The idea of Medicare for all is one that meets with varied opinions and passionate responses. When President Lyndon Johnson signed Medicare into law, he appealed strongly to people’s sense of decency, saying “we’ve just got to say that by God you can’t treat grandma this way!” It’s true that in those days there were shocking stories of the elderly going without care and dying in deplorable conditions without treatment. Lately, the Medicare program has been portrayed as under siege, nearly bankrupt from increased costs and decreasing revenues. But many are asking the question: “Could this work for everyone?”
Medicare for All refers to a policy of expanding Medicare into a single-payer program with no copayments or deductibles, which would then cover every US resident and be paid for with payroll taxes and perhaps some marginal contributions from federal coffers. It would eliminate the private insurance industry entirely.
Insurance providers are the main cause for high healthcare costs. Let’s face it; CEO’s making hefty profits from insurance premiums have no incentive to lower costs. Having a healthcare system that is based on profits is the reason so many Americans are turned down for necessary medical procedures, even when they have “good insurance”. It’s also the reason we pay these exorbitant premiums.
An oft-cited 1991 GAO report comparing the US and Canadian health care systems found that if the US implemented a similar program, the savings would be sufficient to cover all citizens at 100% coverage with no out of pocket costs. Medicare currently functions with a 1.4% overhead. Canadian Medicare has just one tenth higher, at 1.5%.
Many supporters of Medicare for all say that the elimination of third party payers is particularly salient for healthcare revenue management, whereby practitioners and hospitals have had to grapple with as many as twenty different contractors in the process of submitting claims for reimbursement. Some healthcare providers pay up to 30% of expenses on administrative overhead due to the wide array of pitfalls that may crop up on the path to reimbursement.
In a study published by the New England Journal of Medicine, administration costs were over three times higher in US private practices and hospitals than Canadian ones. This is primarily due to the increased amount of time spent dedicated to billing and Medicaid eligibility, that is, chasing down the money and making sure the doctor gets paid, which is simply not a problem in the single payer system.
People who do not support Medicare for all cite the inefficiency in obtaining quality premium healthcare under such a plan. Countries such as Canada and the UK have universal healthcare that works quite well for its citizens, yet the U.S. media tells a different tale. Patients in need of highly specialized surgeries do come to the USA in order to obtain them, but that does not mean they have to. For example the National Health Service can now provide a complete hip replacement in just 16 days.
The boilerplate argument from conservative opponents of The Affordable Care Act poses the question: If an entire sector of the economy (insurance providers and 3rd-party agencies) was eliminated, what kind of repercussions would that have throughout the economy? And, of course, they believe it must be considered how these policies would affect the motivation of doctors to specialize and provide quality care without the resources to do it productively. Medical school is too expensive and Medicare pays too cheap.
The answer can be seen in every other developed nation’s universal healthcare systems. The information Americans receive is much different than the information the rest of the world receives, so it is best to gather source information on universal healthcare from the country in which it exists. Everyone agrees that the US healthcare system is broken and something needs to change. To make the best choice, we need the best information.