Why America Needs Medicare for All. By: Matt Connolly

The United States’ healthcare system is broken. What do I mean when I say this? To start, the US is the only “developed” country in the world to not guarantee healthcare to its citizens through one form or another of a universal healthcare system. A universal, or single-payer healthcare system, is somewhat self-explanatory. An entity, in this case the government, is the “single-payer,” or only insurer in the system. In the US, we have what is called a “multi-payer” system, where there are multiple private insurance providers in the country. Elected Republicans (and even elected Democrats), as well as free-market fundamentalists, will claim that having more than one insurer is better because “competition” will cause these multiple insurers to lower their prices, or else they will be pushed out of the market because their prices are too high. However, this isn’t the case when it comes to healthcare. Single-payer systems perform better in nearly every metric, compared to systems that aren’t universal.

To give an example of how single-payer systems are generally better than non-universal systems, there are two studies that indicate that the US healthcare system is not the best in the world, as some like to claim. The first study, findings by the Commonwealth Fund indicate that, “despite having the most expensive health care, the United States ranks last overall among the 11 countries on measures of health system equity, access, administrative efficiency, care delivery, and health care outcomes.” The US was the only country in this study to not have a universal healthcare system, and the fact that the US ranked last on this list illustrates the problems of a multi-payer private system in terms of health outcomes, access to care, and efficiency. This isn’t the only study with such findings, however. Another study by Health System Tracker found that the US ranked 9th out of 9 countries in terms of health care access and quality of care, despite having the highest per capita health costs out of the 9 countries. A big reason for this disparity between the US and the rest of the developed world is the lack of a public, single-payer system.

In countries where there are private insurers in the market, there can be many problems. There isn’t an incentive for health businesses to provide every person with insurance for a myriad of reasons, including pre-existing conditions, costly procedures, and ease of access to care, just to name just a few, because paying for these areas cuts into these companies’ profits. Because private insurance companies won’t cover people for many different reasons, millions of people are uninsured in the US. According to National Nurses United, approximately 30 million Americans are uninsured, with another 41 million Americans classified as underinsured, which means that the costs associated with their plans make it so that the coverage is not worth the price. With over 1 in 5 people being uninsured or underinsured, this problem is very widespread. In addition, nearly 530,000 Americans go bankrupt every year due to medical bills, according to CNBC, and an estimated 68,000 uninsured Americans die every year because they don’t get the care they need because of lack of insurance, according to the journal The Lancet. The problem of uninsured Americans has been exacerbated as of late. Millions of Americans have been losing their health insurance during the biggest pandemic in the United States in 100 years. Many Americans have their health insurance provided to them through their workplace, and when the Coronavius pandemic hit the US, millions were laid off, which meant that many of those millions lost their employer-sponsored healthcare. According to CBS News, 5.4 million people had lost coverage by mid-July, with another 22 million people at risk of losing their insurance as of mid-August 2020. If you live in a country where you lose your health insurance during a pandemic, it may be time to rethink the country’s healthcare system.
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One of the reasons why our “health insurance” system is so broken is that there is essentially a middle man in the way of you getting care. You pay your premiums to the company, who then takes their cut in the form of profit and bureaucracy, before paying a smaller amount than you paid in to cover you when you need your insurance. Health insurance companies made over $35 billion last year alone, according to Fierce Healthcare. Why should a business profit off of the suffering of people? I certainly don’t think this is moral or even just, but this is essentially the business model of a private healthcare company. Under a universal healthcare system, because the government is the single insurer, it can guarantee healthcare to its citizens (regardless of ability to pay) because there is no incentive for profit within a government system. This means that the government is willing to cover somebody even if it costs more than that person pays in. 

 A good example of a government program that covers all despite the costs associated is the United States Postal Service. The USPS is willing to provide mail to all citizens in the US in a timely manner, whether a person lives right next to a Post Office or in a secluded area. Private postal companies like FedEx and UPS won’t deliver everywhere because it isn’t profitable to do so. The USPS is an example of a public good, where our tax dollars fund this agency in exchange for universal mail delivery at little cost, especially compared to private companies. I believe that our healthcare system should similarly be a public good, wherein our tax dollars fund our health insurance in exchange for universal, free-at-the-point-of-service care (this means no premiums, copays, or deductibles). In addition, a government program would have less wasteful spending, despite what bureaucracy-fearing politicians will tell you. According to the Center for American Progress, billing and insurance-related “costs for traditional Medicare and Medicaid hover around 2 percent to 5 percent, while those for private insurance is about 17 percent.” This means that government programs, Medicare and Medicaid, provide more money to care with less money lost on bureaucratic waste and profits compared to private insurers. Because of all of the problems with our current healthcare system, a single-payer system in the United States seems like a no-brainer. Next, I will explain the Medicare for All policy and how America can one day guarantee healthcare to all of its citizens.
           
An answer to the problems of our current health insurance system can be found within the pages of Senator Bernie Sanders’ Medicare for All bill in the Senate, or in Representative Primila Jayapal’s bill under the same name, introduced in the House of Representatives. The Medicare for All system, if passed, would be implemented over a two-year period, with the first year seeing the expansion of Medicare to cover dental, hearing aids, and eyeglasses, and expanding the Medicare enrollment age to 55 and including those 19 and under. The next year would expand Medicare to all citizens, so that every American would be covered under a single-payer program. Once this system is implemented, premiums, copays, and deductibles would be a thing of the past. Instead of having to pay out of pocket at the hospital, citizens would be issued a healthcare card, and when a person goes to the doctor or dentist, they simply show their insurance card and get the care they need, similar to how a public library currently operates. Public taxes would go up to fund the program. However, think of health insurance costs (premiums, copays, and deductibles) as a private tax, because, for the most part, in order to have healthcare, a person is required to pay these costs, or else they lose coverage. The private taxes paid to private insurers would be gone, and the public taxes would be lower than the private tax, essentially leading to a tax cut. The reason that the public taxes can be lower is, as aforementioned, the system would be more efficient (more money directly to care and less on bureaucratic waste) and the profit-taking middle man would be removed.
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Sanders’ proposal is very generous, and if it were to be passed, it would be one of the most comprehensive healthcare plans in the world. Instead of having to pay for private health and dental insurance, both would be covered under the same single-payer plan. This would make life a lot easier, especially for working families who may not have time to deal with choosing which private health and dental insurer they can afford (if they can afford one at all because of the outrageously high costs). Instead, everyone would get guaranteed insurance with little to no hoops to jump through. Medicare for All would make healthcare cheaper and our lives more efficient, not just because of the removal of headaches associated with choosing plans. Medicare for All would give every person more freedom in terms of their health care. Medicare for All, despite the fear mongering surrounding the policy, gives Americans more, not less, choice.
           
​Pete Buttigieg, a Democrat running unsuccessfully in the 2020 Democratic Primary, ran on a policy under the name of “Medicare for All Who Want It.” This policy was essentially a public option, in which people can opt into a government healthcare program if they want, but which leaves in place private health insurance companies (this name also co-opts the popularity of the Medicare for All plan while being not nearly as sufficient). This policy may sound appealing on its face, but still leaves in place many of the problems of our current healthcare system. For one, millions of Americans would still be left uninsured because the public option would be funded through premiums, which would still be unaffordable to many. Joe Biden ran on a similar plan, which boasted that 97% of Americans would be covered under a public option system. This would still leave about 10 million Americans uninsured, which is 10 million too many. Buttigieg and Biden claimed that a public option gives Americans a “choice” in their health insurance options. The choice, however, is that of which private health insurance middleman to be covered by. The government option could be a good system, but the fact that private insurers still exist is a problem. One thing that insurance companies could do is halt the coverage of their old and high-risk patients and “unload” them onto the government program, therefore increasing the cost of the public option and making private insurance seem better by comparison. This is the danger of leaving private insurers in the market. These companies will do everything they can to stay in business. 

National Nurses United, one of the organizations leading the struggle for M4A

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In terms of other freedoms under a universal system, there is more freedom to choose your doctor. Under our current system, the concept of a “network,” or system of hospitals and doctors in which you can receive care, severely limits your choice of who you can see or where you can go. However, under a Medicare for All system, you would be able to choose any hospital or doctor, for all of the hospitals would accept the same insurance, and therefore can’t turn away someone with incompatible insurance or even one without insurance, because that would no longer be a concern. The choice is really between freedom and security (both in terms of finances and guaranteed coverage), or restrictions and uncertainty.
           
The biggest question surrounding Medicare for All is the question of “how do you pay for it.” Under Sanders’ plan, there is a 4% tax starting with income around $30,000, and working progressively up with income. Some estimates say that the program will cost anywhere from $28 trillion over a decade, according to the Committee for a Responsible Budget (CRFB), to about $32 trillion over the same period, according to both Blahous and the Urban Institute (CRFB). This seems like a lot of money (because frankly it is), but our current healthcare expenditures, when stretched over a decade, exceed even the highest estimates from the CRFB. In 2018, US healthcare spending exceeded $3.6 trillion, according to the Center for Medicare and Medicaid Services (CMS), and this number is only expected to grow. Over a decade, this spending could surpass $40 trillion, and Americans would still be worse off than other nations that have universal systems. In the long run, Medicare for All is estimated to save money. Even if Medicare for All cost more than our current system (although according to all estimates, the plan would cost less), wouldn’t it be worth it to have all Americans covered under a universal system? As previously stated, Medicare for All would be one of the most comprehensive plans in the world, with almost all health expenditures covered. Would it not be worth it to spend more or the same amount as our current system to get more bang for our buck? This to me again seems like a no-brainer. I am not alone when I think this. According to an August poll by Hill-Harris X, 69% of Americans, including 87% of Democrats, 68% of Independents, and 43% of Republicans, support “providing Medicare to every American,” which is a simplistic way to explain exactly what Medicare for All does. Medicare for All is so popular because of all of the benefits associated with the plan, as described before. However, there is one final reason that Medicare for All has the support it does; Medicare for All would disproportionately benefit the working class people of this country.
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In the midst of the Coronavirus pandemic, the last thing a person should have to worry about is not having health insurance. However, as previously covered, there have been at least 5.4 million people who have lost their health coverage during this pandemic, and an estimated 22 million people at risk of losing their coverage. These Americans, many of them working class, lost their health coverage through no fault of their own. Rather, it was the fact that their health coverage was tied to their place of employment and they were laid off during the pandemic. Having a single-payer system would eliminate the problem of losing insurance after being laid off from work. The fact that health insurance can be a benefit through a job means that if you were to get laid off, even if it wasn’t your fault and was caused by a pandemic, you can still lose health insurance. In addition, having health insurance as a benefit through work means that it can be hard to leave a job that you might dislike because it has ‘good’ health benefits for you and your family. Having a universal system means that workers are freer to seek other places of employment because a major benefit that they might get through work is now guaranteed to them by the government. 

Guaranteeing healthcare to every person in America would make our country much healthier. With everyone having guaranteed healthcare, there would be more people that would now be able to get treated for common conditions like the flu, the cold, and other illnesses that can be spread easily. An example of where our current system fails in this way is the foodservice industry. According to Anuj Gangopadhyaya and Elaine Waxman, there are nearly 7.5 million adult foodservice workers in the country. At least 1 in 4 of these workers were uninsured in 2017, and this has had dire consequences for all involved. The CDC says that sick food service workers cause hundreds of illness outbreaks every year in America. Now it may seem like common sense for these sick workers just to stay home, but for a working class person who may not have insurance, working as many hours as possible is the only way to put food on the table, and a sickness won’t necessarily stop this. The CDC finds that almost half of foodservice workers who worked while sick worked because they needed to get paid more. Having a universal healthcare system would protect these uninsured (and even insured) workers because they would have some financial security in going to the doctor. However, a policy like paid sick leave could also provide aid to service workers and actually keep them home when they are sick. The Coronavirus pandemic has exposed another vulnerability in our healthcare system. The fact is that many essential workers (the people working jobs with the highest chance of exposure to Covid) are uninsured. Trying to live through a pandemic while on the “front lines” and uninsured, is at the very least, stressful, and at most, costly and maybe even deadly. Medicare for All would protect workers who don’t currently have insurance by guaranteeing healthcare, which is exactly what many millions of Americans need in this current moment.

Another important piece of Medicare for All is the fact that, if everyone were guaranteed healthcare, unions would be able to fight for more for their workers. When healthcare is tied to jobs, it kills a unions’ bargaining power because the union will spend a majority of their time fighting for healthcare rather than fighting for better wages or working conditions. For example, the UAW union spends a majority of its bargaining power on healthcare, which ends up hurting the other causes a union could explore if all of its members were guaranteed healthcare. I am an advocate for universal unionization because I believe that all workers should be able to collectively bargain with their employers. However, if all that a union is able to accomplish is to secure healthcare (while this is obviously important to all in the union) then the bargaining power of the unions decreases. Medicare for All would therefore strengthen unions.
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The benefits of a Medicare for All system on the working class would be apparent in many different ways. The most basic yet important reason that Medicare for All would benefit workers is that everyone would have healthcare guaranteed to them, and for a person who is working long days to provide for their family, the last thing they want to do is worry about what happens to them and their family if they get sick because they don’t have health insurance. The 1 in 5 Americans who are uninsured or underinsured would suddenly be covered under a generous plan, the 530,000 Americans who go bankrupt from medical debt would no longer have to worry about such debt, and the 68,000 Americans who die every year from lack of insurance may have some semblance of a fighting chance once Medicare for All gets passed. While there are many benefits for workers under a single-payer system, the most basic yet crucial benefits of Medicare for All on the working class is the fact that everyone will have healthcare.

​The future of Medicare for All is not quite certain. While the Democrats control the House, Speaker Nancy Pelosi won’t even bring Rep. Jayapal’s bill up for a vote. Even if the measure were to pass the House and move onto a Democratically controlled Senate in 2021 (assuming that Democrats take control of the Senate after the 2020 election), there will still be a fight there. If Joe Biden were elected president in the coming months, he has said repeatedly that he would veto Medicare for All if it reached his desk. These options don’t sound promising. Yet there is still hope. The fact that over two-thirds of the country now support an idea that, before Bernie Sanders’ 2016 campaign for presidency, wasn’t in the mainstream of American politics, shows that once Americans were shown the broken nature of our current system, we now see a better alternative in Medicare for All. We now want to catch up with the rest of the world and guarantee healthcare to all. It may take years or even decades, but we can’t stop fighting for this important measure. In the meantime, we must elect progressive candidates that champion this policy. However, as we have seen time and time again, electoral politics does not always work in favor of the people. Instead, what we need is an outside movement to pressure politicians into passing legislation that an overwhelming majority of the country supports. I know that I will do everything I can to push for this policy, and strive for a more just healthcare system for all Americans.

   



Works Cited

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CDC. (2016, December 5). Food Workers Working While Sick. Retrieved August 24, 2020, from https://blogs.cdc.gov/yourhealthyourenvironment/2016/12/05/food-workers-working-while-sick/

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(DCD), D. (2017, August 04). Can I get coverage if I have a pre-existing condition? Retrieved August 20, 2020, from https://www.hhs.gov/answers/affordable-care-act/can-i-get-coverage-if-i-have-a-pre-existing-condition/index.html
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Gangopadhyaya, A., & Waxman, E. (2020, April 09). Food Service and Preparation Workers and the COVID-19 Pandemic. Retrieved August 24, 2020, from https://www.urban.org/research/publication/food-service-and-preparation-workers-and-covid-19-pandemic

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Martin, J. (2020, August 04). 87% of Democrats support "Medicare for All," though Joe Biden doesn't. Retrieved August 24, 2020, from https://www.newsweek.com/87-democrats-support-medicare-all-though-joe-biden-doesnt-1522833

Minemyer, P. (2020, February 24). Health insurers' profits topped $35B last year. Medicare Advantage is the common thread. Retrieved August 20, 2020, from https://www.fiercehealthcare.com/payer/big-name-payers-earned-35-7-billion-2019-here-s-one-common-thread-their-reports

National Nurses United. (2019). Medicare for All Act. Retrieved August 20, 2020, from https://act.nationalnursesunited.org/page/-/files/graphics/0419_MFA_Federal_FactSheet.pdf
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New 11-Country Study: U.S. Health Care System Has Widest Gap Between People With Higher and Lower Incomes. (2017, July 13). Retrieved August 23, 2020, from https://www.commonwealthfund.org/press-release/2017/new-11-country-study-us-health-care-system-has-widest-gap-between-people-higher