Our current healthcare system vs. Medicare for All

Michael McKinley, CCI Action and Our Revolution member

The current state of American health care is one of pure, unmitigated fear. Most of us live in a constant panic, afraid we and our family will get sick—not so much for having access to good care, as for not being able to afford it.

The privately-owned, for-profit health insurance industry is a predatory protection racket, and it is no exaggeration to say it is bankrupting and killing us. Ralph Nader calls the immensely profitable Big Insurance, Big Pharma, and Big Hospital monopolies the “Pay Up or Die” industry. Their purpose is to make money. They do this by taking in as much money from you as they can, while paying out as little as possible for your health care, shifting its high cost onto you. They reduce their payout by restricting the amount of care available to you, by erecting barriers to you seeking and receiving care when you need it, and by making you pay as much for it as possible if you succeed in passing their gate. They are gatekeepers, with the power of deciding whether you live or die—whichever provides the highest return.

Examples of barriers:

1. High premiums, deductibles, co-pays, co-insurance exclude many from health care coverage, many of whom are high-risk, low-income customers who need health care the most. This is the new way to exclude those with “pre-existing conditions” from the health care pool—charge through the nose. And people die from it by the tens of thousands every year. Forty-five million Americans did not have health insurance in 2018. Forty-five thousand of them died because of it, mostly because they delayed seeking health care until it was too late, fearful of the costs. This is up from 2016, the last year of Obamacare before Trump took office, when we reached the all-time low of 29 million uninsured, and only 30 thousand dead because of it.

How much does this insurance cost us? The average family of four shells out $28,000 per year for medical care. That’s $1,500/month premiums, $5,000 deductible, $5,000 max on co-insurance/co-pays. It’s also nearly half the yearly income of that average family. In 1999 health care costs were a quarter of yearly income. By 2013 they were a third. Now they’re half. This is whether that $28,000 is paid directly by that family, or indirectly in deferred income if some is paid by an employer. $28,000. As the second biggest expense of doing business in the U.S., the cost of health care is a huge reason why wages have been stagnant for the past forty years. It’s also a big reason why millions of jobs have been shipped overseas, as no other nation forces its businesses to bear the cost of health care.

2. High deductibles, co-insurance, and co-pays supposedly meant to give you “skin in the game” actually skin you alive. They are deliberately meant to discourage you from seeking health care when needed. Forty-two million Americans were underinsured in 2018, meaning they paid high premiums but still could not afford health care because of high deductibles, co-pays, co-insurance. More than 60% of personal bankruptcies in the U.S.—some 500,000 each year—are due to high medical costs. Most of those had insurance. That’s a lot of skin.

3. Discriminatory and often hidden, outrageously-high health care costs for people who cannot afford health insurance or who have the wrong kind. Big insurance works in tandem with for-profit health care providers to keep list prices for health care secret and very high (the “charge master”) in order to increase the value of the “discount” prices they supposedly negotiate for you (the “offer you can’t refuse”). It is a kind of blackmail. These out-of-network prices are often twice to as much as 20 times higher. Networks are deliberately narrow to restrict your choice of providers and your access to care. These narrow networks often result in extraordinarily high “surprise” bills, such as slipping non-network providers you didn’t expect into your surgical team. Gotcha!

4. Restricting what health care they cover. Pre-authorization requirements. Denials, often arbitrary, requiring costly and time-consuming appeals. Delays often kill people. This saves insurance companies money. Health insurers say they need to do this to reduce “unnecessary” healthcare, which is costly to them. As though I’m going to request a few extra colonoscopies just for the fun of it. My dear friend Scott Galindez—whom many of you knew as a journalist and activist for Medicare for All—died because his Obamacare insurer denied him the new kidney that would have saved his life. In spite of his doctor’s recommendations, it was deemed unnecessary and “too costly,” as it was cheaper to just keep him on dialysis three times a week indefinitely. So he died. That’s the price of “unnecessary” care.

5. What’s unnecessary are the complicated and constantly shifting rules, plans, and networks that are deliberately intended to confuse, delay, and discourage you from even seeking care, let alone actually receiving it. And they are time-consuming and expensive to negotiate—for providers as well as for the insured. Even the army of insurance bureaucrats themselves seem not to know or understand the serpentine labyrinth of these everchanging rules. Average annual cost to every doctor in the U.S. for negotiating these rules is $85,000. With a million physicians that amounts to $85 billion. Creating, constantly changing, and applying these rules is the work of hundreds of thousands of insurance employees, and a major part of the $700 billion in annual administrative costs of private insurance.  

What a stupid system! How do we get out of this mess? IMPROVED MEDICARE FOR ALL.

Best care, most comprehensive coverage. Better coverage than existing Medicare, because it is IMPROVED. Better coverage even than the most golden of the gold employer plans. All medically necessary costs covered 100%, as determined by you and your physician. No more insurance or government bureaucrat standing between you and the health care you need, policing the gate with hand outstretched for the “service” charge. Covers everything! Well, not your nose job or botox, and probably not a luxury private room with flowers in that cute boutique clinic. But virtually everything else.

Besides what Medicare covers now in parts A, B, C, and D, Improved Medicare for All covers dental, hearing, and vision; long-term care, both in-home and institutional; pharmaceuticals; disabled services; mental illness, including addiction treatment; all women’s reproductive health care; maternity care from prenatal through delivery; pediatric care; preventive care; rural health care, including ambulance and emergency services, as well as much-needed clinics and hospitals in underserved areas. And much, much more.

Free at the point of service. No premiums, deductibles, co-pays, coinsurance. You see no more medical bills because the government gets the bills. No need for supplemental insurance because there are no gaps. And it costs you a lot less in taxes than you pay now in premiums, deductibles, co-insurance. Remember that $28,000 that your health care costs your family and/or your employer now? With a 5% employee payroll tax matched by a 5% employer payroll tax (only one of the many relatively painless ways proposed to pay for this), that $28,000 shrinks to $3,000 each in taxes for the average income of $60,000. And it will raise nearly $1.7 trillion each year, enough to cover the cost of health care for the 45 million uninsured right now, PLUS the cost of much more comprehensive coverage without premiums for everyone.

Yes, those making more than $250,000 per year will pay more in taxes than they are paying for medical care now. But 98% of us will pay less. I don’t know about you, but I sure could use an extra $25 grand in my pocket each year. What an economic stimulus this will provide to the whole country! Experts predict that it will create 2 million new jobs as well as encourage millions more to move to better work. And because it will remove one of he largest barriers to starting a new business by decoupling healthcare from employment, we can expect hundreds of thousands of new start-ups.

Free choice among all providers—nationwide. Even now with the existing system, 95% of all physicians accept Medicare. When there is only one single payer, all providers—all doctors, therapists, clinics, hospitals, and others that want to stay in business and get paid for their work—will be in the system. Better than any private insurance, or even existing Medicare, you will be free to choose any doctor, clinic, or hospital anywhere in the country. No more narrow networks rationing your care by restricting your choice!

Simple, equitable, efficient. One all-encompassing plan, one single payer. No more rats nests of differing rules to negotiate, no more 300 different plans to choose from that change every year but always seem to offer the same low benefits. No more hierarchy of different charges according to whatever insurance you have—or don’t have. Or wherever you live—with discriminatory low provider rates for rural areas or inner cities, for example. Or however much money you have. Or the color of your skin. All providers get the same fair rates, and you get the same high-quality health care. This simplicity means that the high cost of administration goes way down. Providers save that $85,000/year average administrative cost ($85 billion in aggregate). And we save around $500 billion each year from the $700 billion we spend in administrative and marketing costs (including $100 billion in profits and executive compensation) for the insurance companies.

Truly universal. ALL means ALL. Everyone is in one big pool, sharing costs and enjoying benefits equitably. The whole thing costs us much less individually, while providing more benefits for all. Single payer is the only way to achieve truly universal health care.

Costs less, comprehensive coverage, better care, more choice. No fear.

Amazing, what democracy can do. 

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