Medicare expansion still the best option for affordable, comprehensive health coverage

After the recent GOP repeal and reform debacle, and the recent introduction of a Medicare for All bill by Bernie Sanders and 15 Democratic Senators, I hear some in the GOP saying single payer is socialism. As do most Americans, I like Medicare but don’t like socialized medicine.

As a capitalist and former GOP elected official, I generally believe private enterprise is more efficient than government. For non-economists, socialism is defined as government owning the means of production (i.e. hospitals and medical facilities).

England’s socialistic health delivery system would not work well here. Our VA hospitals, with high waiting times and built-in inefficiencies, are prime examples of the failings of this approach in the USA.

But that does not mean our system is better than many others around the world, especially those with single payer or similar systems.

The Commonwealth Fund’s International Health Care System Profiles (2016) analyzed a number of developed nations. Let’s just look at Australia, France, Canada and Germany (all with more direct governmental intervention in healthcare financing) for a sample comparative cohort.

In the USA, 33 percent of our population experiences financial access barriers annually. The figures in the other nations range from 7 percent in Germany to 17 percent in France.

In the USA, 51 percent of the population finds it easy to get care after hours. The figure is 63-64 percent in France, Canada and Germany. Only Australia with 44 percent is worse than here.

The ability to get a same-day appointment shows a similar pattern. In the USA, 51 percent find it easy. Only Canada is worse. The other nations range from 53 percent in Germany to a high of 67 percent in Australia.

One would think that with the USA at or near the bottom regarding ease of access, we would spend much less than other nations. But the opposite is true.

The cost per hospital discharge in the USA is $21,063 versus only $5,900 in Germany. Our annual out of pocket per capita cost is $1,034, whereas France’s is only $305. Our total per capita health care cost is $9,364 whereas Australia’s runs only $4,207.

Furthermore, as a proportion of GNP, we exceed all others and it’s growing. When I was director of Health Planning for Georgia in the 1970s, healthcare as a proportion of GNP was around 8 percent. It is 18 percent now. By 2021 healthcare expenditures will reach 20 percent of our GNP, per government actuaries (CMS-Medicare), draining needed money from our aging infrastructure, among other things.

The fact is that we are already spending $3.2 trillion a year (2015), much of it via the government. Medicare (20 percent), Medicaid (11 percent), VA/military (4 percent) and public health (3 percent) already total 38 percent of spending. Plus, government is paying for its employees (and prisoners) on the federal, state and local levels with our taxes. In contrast, private insurance and other third-party payers are only 41 percent of the total. (Figures per AARP, April 2017). The bottom line is that we spend more tax money per capita than other nations do, just not as wisely.

The ACA (Obamacare) attempts cost containment, tinkering with the private insurance system which is generating much of the problem. But expenditures have still risen significantly. At the same time, several insurers are having financial problems (possibly due to miscalculating risk via adverse selection) and some have pulled out of the ACA.

The ACA clearly has expanded access to over 20 million more Americans via (a) mandated private health insurance and (b) voluntary state Medicaid expansion … although not in many large Southern states (Texas, Florida, Georgia, etc.) having the most uninsured. Although we no longer have 50 million uninsured, coverage will never be universal with the ACA and the Census Bureau says that there are still 30 million uninsured.

So, now that the disastrous GOP repeal efforts have failed, where to from here?

Medicare, our single payer health insurance system for the last 50 years, is run by our federal government … but preserves our private healthcare delivery (i.e. not socialism). Plus, Medicare is much more efficient and effective than having a myriad of private insurers. Just think of all the money providers will save in billing alone.

Furthermore, administrative costs for private insurance companies include overhead and marketing expenses that single payer Medicare would not have. That is why Medicare currently has administrative overhead of 2 percent and some private companies asked for waivers because they couldn’t get down to the 20 percent ACA overhead mandate.

The main difficulty with our current single payer system, Medicare, is that it covers only the disabled and those over the arbitrary age of 65, i.e., the sickest Americans. To have affordable healthcare with controllable costs, we must expand Medicare to cover all … including the young and healthy.

Yes, taxes will go up for businesses and healthy citizens (especially the 1 percent), but that will be offset via abolishing steadily rising premiums for businesses, plus deductibles, premiums and co-pays for individuals. Physicians for a National Health Program, the leading source of single payer information, states that 95 percent of citizens will see no increase in their personal expenditures.

I think that is a very good trade-off for full coverage of all Americans, don’t you?

This story was originally published September 20, 2017 at 3:47 PM with the headline "Medicare expansion still the best option for affordable, comprehensive health coverage."