortunately for health insurance companies, people get sick a lot. It’s basically a fact of life that at some point, we will all need a doctor. In fact, the 2010 census reported that working-age adults visit a medical professional 3.9 times a year. And this was a decline from the previous census. So insurance companies are in a real pickle; they have to cover us all while still putting money in their own pockets. The way that they do this is by not actually covering everything that everybody needs. And this is where the real problems start for many insurance-buyers, because people often assume that their insurance will cover all medical bills. Unfortunately, this isn’t the case. And hospital bills are not cheap. A quick google search for “medical bills” will bring up pages and pages of results such as “How To Pay Huge Medical Bills On Small Income” and “Slash Your Medical Bills: 7 Ways To Haggle”. Haggling your way out of medical bills?!? This conjures up images of flea markets and bargaining for lower cheap commodities, not life-saving medical services. And the fact that so many people are turning to google for answers to paying medical bills should be a huge waving red flag screaming “fix this now!” And this brings us to the biggest question: if our healthcare system is so broken, how do we go about fixing it? Well, it won’t be easy.

As previously stated, the best healthcare model in the world already exists in the United States, among other places. It’s the *dreaded* socialized medicine model, and even though we shrink away from it in fear, we’ve actually been utilizing it for decades, with Medicare and Medicaid. Currently 17% of the US population are enrolled in Medicaid and Medicare (Leonard 2015). Other countries, like the United Kingdom, have much broader and far-reaching models of nationalized medicine.

The U.K.’s model is entirely based on nationalized (or, if you prefer, socialized) medicine. Here’s how it works: every single resident of the U.K. pays a tax that contributes to the National Health Service. And then the National Health Service covers every single U.K. resident. Found under the “about” section of the NHS website is a tab called “principles”. There are three core principles that have guided the NHS since its founding: that it meets the needs of everyone; that it be free at the point of delivery; that it be based on clinical need, not the ability to pay. To me, these sound pretty wonderful. These principles are the basis of socialized medicine. Any resident can go into any hospital and be treated for any and all of their ailments and be able to walk out without paying a cent. This is so different from all hospital visits I’ve ever had in the United States. When I was 17, I got terribly sick and I couldn’t stop throwing up. My mom took me to the emergency ward of our local hospital, in Princeton, New Jersey. Before I was even taken to a bed, my mom had to spend twenty minutes filling out insurance forms and making sure that the hospital knew that we could pay for any treatment I would need. Meanwhile, I was still puking in the waiting room. So I, for one, would love a healthcare system that prizes treating patients over making a profit.

That being said, the National Health Service is not a perfect system. It doesn’t cover every single operation or treatment plan. But it covers most, and, more importantly, it’s a more unified system than the one we have. In the U.S., one insurance company might cover a procedure, but another company might not. And there’s no real logic to deciding that. In the U.K., there is a government office that decides what is and isn’t covered – the National Institute for Health and Clinical Excellence, NICE (Reid 2009). The main pro of this system is that every single doctor in the country knows what isn’t covered, and can advise their patients accordingly. And, here’s the genius thing, doctors in the U.K. aren’t paid on a fee-for-service basis like in the U.S. This is perhaps the biggest benefit to a nationalized health service – doctors are paid by the patient, not by the procedure. In the U.S., doctors are paid for every test, procedure, and operation that they perform (Hagland). There’s no reason for them not do run every single test to get the most money they can out of every patient. Of course, this is assuming that all doctors want to make a profit, which may not be true. And let’s give them the benefit of the doubt and say that doctors want to give their patients the best possible service, and so to be as thorough as possible they run extra tests. But for every procedure done, somebody has to pay, and with health insurance companies trying as hard as they can to make a profit, there are plenty of reasons for them not to cover every procedure. As another personal example, my dad at one point had 4 different doctors – general practitioner, kidney doctor, pancreas doctor, and gastro doctor (yep, all different people). They all wanted to run blood tests on him multiple times a year, for various reasons. And, not to brag, but my dad has the king of all health insurance plans. Yet his insurance only covers one blood test every three months. And because none of the doctors communicated with each other, there was no way for them to share the results of the testing with each other. I’ve never seen my dad as mad as when he was on the phone with each doctor and with his health insurance representative.

Contrary to this, doctors in the U.K. are paid for every patient that they have in their service (Reid 2009). So in the U.K. there’s a much bigger incentive for doctors to practice preventative medicine. Not only that, but they’re also paid based on performance. And just to reiterate how great this system is, in 2014 the Commonwealth Fund (based in Washington D.C.) ranked 11 countries’ healthcare systems, and the NHS came in first (Campbell and Watt 2014). I’ll give you three tries to guess who came in last. Yeah, it was the good ol’ US healthcare system. The implications of this system are huge. Doctors’ entire salaries are based on how well they treat their patients. There is no such accountability system in America.

The other great thing about having one healthcare system is that there is only one system. Any resident of the UK can walk into any hospital and there name will be recognized in the system – their entire medical history will show up, to prepare doctors, nurses, and other medical professionals about past procedures, chronic illnesses, etc. To go back to my dad, he used to live in England. And when he got really sick over there, even though the NHS would have paid for every blood test that needed to be run, my dad actually only got blood drawn every three months because all of his doctors could see all of the results of every test ever run on him. With a government-run healthcare system, there’s no need to run extra tests or repeat procedures. This makes medicine simpler for both doctors and patients.

So if we already have a successful Medicare system for some, and other countries have successful Medicare-like systems for everyone, what’s stopping us? Well, in a word, capitalism. In our country, we’ve been socialized to believe in the American Dream: work hard and you’ll be successful. The flipside of this is that those who aren’t successful didn’t work hard enough. And we shouldn’t reward laziness with free medical care. And this is why Medicare and Medicaid actually have lasted this long. We should help the elderly and those in abject poverty. The elderly have worked all of their lives and deserve to retire in comfort. And the truly impoverished are so utterly helpless that, while they don’t deserve healthcare, we’ll give it to them because they clearly can’t help themselves. And that’s where we draw the line. And the crux of this goes back to capitalism: we live in a world with commodities to be bought and sold. Health is a product. We can buy it. It’s not something that we provide to everyone.

Well that seems daunting. How do we change this? Well, the practical answer is far simpler than it may seem: we expand Medicare to cover every American, not just after the age of 65. And this is exactly what Bernie Sanders wants to do. Now, this isn’t the first time that politicians have tried to implement a national healthcare system. It’s been happening since the beginning of Medicare itself. But the harder change that we need to make is that we need to stop thinking about health as a commodity, and we need to start thinking about it as a basic human right. And funnily enough, the same type of arguments for a nationalized system of healthcare have been used against it. The American Medical Association spent much of its resources arguing that a government healthcare system would be “a hindrance to scientific progress, and detrimental to the doctor-patient relationship” (Knoblauch 2014). Basically, they’ve been making a moral argument that government-funded healthcare systems are wrong. And for a while, advocates of a single-payer healthcare system tried to argue in terms of logic and reasoning – it makes financial sense to switch. But, as other nations have shown us, this isn’t the right type of argument to make. We need to make a moral argument about the benefits of a Medicare-for-all type of system. And, in fact, this is a stronger argument: We need to make sure that every single American has a basic level of healthcare. Healthcare should be a basic human right, and should not be reserved for those who can afford it.

Of course, this isn’t a simple argument to make. There are many who would argue the opposite, that healthcare shouldn’t be a basic human right. Dr. Valerie Biousse, interviewed by T.R. Reid, makes the argument that “when we get sick, then everybody is equal” (Reid 2009: 215). Every other industrialized nation and many worldwide organizations have made the argument that healthcare is a basic human right. This isn’t so much an issue of whether the United States is being a leader on this topic, it’s whether we can catch up to literally every other nation. We are letting citizens (45,000 a year, if that Harvard study is accurate) die simply because they can’t afford healthcare. This has become an issue of prioritizing profits over human lives. If we understand healthcare in this way, the argument for a Medicare-for-all type system is much stronger.

This is not the type of change that can be made incrementally. Mostly because it just doesn’t make sense for this change to come gradually. We can’t just slowly move forward the Medicare coverage age until it hits birth. In fact, that’s how Medicare start and progressed until it stopped progressing in 1972 (Altman 2016). The main reason gradual change doesn’t work is because at every step, there’s space for opposition to come in and stop it. To combat this, we need a complete and sudden overhaul of the system. And, luckily for us, Medicare already exists! We don’t need to reinvent the wheel on this issue.

Bernie Sanders and others like him are fighting to ensure that all Americans have basic access to healthcare, regardless of income, with a Medicare-for-all single-payer system. This is a fight that has been going on for decades. The biggest obstacle is our belief that healthcare is an economic issue, not a moral one. Right now, in the USA, the only people who have guaranteed access to healthcare are the elderly, the incredibly poor, and veterans. Everyone else is thrown into a marketplace with winners and losers. Our capitalist society is letting people down, and it’s actually becoming a life or death situation. We can no longer stand idly by and allow many of our fellow Americans to go living in fear of needing a doctor. We have to switch to a fairer and more just system of healthcare. So Republicans may be hellbent on destroying Medicare, but at the end of the day, arguments against universal coverage are arguments that value profits over lives.

References:

Altman, Nancy. 2016. “How And Why Medicare for All Is a Realistic Goal.” The Huffington Post. Retrieved April 4, 2016 (http://www.huffingtonpost.com/nancy-altman/how-and-why-medicare-for_b_9063970.html).

Anon. n.d. “Medicare For All: Leaving No One Behind - Bernie Sanders.” Bernie Sanders RSS. Retrieved April 3, 2016 (https://berniesanders.com/issues/medicare-for-all/).

Anon. n.d. “About The NHS.” The principles and values of the NHS in England. Retrieved April 4, 2016 (http://www.nhs.uk/nhsengland/thenhs/about/pages/nhscoreprinciples.aspx).

Anon. n.d. “What Is Single Payer?” Physicians for a National Health Program. Retrieved April 4, 2016 (http://www.pnhp.org/facts/what-is-single-payer).

Campbell, Denis and Nicholas Watt. 2014. “NHS Is the World's Best Healthcare System, Report Says.” The Guardian. Retrieved April 4, 2016 (http://www.theguardian.com/society/2014/jun/17/nhs-health).

Leonard, Kimberly. 2015. “America's Health Care Elixir.” US News. Retrieved April 4, 2016 (http://www.usnews.com/news/the-report/articles/2015/07/30/medicare-changed-health-care-in-america-for-the-better).

Reid, T.R. 2009. The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. New York: Penguin.

Waldman, Paul. 2015. “Why Republicans are hellbent on destroying Medicare,” The Week, October 30. http://theweek.com/articles/585955/why-republicans-are-hellbent-destroying-medicare

Hagland, Mark. “How Does Your Doctor Get Paid?” Frontline. http://www.pbs.org/wgbh/pages/frontline/shows/doctor/care/capitation.html