Terry H. Schwadron
April 12, 2019
However futile, Sen. Bernie Sanders did the Right Thing: He has formally re-introduced legislation to launch the Medicare-for-All plan for health care access, bracing the elephant in the room. As it stands, it most like will not pass Congress.
What makes it particularly right is that he is not waiting until he or another Democrat succeeds Donald Trump as president in 2020, who takes exactly the complete opposite position, removing government from health care to the degree possible. Instead, Sanders acknowledges that he has a good perch for leadership in the Senate right now, and that he is in his job to fix things, not just talk.
What troubles me about the introduction is that we’re missing the campaign to make this successful legislation. After all, this is about persuasion, not just a declaration, right?
The intent for Medicare for All is to provide health insurance to all Americans under a single plan run by the government and financed by taxpayers. Private insurers could remain in business to provide benefits, such as elective surgery, not covered by the government. Clearly, the main drawback is the cost — as high as $32 trillion over 10 years.
Sanders — and others, including a study by the RAND Corporation — say Medicare for All would save middle-class families money by decreasing their premiums and out-of-pocket costs. Essentially, the bulk of the average $12,000 a family in insurance payments would be transferred to taxes. In return, a swollen health insurance population would have vast new negotiating power and — theoretically — could win better prices for medical costs, hospital bills and pharmaceuticals as a result.
If you believe — and generally, I do — that a wider guaranteed health insurance could not only add upwards of 30 million new health insured, but result in some significant savings in medical-related costs, then this is a good moment.
It is particularly good because Trump has promised to dump Obamacare without a plan for any replacement besides the skimpy health plans we’ve seen emerge from groups of companies.
But tackling health care, as we saw a decade ago, is a huge undertaking, and it takes a lot more than introducing the bill, and even jawboning about health care as a human right, to win the day for a legislated full system to deliver health care in America.
I think Bernie would have been better served to hold some well-planned public hearings to allow all interests in the health care area a chance to participate, vent, shape, or otherwise testify towards a negotiated settlement. There is something here that feels just as doctrinaire as Trump’s actions in offering a top-down settlement first as The Answer to vexing problems.
Bernie is right that we cannot continue with current systems. Health care costs rise annually, medical providers are turning things inside out to support themselves, pharmaceutical companies have too many examples that come across as greed, and the last person in this financial chain is the individual patient.
I just had a hip operation, a fairly common procedure that required a single night in the hospital; I see from my own insurance coverage that this has cost the insurer $50,000, quite apart from costs from pre-operative pain treatment, or absence or interference with the day to day or even physical therapy. The same operation will cost more or less at other hospitals in other cities. It seems like a lot of money, and invites questions about whether medical costs should be set by the marketplace or by some set of standards.
The New York Times just published a set of cost analyses of Medicare for All. The interesting thing is that the analyses vary with all the assumptions that are built in. Introducing a bill to create Medicare for All will not resolve all the issues. We need more information to understand what we’re doing, and we need it to build more of a sense of political consensus.
The issues here are myriad even within the general acceptance of the Sanders plan. Medicare doesn’t pay for all costs now, even for older Americans, its target group; instead, we all recognize a need to hold a supplementary health insurance plan or two to cover aspects of health that are beyond what Medicare can do. Yet that simple fact does not appear to be a factor in the Sanders plan.
Sanders points to the Canadian health system as the prime example in forming Medicare for All. Of course, every politically conservative person in the country is already lined up to oppose any plan that puts health care in the hands of the government.
There is a lot of trust in the Medicare for All approach that things will work out for the general good. Yet in the cases of Europe or the Veterans Administration, there always are complaints about patient waits or lack of choice in service provider. Other countries pay less for the same pharmaceuticals that cost Americans so much each year. Are doctors, hospitals, health providers willing to accept cost controls in a Medicare for All world?
The ideas here deserve more information gathering along with the courage to introduce the literal legislation.