Costing Out Medicare for All

There is still a great debate going on as to whether we can afford Medicare for All. I prefer, rather, to use the term Universal Healthcare (UH) as I do not want to be restrictive in what we can come up with. Maybe Medicare for All is too expensive but a better plan is actually cheaper, etc.

The first stage of this discussion is the one we need now, which can be couched in the form of a single question: Is there enough information to believe we can afford UH to vote politically to have such a thing?

The answer is a clear yes. Other Western countries have better health outcomes or equal health outcomes than we get here and they pay far less for those outcomes.

Therefore we can afford to do UH and we should vote to do so.

The big question is then “Can we do it well?”

Those who believe in American Exceptionalism (U . . . S . . . A . . . U . . . S . . . A . . . !) must believe that not only can we do it, we can do it better than those other countries, especially the shit hole countries.

But, but “God is in the details!” (Not the Devil, people, get it right!) Yes, that is true, but any details being offered up in the current campaign for president are irrelevant because they are non-binding. We can also count on doctors working to protect their earnings. We can count on Big Pharma working to protect their immense profits. We can count on actual costs going down naturally, if for no other reason than Health Insurance company profits will no longer be extracted as rents from the system (see Addendum below).

The attractive thing about Medicare for All is that it has a proven track record of service, of frugality (3% operational overhead), and acceptability. That is political thinking however.

We could either: put health insurance companies out of business or allow them to offer supplemental insurance coverage (true catastrophic insurance) or we could do what Switzerland does. All of the health insurance in Switzerland is offered by private insurance companies (thousands of them). The government, however, limits how much profit those companies be made and dictates what is covered and what is not (no more insurance company death squads). (That this is acceptable to those companies is the fact that over 4000 of them are doing that business, the profits being like they were 50-60 years ago and steady and safe, just like insurance companies used to operate.) The Swiss government also forms and reforms risk pools to make sure that the risks are shared widely. So, UH can include private insurance companies as Switzerland does or it can basically relegate them to the high risk end of the spectrum or even eliminate them.

For example, I don’t think UH should cover rare medical events, e.g. the birth of conjoined twins. If we go down the road of “Oh, we can’t let anything bad happen,” we will soon be broke. Rare, almost untreatable cancers, well, that is sad but not an obligation of the many to the few. So, I think UH should focus on the common ailments that are treatable and allow the insurance companies to sell expensive policies to those who want protection from rare life threatening diseases and accidents, e.g. ‘Every bone in his body was broken but we were able to put him back together.”

But, that’s a detail, too.

Battling out the details in a political process is a vain effort and will not inform us. All we need to know is that other countries can produce health outcomes equivalent to, or better that, ours for much less than we currently pay. This tells us that UH is something we can do. Then it is a matter of political will, and unfortunately, power politics.

Addendum Check out The American Health Care System Costs Four Times More Than Canada’s Single-Payer System (and the Public Option Won’t Help)

Here’s a taste: “The average American pays a whopping $2,497 per year in administrative costs — which fund insurer overhead and salaries of administrative workers as well as executive pay packages and growing profits — compared to $551 per person per year in Canada, according to a study published in the Annals of Internal Medicine last month. The study estimated that cutting administrative costs to Canadian levels could save more than $600 billion per year.”

“Despite the massive difference in administrative costs, a 2007 study by the Centers for Disease Control and Canada’s health authority found that the overall health of residents in both countries is very similar, though the US actually trails in life expectancy, infant mortality, and fitness.”