Map of life expectancy at birth from Global Education Project.

Thursday, September 14, 2017


The details of the Bernie Sanders Medicare for All proposal aren't really important, because obviously it isn't going to become law. If you're interested there is an accessible discussion here.

It is interesting that he's rounded up 16 senatorial cosponsors. At least we're finally talking about -- yep -- universal, comprehensive, single payer national health care. The term "comprehensive" does apply, because this actually goes beyond existing Medicare to provide dental and vision coverage, and he also appears to envision lower out of pocket costs. Also, Medicare would negotiate drug prices. Long term care would still be handed off to something unspecified, which would presumptively be the existing Medicaid long-term care benefit, which requires that people impoverish themselves. We can debate that issue separately.

While at least talking about this is a necessary step, there are many reasons why it seems unlikely to happen any time soon. Here are some of the main bullets.
  • Names will never hurt me? I'm afraid they will. It's socialism! Well, maybe so, you can apply the term to it if you want to. Sure, that makes Canada and Norway totalitarian dungeons, which is not what the people who live there seem to think, but the word has power in this country. It's a government takeover of health care! No, not really, it's a government takeover of health insurance. But still, the rhetoric will fly about bureaucrats sitting between you and your doctor, just as it did with the Affordable Care Act. The largest tax increase in history! Probably so, but the taxes replace the money you're already paying for health insurance and out of pocket costs. In fact most people would save money, and for that matter, so would most employers. Which makes one wonder why big corporations aren't for it. As a matter of fact, many of them used to be. Lee Iacocca, when he ran Chrysler, favored single payer health care, arguing that having to pay for employee's health insurance put U.S. companies at a competitive disadvantage with their counterparts in more civilized nations. But it's contrary to the ideology of current corporate executives, plus which their personal taxes would increase and their personal wealth is all they care about. The corporate media won't be of any help explaining all this.
  • Yes, it would largely put the health insurance companies out of business. They might have some residual role selling supplemental insurance for people who want to get their health care without having to mingle with the riff raff, maybe some long term care insurance, maybe there would still be something like the Medicare Advantage program which would give them a role as middlemen. But basically, Aetna is history. I'm not sure what you would do about this -- there is a fair argument that the federal government would need to buy them out at the market price before passage of the act. That adds to the cost. Also their employees would be out of work. Yes, it's unnecessary make work, but so is the army. These are big political problems.
  • Drug companies would see their profits reduced. That's a good thing, but obviously they have enormous lobbying arms and they give  lot of money to politicians. Same consideration as above may apply to their shareholders. Yes, there are always political risks in owning stocks but this is pretty radical.
  • Not clear what the American Medical Association will think. They have opposed single payer plans in the past because they don't trust the government not to squeeze their incomes. 
There are  other political obstacles but these seems like plenty enough to make this very unlikely. Do you see a plausible path to single payer health care in the U.S. any time soon?


Don Quixote said...

Short answer to your question: No. Too many greedy assholes in America, too much inherent racism in the nation's founding, history and structure. However, if a candidate is willing to ride the wave of popular support...and if a major party is willing to back that candidate...and if votes are cast and counted accurately [if we can wean ourselves from electronic voting}...

Anonymous said...

The average health insurance rate hike for ObamaCare in New Mexico will be 31% to 46% in 2018. FYI