by Ronnie Nathan
Currently, 32 of the 33 advanced nations in the world provide universal access to standard of care healthcare to their citizens. The United States is the lone exception. Of those nations, the United States spends approximately twice as much per capita, with significantly worse outcomes. Approximately 20 – 25 million of our fellow citizens have no medical coverage at all. It’s absolutely true that if you are fortunate enough to have a Cadillac plan, the American medical establishment offers the finest, most advanced medical care in the world. If you are not fortunate, however, your treatment options would be better in Canada and all of Western Europe.
I suppose the first issue is whether universal access to standard healthcare is a worthy goal, whether it justifies taxing everyone to achieve that goal. In my point of view, every government program, from defense spending to Social Security, is a transfer of wealth in the form of taxes. Call it national defense or insurance; if the government takes money from you, it is a tax, and if it spends it on something, someone else benefits. So, why should we tax folks so everyone can enjoy decent healthcare? Because, for me at least, it is a “sanctity of life” issue, no less sacred than the abortion issue. Just as I oppose all abortions, without any exceptions after week 20 (unless the mom’s life is imminently threatened), I think it is immoral and unacceptable that any of our citizens’ lives are at risk because they can’t afford readily available, standard of care treatment.
The next issue is how do we get there? It seems to me that there are three key elements on the roadmap to universal coverage. The first and most difficult is lowering costs, which I address later in this article. The second is separating medical insurance from employment. The third is to make the transition incremental. The Affordable Care Act (Obamacare), with all its shortcomings, began the process of incrementally moving toward universal coverage. Universal Medicare, which I believe is ultimately the most sensible goal, separates coverage from employment.
Let me be clear. I am agnostic about how we achieve the ultimate goal of universal coverage. If anyone has a better idea, I’m all ears. It just seems to me that since the infrastructure and bureaucracy are already in place and the transition can be incremental, without too many jarring adjustments for individuals, Universal Medicare makes the most sense for America. We can begin by offering folks under 65 the option of buying into Medicare. Then, we can slowly expand the pool of who is eligible for Medicare. I would immediately give every veteran a Medicare card, then gradually lower the age for eligibility until it is universal.
Universal Medicare, as I envision it, isn’t a blanket that covers 100 percent of all medical treatment for all Americans. It essentially functions as Medicare currently does for seniors, with limitations, co-pays and things that simply aren’t covered. As I said, the bureaucracy and infrastructure are already in place. The increase in FICA necessary to pay for it will be offset by the savings in private insurance premiums currently paid for by employers and individuals who are not covered by their employers. Medicaid will disappear. The issues in veterans’ healthcare and the VA will be addressed, as vets will be covered by Medicare, and the VA can focus on the specific needs unique to vets. Those who can afford it will purchase supplemental insurance in the private market, as current Medicare recipients do. The private market can compete with Medicare, as Medicare Advantage plans currently do, but without the subsidies.
Yes, based on fiscal sustainability, medical care will be rationed just as it is now by the private insurance actuaries and Medicare. While single payer and universality are socialist aspects, the system will still be based on private providers who will compete in the healthcare marketplace and sliding scale co-pays, which I strongly advocate, can create incentives for everyone to control costs.
Tort reform is also a key component in implementing Universal Medicare, IMHO, to reduce costs by eliminating the epidemic of unnecessary tests administered simply as protection from lawsuits. If you want that extra test, pay for it yourself! Changing the medical payment paradigm from fee for service to medical outcomes is another huge area for lowering costs. Another huge area for savings, in addition to fraud and abuse, is in end-of-life treatments that are very costly without significant medical benefits. That reform alone would make current Medicare fiscally sustainable long into the foreseeable future. If an individual wants life preserved at all costs or wants a knee replacement at 85, they can either pay for it themselves or pay for supplemental insurance to cover it. Currently, Medicare covers only the oldest and sickest Americans. By expanding the risk pool to every American, the entire system becomes more fiscally sustainable.
I understand and sympathize with those that decry the expansion of government, but that train has already left the station, never to return. By all measures, the government is inextricably bound to the delivery of healthcare in America. Advocating for a system that restores the unregulated free market to the healthcare market is like advocating for the government getting out of the road building and maintenance business in favor of private toll roads. It may be an interesting subject for a parlor game, but it’s never going to happen, and for very good reasons.
Is it perfect? No! But the benefits of every American having access to standard of care healthcare far exceed the costs. Its time has come!