Improved Medicare for All: simple, universal, affordable

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M.O. Stevens/Wikimedia Commons

We can meet the health care needs of us all, in a way we each can afford, spend less and have better health care. 

To get there, we can build on what works — Medicare, which has the highest satisfaction rate of any U.S. health care coverage. It can be improved by covering hearing, dental, vision and long-term care, while eliminating deductibles and co-pays. We need the profound administrative simplifying of one, not-for-profit system. The administrative savings on the payer and provider sides and the leverage to negotiate fair drug and hospital charges are what accomplish affordably covering everyone with such robust care. 

Opponents of Improved Medicare for All invoke the fear of taxes. The good news is pre-paying for health care based on income is progressive; the CEO and the janitor no longer pay the same. And, when care is needed, good care is the focus, not the cost. 

To get there, we need to take the leap. For-profit insurers will always have the incentive to collect premiums and avoid paying for care; they compete to avoid risk. Through deductibles, high co-pays, narrow provider networks, prior authorizations, claims denials and surprise billings, as well as covering the younger, healthier and wealthier, and avoiding the older, sicker and poorer, they’ve become very good at meeting these incentives and will continue as long as we let them.

It is also important to see how the insurance corporations, in partnership with the drug and large hospital corporations, work as a price-fixing cartel. They’ve succeeded in being able to charge us almost twice the average per person as do other countries with universal systems that have better outcomes. No wonder they are the largest lobby to control our politics to maintain what works for them. 

We often hear health care described in terms of a marketplace: that we need choice of insurers, that competition will control prices, that price transparency will inform savvy consumers of health care, and that we need to pay at the time of care to have skin in the game. But health care can have the same message as a thief in a dark alley: “It’s your money or your life.” Mostly, we don’t know what health care we’ll need, and then, when we need it, we need it. The past decade has seen the Affordable Care Act (ACA) increase the percent of Americans who have coverage, mostly through the expansion of Medicaid. At the same time, the scourge of under-insurance has grown. Conservatively, a quarter of Americans who pay premiums every month are not able to afford care when needed. While the ACA has helped some to get needed care, it has exaggerated an already complicated system, throwing more taxpayer dollars at private insurance.

Colorado has seen recent attempts to create a public option. Intense pressure got the legislature to scale back to a model based on private insurance. There is false hope stated that a public option can be a stepping stone to a universal system. Rather, big medicine wants to maintain focus on the public option, and not on an improved Medicare for All. Win or lose, with the fight about public option, for-profit insurance abides and big medicine wins, not us.

How we pay for our health care is a major part of how we structure racial and economic inequality in our country. Even before the pandemic, seven to nine million Americans have been driven into poverty every year, just paying for needed care. While maternal mortality rates for white women in the U.S. are twice as high compared to Canadian women, for Black women in the U.S. rates are six times higher than in Canada. The pandemic has shown that people of color are two to three times more likely to be infected and two to three times more likely to die from COVID. Yet, the inequities in health care greatly lessen at age 65: It’s not magic.

In 2019, the Colorado legislature passed the Health Care Cost Savings Act (HB 19-1176). It created a task force to compare the costs and other social impacts of three fundamental ways to pay for health care: how we do now, a multiplayer universal health care system, and a single payer system. The task force hired the Colorado School of Public Health to do the analysis. The task force will take the CSPH’s report and create a final report to the Legislature by Sept. 1. While the CSPH’s full report is not yet public, their conclusion is:

 “For health care reform in Colorado, introducing universal health coverage that is either a multi-payer or single payer system has the potential to increase access to care, improve health outcomes, and possibly provide sector-specific employment benefits. Our cost estimates suggest that a multi-payer universal health care system will likely lead to small increases in the total cost of Colorado’s health care system. Introduction of a full publicly financed and privately delivered health care system could yield significant healthcare savings, particularly if pricing regulations are put in place to control cost growth in the future. The financial health of hospitals and clinics and clinician retention should all be carefully considered with any potential pricing regulations.” 

Wealthy, powerful interests see things working just fine. The majority of Americans want improved Medicare for All to create the kind of society we want to live in.  

Bill Semple is the Board Chair for Colorado Foundation for Universal Health Care. Just Economics is written by members of the Economic Justice Collective of the Rocky Mountain Peace & Justice Center.

This opinion column does not necessarily reflect the views of Boulder Weekly.