Medicare for All: An Obvious Solution Long Delayed

“The fact of the matter is, what we are now talking about doing, most of the countries of Europe did years ago. The British did it 30 years ago. We are behind every country pretty nearly in Europe in this matter of medical care for our citizens.”


Most would probably read this quote and assume it originates from some proponent of Medicare for All during this current election cycle, a fair assumption to make. But they would be wrong. These were the words of President John F. Kennedy, delivered at a 1962 event in Madison Square Garden. While at the time President Kennedy was promoting a public insurance program for the elderly which would eventually see fruition in Medicare, so unabashed an appeal to nationalized European social programs is considered perhaps even more revolutionary than it did 50 years ago; a perfect encapsulation of how U.S. politics has drifted retrograde on health care.


Health care has been an issue near the forefront of American politics for decades at this point, and the 2020 election cycle has an ample amount of debate on the topic. Yet, despite all the Medicare For All derivatives that have popped up during this election season – Medicare for All Who Want It, Medicare for America, and “Medicare For Choice –” some, but not nearly enough, discussion has been had on the fundamental principles which undergird this issue. If it were, it would become fairly apparent that the universal, single payer Medicare for All bill proposed by Vermont Senator Bernie Sanders and supported by many other progressives is the obvious way forward on this issue.


It would be surprising if anyone held the United States up as some great model for a modern health insurance system. Among the post-industrial nations, it can be ranked fairly low. The United States has, by far, the highest per capita expenditures on health care, with approximately $10,000 spent per person. Yet, it maintains just the 27th highest life expectancy at birth in the OECD and has an amenable mortality rate comparable to developing nations of Eastern Europe. Medical bills are cited for two-thirds of all bankruptcy filings, while medical bankruptcies are virtually unheard of in much of the developed world. Those nations which lead on medical care for their citizens have adopted some form of single payer system. Though some have not completely nationalized their systems, virtually all have levels of regulation far exceeding that in the United States.


At its most foundational level, insurance functions successfully by including as many in its pool as possible. The more people contribute to the pool, the less each contribution will need to be and/or the more available funds that can be drawn upon to cover those within the pool who need assistance. This fact was why the individual mandate of the Affordable Care act was so crucial. Without a type of compulsory reason to enroll in insurance, many of the young, healthy, or financially unsound can drop out of the insurance system, leaving only the older and sicker to pay, raising prices, summarily driving even more people off of insurance in a vicious cycle.


As Senator Elizabeth Warren has pointed out, insurance companies, like all private corporations, operate on the profit motive. In the case of health insurance, how then would a corporation generate maximum profits? That seems fairly simple; charge as much as it can from as many people as it can while spending as little as possible on actually covering medical services. This really offers little to no incentive to ensure customers receive quality affordable care.  Rather it would seemingly incentivize insurance companies to reel in as many people as possible with empty promises shrouded in convoluted legal jargon then go on to deny coverage as often as possible, at least up to the point where it would start driving customers away. While there are certainly well-intentioned insurance companies which might avoid such schemes, companies can still not only pursue these tactics but, in a way, are incentivized to do so, presenting a glaring lapse in our current private system.


Among the most common objections to a government-run health care system is a complaint about bureaucracy; that by stepping into the arena of health care in this way, the government would necessarily create a massive, unwieldy, and inefficient bureaucratic structure. Such an objection’s baselessness can be made obvious by simply pointing out that such an ungainly bureaucracy already exists today, just within the private sector. Nearly 1/5 of the modern American GDP is spent on health care, with millions of jobs arising from the insurance industry. While employment figures are a legitimate concern and steps should be taken to ensure that as many as possible retain gainful employment in the health care system, this does not mean fundamental change cannot be taken. The fact that an entire industry has developed centered around this staggering inefficiency is not a particularly convincing argument against change if said inefficiency so damages people’s lives as it does now.


Another common attack against a Medicare for All system is that a large percentage of Americans receive their health care through their employers, and many find it satisfactory. This is true enough, but this could hardly be called an optimal state of affairs. Something so instrumental in a person’s ability to maintain the health of themselves and their families very much seems an unfair bargaining chip an employer can hold over their employees. How many have decided against pursuing other career paths, or against petitioning their employer for a better contract out of fear that they might no longer receive insurance? This danger was jarringly demonstrated by 2019’s General Motors strike, during which GM suspended striking workers’ health insurance plan.


Finally, we turn to what is most certainly the most common question that arises whenever single payer health care is discussed: “How are you going to pay for it?” The obvious insinuation of these queries is that a national health care system will be prohibitively and unrealistically expensive, making debate on the policy’s actual effectiveness moot. Ironically, this seems to be the easiest of the complaints with the policy to dismiss. Two independent estimates of the currently proposed Medicare for All bill came to a figure of $32 trillion over the next decade, a daunting number to be sure, but somewhat less shocking when one realizes projections for health care expenditures under current systems in fact total to $2 trillion more over that same period. Admittedly, the author of the libertarian-leaning Mercatus Center study which demonstrated this pushed back, insisting that this was only true under overly generous predictions. Regardless, the fact remains that this program would have roughly the same, if not a lower, net cost, all while extending coverage to all of the millions currently uninsured and offering more benefits than currently exist under Medicare, as was reaffirmed in a CBO report on single-payer health care. Moreover, the insinuation that proponents of Medicare for All are simply trying to conjure this money from thin air is preposterous. Funding for such a program would obviously come via new tax structures which would replace deductibles, premiums and the like, allaying the frequent “your taxes will go up” scare tactic.


For all the criticism that has been flung at Medicare for All, it seems only common sense to turn a critical eye toward the proposed ideas of the program’s opponents. In doing so, I find myself disappointed, however, as it seems that the Center and the Right really have no interest in addressing many of the problems underlying the modern American health care system.


As for the Right, I am often left questioning if the Republican Party has any substantive plan for the American health insurance system at all. The answer thus far has been a resounding no. It seems that, at best, the most Republicans can muster is some canned answer about how terrible and tyrannical Obama was for creating the ACA and some vague notion of reduced government being the solution. Congressional Republicans did attempt to pass a health care bill in 2017, titled the “American Health Care Act.” Upon review, the Congressional Budget Office found that the ill-fated legislation would have seen 24 million more people uninsured. Not only that, but the measure provided that insurance companies could charge elderly people 5 times as much as younger enrollees; indeed it appeared as if the AHCA would have most disadvantaged the sick, poor, and elderly, the very people which health insurance is definitionally meant to assist.


A conservative would no doubt argue that people should have the liberty to choose whether or not they want to be insured at all, and that the cost of care should be borne by those who use it most. While they’d be entitled to that opinion, and all being fair it seems a logical conclusion to reach, in practice it simply proves utterly impractical. Without some mandate in place, those who believe they need insurance least will leave the marketplace, driving up costs, and, if the brunt of insurance costs are actually faced by the old and sick alone, the expenses of modern medicine would be overwhelming, defeating the supposed purpose of medical insurance.


Moving back leftward, much of the established Democratic party appears only incrementally better than their Republican colleagues. Although not advocating for anything so nearly as disastrous as the AHCA, more centrist-leaning Democrats seem thoroughly convinced that incremental reform around the margins will be sufficient to repair America’s broken health insurance system. These prevailing sentiments could be seen in the 2010 passage of the Affordable Care Act. Itself already a far cry from the single payer system Barack Obama embraced in 2003, the bill was furthered watered down by protests from the President’s own side. Most notably, Connecticut’s then-senator Joe Lieberman, the party’s 2000 nominee for Vice president turned independent caucusing with the Democrats, torpedoed the public health insurance option that was to be a cornerstone of the Affordable Care Act. More than anything, the Obamacare fight demonstrates that approaching the negotiating table with an already neutered health care bill will not be met with the ready consent of opposition as was the likely hope, but rather will be met with demands to drag the legislative bill even further right.


This refusal to sign on to a more socialized health care has continued into this election cycle. Frontrunner Joe Biden has positioned himself as a defender of Obamacare, suggesting that his enemies on his left are trying to “scrap” the Affordable Care Act. During a September debate, as Bernie Sanders mentioned how much more costly health care is in this country, Biden simply quipped “This is America.”


Why do so many politicians seem hell-bent on seeing no meaningful change in the health insurance system? While each politicians’ motives can be known only to themselves, the roughly $150 million insurance companies have spent on lobbying, and the tens of millions of dollars American political candidates have received from the insurance industry, leaned towards Republicans but considerable in both parties, certainly speak volumes.


Take South Bend Mayor Pete Buttigieg as a case study. Early in this election cycle, the Indianan sang the praises of Medicare for All, explaining how Obamacare was, in fact, a compromise with conservatives on Morning Joe and assuring questioners on Twitter that he was all on board with Medicare for All. As the campaign went on and his wallet became heavier and heavier with well over a million dollars in health industry contributions, the mayor pivoted and can now be counted on to naysay the program as unrealistic at each debate.  Instead he has been pushing for a public option plan rebranded as “Medicare for all who want it.”


Unfortunately, medical care does not lend itself to such an incremental approach. So long as health insurance companies are incentivized to conjure up some addendum or proviso revealing that enrollees are not actually insured, the American health insurance system will be fundamentally flawed. Health insurance is simply an area where glaring market failures exist, demanding the public sector to intercede. As John F. Kennedy pointed out all those years ago, the nations of Europe already progressed on the subject of medical care ages ago, in some cases literally. The foundations for Europe’s first national insurance program were laid down in the 1880’s by Chancellor Otto Von Bismarck of the German Empire. This example is all the more poignant, as Bismarck has become something of a hero of European Conservatism; yet even he saw this as the most pragmatic approach to delivering medical care. Something which could, in many cases, literally mean life or death should not be left as a commodity for the market to dictate but instead be held up as a matter of the public good, which happened with national defense, policing, firefighting, and all other basic necessities preceding it. In this country, we have a party on the far right who seems to reject modern health insurance as a concept, while those on the center left seek to maintain a status quo which is intrinsically broken. The way forward on this is clear: Medicare for All.