I would like to see the United States adopt a single-payer healthcare system for all Americans who want it-- basically, Medicare for all. Despite complaints about waste and abuse in Medicare, it is still more efficient and operates with a much lower overhead than private insurance companies. Waste and fraud can be dealt with--wresting away billions of dollars in profits from insurance companies can not.
Implementing Medicare for all would not be terribly difficult, and could be done by increasing Medicare eligibility over time, starting with reducing the age of eligibility, then by allowing self-employed to join, followed perhaps by uninsured children, and continuing until everyone is eligible. In this way, growth could be slower, fraud and abuse could be worked out, and other changes could be made. Of course, anyone who does not want Medicare would be able to buy alternate insurance, and a market for supplemental insurance would also be created.
Clearly, any single-payer system for 300,000,000 Americans would be expensive. I have never heard of nor seen results of a study that would confirm this, but I have a hunch it would be less expensive than healthcare today. For example, if all the money collected by insurance companies in premiums and all the money paid directly for patient care were re-directed as a payroll tax, would it be enough to fund Medicare for all?
Looking at the advantages to a single-payer system makes it obvious to me just how involved the health insurance industry is in the legislative process. Under a single-payer system like this, health care providers, doctors, and hospitals would remain private. Prices would be negotiated between Medicare and the payees. Why wouldn't the providers be happy with this arrangement? They would no longer have the overhead of working with multiple payers, they would not have to deal with billing and collecting directly from patients, and they would have 46,000,000 potential new paying patient-customers.
Why wouldn't employers also be in favor of Medicare for all? Although they may have to pay a percentage of their employees salary as a Medicare tax, it would likely be cheaper than what they are currently paying for health insurance premiums today. My employer provided health insurance costs over 17% of my pay for arguably poor quality insurance. Would a payroll tax that would cover Medicare for all be more than that? I don't think it would, and would like someone to find out.
So that leaves the insurance industry, the only real loser in a single-payers system, they are who is preventing this change.
If Medicare for all is too objectionable, and private insurance is the only acceptable way to move forward, then it is time to eliminate profit in health care and introduce strict price controls to reduce costs. Insurance must be affordable, and for those that can't, there must be government subsidies to pay for it.
Unfortunately, the US seems far from ready for real healthcare reform. For now, we'll have to settle for health insurance reform. For real change in the way we approach healthcare, we'll have to change the way we approach our outlook on human life and on government. We must acknowledge that all human life is worth taking care of, and worth paying for. Everyone would likely say that is true, but actions clearly show differently. When this happens, we'll know it, because schools will be properly run and funded, people will have enough food to eat, and people will speak out, in force, against people making money by making even the most basic of human needs--health care--unaffordable.
Next, Americans will have to change our view of government. It does not have to be the enemy-- it is not always the inefficient beast that it is made out to be. The federal government and state and local governments all over the country efficiently provide services to people every day, services we take for granted. I will not deny there are abuses and excesses, and a lot of room for improvement. But there is a lot done well, and I think providing single-payer healthcare could be done well, too.
The next post in The Itch for Healthcare Reform will address the proposed legislation. What will the bill really do? Will it help improve our rankings worldwide? Will it make insurance more affordable? Will it make insurance more accessible? Will it reduce overall costs? Perhaps by then, the proposal will not longer be just a bill, but be passed and signed into law!