Today, Donald Trump and the GOP failed to achieve the single most visible part of their agenda, namely the repeal / replacement of the ACA. This means that, at least for the foreseeable future the ACA remains in place. This is great news but it doesn’t mean we can stop worrying.
There are any number of problems with the ACA. In the short run the Democrats should immediately start proposing legislation to make needed adjustments to the program. At least a few Republicans having seen that their own party won;t produce anything positive, might come along to make the current system better.
But the fact is that we are simply not going to get what we want without creating a single payer system, which I prefer to call Medicare for all. Every other country of any note in the world has a national health care system. Somehow, we as Americans were convinced that anything that came from the government was Socialism and we were terrified of it. The rationale for not having a Medicare for all system is that we can’t “afford it”. If one understands the facts, one can readily see that this is a completely false narrative.
Like many things in American society, we have basically hidden the true costs of how we do things which creates a false impression of what reality is. First of all, the United Sates has the highest per capital health care costs of any major nation in the world. The narrative that says that a single payer system would cost us more is easily disproved by looking at any other major nation. They all spend less on health care than we do. That’s a fact.
Now it is true that a Medicare for all system would increase your taxes. But it is an illusion that you would actually pay more out of your household budget. It would simply be a cleaner system without all the hidden costs. We have what is called an employer based system in which most people get covered through their place of work. For the vast majority this isn’t completely without charge, usually the worker pays a portion of the premium and supposedly the company pays the rest as a benefit.
But the fact is, this is an illusion. Companies do not pay for your health care. The consumers of the products those companies produce are paying for your health care. Companies pass on the costs of insuring their workers, assuming that they do provide benefits, into the cost of the products or services they sell. They have to. That’s how a business makes a profit.
So, in every single thing you buy, every service you purchase is the cost of the insurance that is supposedly being provided as a benefit by the employer. They aren’t really paying for your health insurance, you are paying for it indirectly through the cost of goods and services. It is a hidden cost which artificially creates an illusion of what you are paying for health care.
The fact is that you are paying a whole lot more than you think you are for health care in the US. I’m sure you have already experienced the ridiculously high premiums which seem to go up every single year. I am also sure you’ve noticed those deductibles which also seem to get larger all the time. What many people are unaware of is what they are paying indirectly via the hidden costs that do not get labelled as health care costs when they pay them.
First of all is the cost to the rest of us of every uninsured person. The folks who do not get any health care coverage typically do not have the money to buy their own. So, they end up not getting the preventive care they should, which leaves them less healthy and when they experience their inevitable health crisis, they use our emergency medical system as their health care provider. This is far and away the most expensive way to provide care and it typically is un-affordable for these people, who then cannot pay, and the hospitals end up writing off the debt. Those losses get passed on directly to the consumers of health care who can pay. You and I are already paying those costs in the prices we are paying.
Then there is the cost of the inadequate insurance that many people have because it is the only thing they can afford. Before the ACA many people’s plans were inadequate to really protect them, especially against catastrophic illness. The ACA had provisions which set certain minimums services that had to be covered in an insurance policy to be considered as adequate. The repeal effort specifically targeted these provisions. The repeal would have put us back to the days when people would have insurance and feel secure only to find that their coverage didn’t come close to covering their real needs in a crisis.
But even with the ACA in place, it is a fact that the number one cause of personal bankruptcy in the United States is medical costs. It is still the case that in our country we have decided that it is acceptable for families to be wiped out financially, a disaster that actually effects multiple generations not just an individual or a couple, due to the cost of medical care. Quite apart from the social cost of family bankruptcy, every time an individual declares bankruptcy, someone, like the banks and their other creditors eat that debt. So. once again, those costs get passed on to the rest of us via increased interest rates, higher service charges, and the increased cost of goods and services. We do not see them as costs associated with health care but they are.
If we can get to a Medicare for all system, we would have none of those hidden costs. We would know exactly what we were paying for. Yes, Federal Taxes would go up. But there could be some relief at the state level as Medicaid, which is administered through the states would not be necessary anymore. The states could save a huge amount.
We wouldn’t have the costs of the uninsured or costs of the bankruptcies being passed on to everyone else. But most importantly, it Medicare for all would almost certainly bring down costs. For profit health care has an automatic built in pressure to raise rates and decrease service. That is precisely how a business increases its profits. Anyone who thinks that competition and market forces are sufficient to bring costs down simply hasn’t looked at the realities of private health care. There is no evidence whatever that this works.
Not having an employer based health insurance system could also drive wages up bu giving the worker more freedom to choose employers. Right now, many folks stay at jobs they hate, or work at pay the is inadequate to cover their expenses simply because they hesitate to lose theior insurance. Essentially, they are held hostage by the employers who offer benefits and don;t feel free to move around. With Medicare for all system, it would be much cleaner with workers making their decisions about staying or leaving a work place based on wages and work conditions and not on trying to protect the family’s benefits. Over time, this greater choice would create an upward pressure on wages.
Insurance works by distributing or spreading the risk pool. A medicare for all system would mean that 100% of our citizens would be participating in the system. Everyone who pays Federal taxes, either themselves or indirectly via the cost of good s and services they purchase would effectively be paying into the system. Federal income tax is a progressive system so the wealthy would pay proportionally more and the poor might pay very little.
This isn’t rocket science. Every body else has figured this out but us. Are there issues in other countries? Certainly. Every system can be tweaked and improved on. But it is just plain true that the down side of our health care system, which is fast getting un-affordable by anyone but the elites, really outweighs the upside. There is a very good reason that in no other country in the world are they looking at the US system and saying that they want what we have. When you hear any foreigner extolling the US system it is invariably a rich person who can afford to pay whatever the market as asking to get their care. It sure as hell is not the average person. They look at us and think we are crazy.
Let’s get behind Bernie Sanders and make single payer the issue of the day. Help educate the working class folks out there who are being hammered by the current system and educate them why this is in their direct self interest. Help them see through the right wing propaganda and scare tactics. If one gets passed all the BS, it is actually a rather straight forward issue.