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By: Kay Rollins
The problems with American healthcare have been obvious and conveniently ignored for decades. According to the Kaiser Family Foundation, there are roughly 30 million American adults who are uninsured, having lost their job, been unable to afford it, or being denied by insurers. Consequently, Charles Blow in the New York Times writes that “Nearly 45,000 annual deaths are associated with lack of health insurance.” However, for the 44 million Americans who do have healthcare, but are “underinsured” because of high costs, the picture isn’t much brighter. The Kaiser Family Foundation reports that around half of all insurance policy-holders face a deductible, the amount people need to pay on their own before their insurance kicks in, of at least $1,000, a cost that 40% of Americans cannot pay.
In the face of America’s healthcare crisis, “Medicare for All” was born. However, the details of the program are often misinterpreted by politicians, voters, and executives. The question of what Medicare for All actually means is a subject of widespread debate. Fundamentally, Medicare for All is a single-payer healthcare system where the government absorbs all the costs of healthcare for all Americans. No insurance companies, premiums, or copays needed. For the average voter, this seems pretty good: Over 60% of Americans support the policy, including a majority of Republicans, according to a recent morning consult poll. Bernie Sander’s bill, the only major Medicare for All bill currently proposed in America, would have a short phase-in period where America transitions from the status quo to his plan, essentially implementing Medicare for All within a year.
However, America still has questions: How much does it cost?; How would we pay for it?; What happens to my current insurance?; Would this hurt the quality of care? Although the Biden administration, which has thus far rejected Medicare for all programs, is unlikely to pass the bill, it is still important to understand it. Specifically, we need to see how covid impacts Medicare for all debate, how politicians have responded to it, how it could impact the economy, and finally how it could affect health in the US.
First, Medicare for all had become a more prominent topic in the era of covid. The Covid-19 pandemic has forced American attention to the issue of healthcare. Google Trends, which tracks online searches, records a 24 point increase in searches for “healthcare” since New York declared a state of emergency. At the same time, Jennifer Tolbert, an associate director for the Kaiser Family Foundation’s program on Medicaid and the uninsured explains that “A crisis like this, where everyone is at risk and everyone can be affected, highlights the gaps in our healthcare system in a way that we don’t often see.” But with millions losing their insurance and income, countless Americans will fall through those gaps. According to an analysis by the consulting firm Health Management Associates (HMA), the Covid-19 crisis could lead to between 12 million and 35 million people losing employer-sponsored health coverage due to job losses. That’s why a morning consult poll from April finds that Medicare for All is now at its highest level of support in 9 months, with over 60% of Americans supporting the policy.
Despite this, the bill has limited support from politicians themselves. Proponents of Medicare for All have not been straightforward in answering questions about the program during the summer, Elizabeth Warren spent most of the Democratic debates avoiding the question regarding if Medicare for All would increase taxes on the middle class. Furthermore, the Biden Administration has rejected Medicare for all as a policy, instead of arguing that we should reform Obamacare. Politicians are likely right to be wary of the policy: most Americans are on employer health insurance, which, under the bill, would disappear. Regardless of if Medicare for all would be positive in the long term, it certainly presents a major disruption in the current healthcare system, raising the stakes politically.
M4A’s economic impact is also a major point of contention. In our current system, Americans spend around 3 trillion dollars a year on healthcare, most of which goes to private insurance companies. Some researchers, like Scott Atlas of the Hoover Institution, claim that medicare for all would only increase the costs of healthcare, As more people would utilize healthcare and the private competition between insurers will no longer drive down costs. On the other side, in a 2019 study from PLOS Medicine, Christopher Cai and his colleagues at three University of California campuses examined 22 studies on the projected cost impact of single-payer health insurance in the United States. They concluded that all 22 studies found that Medicare for All would save America money over the course of a few years. The reasoning is simple: by eliminating bureaucratic inefficiencies, removing the perverse incentives of insurance companies to increase costs, and improving public health, we save money. However, Medicare for all will still cause the government 3 trillion each year, leading those like Mitch McConnell to warn of catastrophe if America continues to increase the federal debt, (although it should be noted that increased deficits are rarely problematic.)
The final issue which determines the state of Medicare for all is the impact on public health. These last few years have seen an influx of physician support for the policy: American College of Physicians, the second-largest doctor’s group in America, officially endorsed Medicare for All last year, stating that “the nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many.” However, some worry that single-payer will lead to long waiting times, cut qualify of care (like the veterans association, one of America's few government-run healthcare programs), or reduce access to specialist care. There is also a profit incentive (ironically as a result of not having medicare for all) which can create opposition to medicare for all. Lobbying groups from the healthcare industry, particularly pharmaceutical companies and hospital lobbyists, have become outspoken antagonists of the policy to protect their own high prices, thus further decreasing the odds the bill could pass any time soon.
Opponents to Medicare warn of potential “mass disruption” to American healthcare, which they say far outweighs any existing issues. Whether we like it or not, that “mass disruption” is already happening. The only question is if Medicare for all is the answer to our problems.
Discussion Questions:
Should America pass medicare for all? Would medicare for all harm or hurt America's economy?
How should Biden reform America’s healthcare?
What changes need to be made to the healthcare industry in the wake of covid 19?
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