As the Affordable Care Act struggles for survival under attack from President Donald Trump and Republicans, many Democrats want to go further than protecting Obamacare by establishing “Medicare for All.”
Pramila Jayapal, who represents most of Seattle in the U.S. House, is introducing a bill that would provide universal single-payer health care for all Americans. It has garnered more than 100 co-sponsors.
Most Democratic presidential candidates support some form of universal coverage, too. Some, such as Sen. Bernie Sanders, would eliminate private insurance. Others back the general idea but wouldn’t go so far. One step would allow people to buy into Medicare at age 50.
A poll by the Henry Kaiser Family Foundation showed 56 percent of respondents favor some form of single-payer coverage. This compares with about 40 percent at the turn of the century.
History may be a guide. Federal laws for food and drug safety were impossible until Americans’ minds were changed by muckraking journalism and Upton Sinclair’s famous novel about the Chicago meatpacking industry, “The Jungle.” Social Security was a fringe idea until the suffering of The Great Depression. Ronald Reagan denounced Medicare proposals (“socialized medicine”) in 1961, but actual Medicare was too popular for him to dismantle as president in the 1980s.
So rather than magical thinking that a progressive presidential candidate can defeat Trump — no sure thing — and instantly proclaim Medicare for All, let’s look at the practicalities and economics.
Today’s fractured system delivers excellent care — for those who can afford it. Even so, Americans pay far more for prescription drugs and many other health services than is the case elsewhere.
Under Medicare for All, the federal government would pay for all or most health care. Under current law, Medicare and Medicaid cost the government $1.4 trillion a year. This could rise to anywhere from $2.8 trillion to $3.9 trillion under single-payer. Much of the difference in cost projections depends on better administrative efficiencies and lower drug prices.
Even using the least expensive forecast, “federal spending on health care would still increase by 10 percent of GDP, or more than triple what the government spends on the military.” Tax increases might hit the middle class, not just the rich.
What we would get, in theory, is universal access — no small thing. It’s a given in every other advanced nation.
Universal systems
Universal systems enjoy much lower costs than is the case in today’s American system. Canada is one example, providing better care at lower cost, but physicians still enjoy the same autonomy as their colleagues in the United States.
Sandro Galea, an emergency physician and dean of the Boston University School of Public Health, wrote in the Harvard Business Review: “If implemented correctly, a centralized payment structure can create a health care system that is genuinely organized around health.”
Today’s U.S. system is organized around increasing profits, marketing and developing advanced drugs and treatment available to only a fortunate minority.
Still, economist Victor Fuchs offers some nuances and cautions in an article for the Journal of the American Medical Association.
“To have any chance of success in the United States, single-payer would have to be simple, require a minimum of bureaucracy, be based on decentralized organizations to provide care and provide opportunity for individuals to choose among competing health plans,” he wrote.
We’re not at a consensus on universal coverage yet. But that doesn’t mean never. Events are moving fast, and often surprisingly. So don’t be quick to write off Medicare for All, or dismiss it without studying the details.
Jon Talton is an opinion writer for The Seattle Times. jtalton@seattletimes.com
