The notion that healthcare is a human right rather than a privilege has captured the centerpiece of robust national conversations since the Presidential campaign of 2016 and the movement it spawned earned a momentous Congressional Committee hearing on April 30.
Medicare, a popular program covering seniors and the disabled since 1965 to be extended to the entire population, titled ‘Improved Medicare for All (MFA/M4A)’ now tops the list of proposed solutions for our current broken and fragmented system that fails a fifth of the population, evidenced by 29 million Americans uninsured and 44 million underinsured.
Meanwhile MFA has acquired multiple interpretations creating a number of mutants, as shown in the table below compiled by journalists Austin Frakt and Aaron Carroll in the NY Times of February 21, 2019:
1) Medicare for America Act by Reps Rosa DeLauro and Jan Schakowsky (D-CT, IL)
2) Medicare X by Rep. Brain Higgins, Senators Tim Kaine and Michael Bennet (D-NY, VA, CO)
3) Choice Act by Rep. Schakowsky and Sen. Sheldon Whitehouse (D-IL and RI)
4) Choose Medicare Act by Senators Jeff Merkley and Chris Murphy (D-OR and CT)
5) Healthy America Program by Urban Institute Fellows
6) Medicare Extra by Center for American Progress
7) Medicare at 50 by Stabenow (D -MI)
8) Medicare Buy in Bill by Reps Schatz and Lujan (D- HI and NM)
9) Medicare for All Act of 2019 by Rep. Pramila Jayapal (D -WA 7): HR 1384
10) Medicare for All by Sen. Bernie Sanders (Ind -VT): SB 1129
Only two, #9 by Congresswoman Jayapal and #10 by Senator Sanders meet the chosen criteria of universality, ending of premiums, of employment-based coverage, and of cost-sharing. If other core measures required of an inclusive (everybody in, nobody out), comprehensive and sustainable healthcare financing system, like affordability by 90 percent of us, system-wide cost-containment and meaningful choice were applied as filters, it becomes abundantly clear that ONLY a publicly-funded, privately-delivered national program, known as single payer plan, best formulated in HR 1384 fits the bill. Eight other look-alikes on the list are variants with one common theme: a misplaced faith in the power of ‘free market’, a failed mantra in healthcare enterprise since 1980.
A federally financed plan providing for comprehensive care and covering prescription drugs, and more when medically necessary, with no payment due at the point of care, funded like Medicare but with a higher payroll deduction and a modest surcharge on high incomes, replacing premiums, deductibles and copays is the only pragmatic option with a proven track record of delivering the goods, not only for 55 million Medicare beneficiaries but in Canada and in most other advanced economy nations.
US is the outlier, spending twice as much on healthcare and ranking 35th in the WHO tabulation, based on population health metrics. Affordability of the proposed plan, at the kitchen-table level is a NO brainer with the House Bill estimating that an average family of four with a median annual income of $55,000 will be spending well under $5,000 a year versus $18,000 currently as premiums, deductibles and other out of pocket expenses. Societally the plan will yield an annual savings of $500 billon from the present yearly tab of $3.5 trillion. With a net 10% reduction from what we now expend and by renaming premiums – plus as taxes, all Americans can be covered for all medically necessary conditions and services!
Clout accruing to the single buyer under the national plan permit bargained pricing for drugs, global budgeting for hospitals and other institutional providers and negotiated fee schedules for doctors and other practitioners. This critical feature constitutes the heartbeat of any unitary funding mechanism, allowing for effective cost management. Elimination of superfluous and wasteful middlemen-rentiers between patients and providers is a prerequisite for exercising efficient stewardship of the finite resource that healthcare dollars represent. Egregious diversion of this for profit-greed is obvious when contrasting Medicare’s 2% overhead with 20% among private plans, including for obscene executive compensation packages, dividends, marketing and more, recklessly driving up costs. This dire situation prompted Warren Buffet to remark that healthcare system is the tapeworm of American business.
Choice that matters, of doctors and hospitals are kept REAL, just like in the traditional Medicare and is fortified in the new plan. No survey, poll or study has shown that Americans love their health insurance company. Availability of 1,500 plans with 4,800 products on offer provide no more than Hobson’s choice, a convenient fiction! Like for defense, police-fire services, infrastructure, public schools, libraries and others, the cost burden of healthcare furnished as social insurance is spread equitably over the whole population, aggregated into a single risk pool.
Consequent rebirth of a noncommercial milieu will liberate the healthcare professionals from bondage to Mammon and facilitate rededication to the noble mission of providing optimal care with competence and compassion and thereby derive fulfilment from the chosen calling. Such a work environment is destined to remove the bane of ‘burnout’ and rising incidence of mental illness including suicide risk among doctors and others of the healing community.
Myths and misinformation abound in the public square regarding the MFA plan, predictably generated by the coordinated efforts of the interest groups comprising giant insurance companies, Big Pharma, hospital conglomerates, organized medicine and others. Remembering Frederick Douglas’s words, ‘power concedes nothing without demand’ is apropos while confronting the formidable challenge. Fear mongering should be countered by recalling FDR: ‘the only thing to fear is fear itself’.
Finally Shelley’s lines in ‘Mask of Anarchy’: ‘Rise like lions after slumber….You are many and they are few’ remain a potent source of inspiration and courage needed for sustaining the arduous and prolonged struggle under way for securing healthcare justice in our country.
Ahmed Kutty MD lives in Peterborough