A friend ‘s story is a perfect segue for discussing the crisis in healthcare unaffordability encountered by millions in our society.
Joanne (pseudonym) was put on COBRA, the transitional insurance plan when she lost her job, costing $5,000/year and a $3,000 deductible. When COBRA coverage expired in six months she was put in a high risk pool with a $10,000 deductible and had to forego three recommended scans and follow up care for cancer. Her out of pocket medical expenses, with insurance was $15,000 a year, nearly a third of her paycheck!
Similar stories abound in our country. It does not have to be like this. Saner ways of equitably financing healthcare have existed in other industrialized nations for nearly a century. Sen. Elizabeth Warren on Oct. 31 published a detailed proposal for funding an ‘Improved Medicare for All’ national health plan, fleshing out the Sanders Bill introduced this April that she has endorsed. Her approach differs in some respects from Sanders in that Sen. Warren if elected president, on day one will give ‘marching orders’ to negotiate and, if necessary regulate prescription drug prices with Big Pharma.
Repeal of Bush era ban on Medicare bargaining for drug costs will be top priority out the gate. In the first year of her presidency Medicare eligibility age will be lowered to fifty, with no buy in required other than paying for part B, just as current beneficiaries do. Children up to age 18 will be enrolled in the new ‘Improved Medicare’ plan, eliminating the need for Children Health Insurance Program (CHIP). The resulting expanded pool of Medicare beneficiaries, by the end of the third year will erect a formidable bulwark for defense against the inevitable, coordinated and vicious attacks from the powerful corporate healthcare interest groups.
This large, energized and entrenched constituency will be ready to join battle for birthing a national program supplying healthcare as social insurance, with no financial barriers while accessing needed care: first dollar coverage! The repeal gang will be on the wrong side of history. By the end of her first term, a comprehensive and simplified national public funding plan, located mostly in the nonprofit sector of the economy and keeping care delivery private as now, will have become law of the land, all things going copacetic politically. Choice of doctors and hospitals will only be fortified, as networks and panels will all become obsolete.
No American was out shopping this Black Friday, choosing from some 1,600 insurance products ‘on offer’! Warren takes on the elephant in the room: paying for the ambitious, urgently needed and long overdue measure for doing justice toward the sick among us, when they and their family are at peak vulnerability.
A small increase in payroll withholding shared between employer and employee, redirecting state and local government funds now expended on workforce health and Medicaid into the Medicare Trust Fund, a modest healthcare surcharge on high income households, a two cents per dollar wealth tax on those with assets over $50 million, a 0.1 percent levy on Wall Street transactions are a few of the progressive taxation proposals for sourcing the needed revenue. Middle and low-income groups will not see a penny’s worth of tax hikes! Price bargaining with drug companies, global budgeting for hospitals, negotiated reimbursement rates for practitioners and eliminating system – wide waste and fraud on transitioning in to a service rather than marketable commodity model, are foundational for building a sustainable, equitable, efficient, scientific evidence-based, inclusive and compassionate healthcare ecosystem that this great, prosperous, fairness-imbued and Providence-blessed nation that we all proudly call home, deserve!
Presidential campaign’s plan is not a congressional bill, even as Warren’s broadly aligns with Washington Rep Jayapal’s House Bill 1384, with its predecessor HR 676 by former Michigan Rep Conyers and with Sanders’ Senate Bill 1804. What will emerge at the end of the prolonged and compromise-ridden legislative ‘sausage making ‘ process can only be approximated, not predicted, as expected in democratic governance.
A careful analysis of the Warren plan, read in conjunction with the funding mechanisms outlined in the Congressional Bills leads to the unmistakable conclusion that an average family will pay a total of $5,000 a year for healthcare, instead of $20,000 currently. The country will save $500 billion annually. The program will reduce poverty by 20 percent nationwide. The savings going into the pockets of ordinary people, estimated at eleven trillion dollars over ten years is a tax cut for working Americans. Everyone pays and everyone in need benefits: as American as apple pie! Crisis carries opportunity.
With Warren leading and us, the stakeholders helping to generate the necessary political will, corporate stranglehold on our healthcare system can be broken. We must liberate it for ‘patients over profits’. The naysayers should listen to Nelson Mandela: “It always seems impossible until it is done.”
Ahmed Kutty, MD, lives in Peterborough. He is an activist with Physicians for a National Health Plan.