Should the U.S. adopt Medicare for All? | The Tylt
Should the U.S. adopt Medicare for All?
A single-payer system would replace insurance companies with a government-run system. In the plan Vermont Senator Bernie Sanders is proposing, Medicare would be expanded to include all Americans, reducing administrative costs and allowing the government to negotiate prices with both hospitals and drug companies to reduce costs. As Sarah Kliff explains in Vox:
Single-payer systems also have an advantage when it comes to bargaining down prices. Because doctors and pharmaceutical companies basically have no choice but to accept the terms laid out by the government, single-payer systems often feature much, much lower prices than systems. The United States, for instance, pays much more for most health-care services than single-payer systems do. It’s worth noting that many multi-payer systems, like Germany, achieve similar savings to single-payer systems by having the government set health care prices.
Currently, insurers are working under a perverse set of incentives which cause companies to actively avoid and push out the sickest patients. Insurers are primarily focused on reducing costs, but only to increase profit margins, not for patients or the greater good. Costs are skyrocketing out of control, but no one has the incentive to slow it down. Robert Reich writes:
Insurers say they’re consolidating in order to reap economies of scale. But there’s little evidence that large size generates cost savings. In reality, they’re becoming huge to get more bargaining leverage over everyone they do business with – hospitals, doctors, employers, the government, and consumers. That way they make even bigger profits.
Sanders argues a single-payer system would be $6 trillion cheaper than our current system.
The United States currently spends $3 trillion on health care each year—nearly $10,000 per person. Reforming our health care system, simplifying our payment structure and incentivizing new ways to make sure patients are actually getting better health care will generate massive savings. This plan has been estimated to save the American people and businesses over $6 trillion over the next decade.
At the end of the day, Reich says Americans have two choices:
The real choice in the future is either a hugely expensive for-profit oligopoly with the market power to charge high prices even to healthy people and stop insuring sick people.Or else a government-run single payer system – such as is in place in almost every other advanced economy – dedicated to lower premiums and better care for everyone.
But critics argue a single-payer system would reduce American freedom by putting the government between an individual and his or her medical provider. This is evident in Canada where wait times for same-day or next day consultations trail below the international average. Critics say single-payer systems lead to rationing of care. Canada has been able to maintain its system by sending overflow patients to the U.S. for treatment. But there would be no equivalent option if the U.S. were to adopt a single-payer system.
The reason the Canadian health-care system works as well as it does (and that is not by any means optimal) is because 90 percent of the population is within driving distance of the United States where the privately insured can be Seattled, Minneapolised, Mayoed, Detroited, Chicagoed, Clevelanded, and Buffaloed, thus relieving the pressure by the rich and influential to change a system that works well enough for the other people but not for them, especially when they are worried or in pain.
Single-payer systems would give the government control over who gets what treatment. As it exists right now, that decision is between a person, their doctor and their insurance company (or if they have enough money, however much they can shell out for treatment). Critics say the government should not be the one who decides whether a person deserves treatment or not.
In single-payer systems, the government sets parameters for what services it will and won’t cover. Countries often do this by looking at which treatments are "cost-effective"–health-care-speak for which medical interventions deliver good results at a lower price. Some treatments get left out, which can spark fierce debates. In Britain, for example, an agency called the National Institute for Health Care Excellence is in charge of evaluating what treatments it will pay for — and in which situations. Britain will limit certain treatments to certain types of patients, based on where research shows them to be most effective, which can often touch off fierce debates.
Then comes the bill itself. Critics say single-payer systems are exorbitantly expensive and Americans would not want to hand over the money needed to make a single-payer system work.
The system’s costs are hidden. Many Canadians — and many progressives abroad — like to think that health care is “free” in Canada, when in fact, Canadian taxpayers pay, on average, $10,500 per year for all their health-care needs. Canadians simply have no concept of how much the services they consume cost, since the CHA prohibits providers from ever showing patients a bill.
Single-payer systems would have a lower quality of care, raise taxes and limit the options a patient would have. It would unnecessarily add government bureaucrats into the decision making process. Opponents of single-payer say the United States is better off with its market-based system.