Both Warren & Sanders propose a form of single-payer, government run healthcare. Both have been critiqued for being extreme and out of step with the American people, that the plan is unaffordable. Let’s examine the facts.
Unwatchable Debate: I made the comment after the Nevada debate that it was borderline unwatchable. Update: It has become entirely unwatchable, as candidates flail their arms throughout, interrupting and running roughshod over time limits. I gave up and turned it off. If the moderators can’t control things, one of the candidates should make a public statement: “I watched a tape of last night’s debate. It was Trump’s dream, a bunch of Dems behaving like school children interrupting and blurting responses and I was as guilty as anyone. I will no longer raise my hand, I will respect the time limits, I will not interrupt. For the sake of the country, I hope you will do the same.” First candidate to make that statement gets a boost in the polls.
What did you think? Who won? Why?
Connecting the Dots
The Reason Medicare-for-All is Deemed Impossible Is the Same Reason Why Gun Violence Prevention, Affordable College, Universal Pre-K, & Addressing the Climate Crisis Are Out of Reach: We Are Being Had
Before we dive into an examination of Medicare for All, a few words about why we even need to have this discussion. Most of the developed world has some form of universal healthcare and in ALL instances the care is less expensive, more easily accessible, and results in better health outcomes. Yet, in America, the concept is deemed off the table by centrist Democrat and Republican politicos as being too extreme.
Most of the developed world has universal healthcare, stronger gun violence control measures, more progressive tax policies, more affordable college, universal pre-K, and many other progressive policies. Why not here in the US?
In March 2019, Retake published a post, Wonder Why So Many of Our Bills Are Not Getting Through? that outlined very clearly the level of broad support for all of these policies and the insidious ways in which lobbyists, big business, and research foundations funded by the 1% collectively conspire to ensure that these policies are viewed as unrealistic, too expensive, and undermine American values.
To understand how and why Medicare for All is so misrepresented and misunderstood, it helps to understand the extent to which the policy debate in so many areas is circumscribed by the priorities of the wealthy, Wall St. big business, and mainstream media. I recommend that before you read this post or just after, you review the post from March as it will provide a broader context and a deeper explanation for just how systematically our priorities are shaped and/or ignored. Click here to review the post from March.
At the end of this post, we close with a video from John F Kennedy as he speaks to the American people in 1962 about the critical need for universal healthcare and the important role government should play to ensure justice in America. It is stirring and still timely speech and you will find echoes of Warren and Sanders throughout.
The State of US Healthcare
Before we dive into Medicare for All, a quick look at the state of our current healthcare system. In brief, as Walter Cronkite famously opined, “America’s health care system is neither healthy, caring, nor a system. ” It is a mess and not many are happy about it. From the Washington Post:
Relative to people in other wealthy nations, Americans are less likely to be in good health and more likely to die of preventable causes. Our babies and mothers are more likely to die after child birth, and our lives are shorter overall.Washington Post: “Here’s the Medicare for All Study Bernie Keeps Bringing Up”
The assertions above are validated with links to studies, but the charts that follow, excerpted from a Kaiser Family Foundation study, offer ample evidence of the state of our healthcare system. The US is last in the developed world in virtually every health outcome measured in the study. Here are a few samplings.
The US Leads the Developed World in Years of Life Lost
The US Leads the Developed World in Disease Burden, Fully 31% higher in the U.S. than the comparable country average.
US Leads the Developed World in Errors in Medical, Medication & Lab Errors
US Leads the Developed World in Rates of Preventable Conditions
And, With All Those Health System Deficits, US Leads the Developed World in the Cost of Healthcare.
With so much evidence of the need for vast improvement in our health system, why are policymakers so reluctant to examine seriously whether other options might achieve better outcomes? And remember, for each one of those charts, for each percentage point indicating a failing of our healthcare system, thousands and thousands suffer or die unnecessarily. And for this, we also pay more. As the review below makes clear, we pay much more.
Medicare For All: Myths & Realities
Single-payer has been marginalized and attacked by centrist Democrats and mainstream media for being too expensive, for not having the political support necessary to be enacted into law, and for taking away private plans for 150 million Americans. Today we examine these concerns one by one.
Medicare For All has been practiced throughout the developed world, in some cases for almost a century (England). These countries achieve far higher healthcare outcomes at far less cost (above). But numbers have a way of obscuring the human impact. With Medicare for All, we can improve and extend our lives, reduce the stress so many face caused by high co-pays, high premiums and denied coverage, and, as described by a recent Yale University study, Medicare For All can also significantly reduce what Americans, employers and the government pay for their healthcare.
Affordability & Quality
Last October, Yale University’s Center for Infectious Disease Modeling and Analysis published an independent study of single-payer healthcare, a plan that is essentially what is proposed by Bernie Sanders and Elizabeth Warren, although Warren has retreated a bit from her initial plan. As the excerpt below makes clear, not only is the government-run, single-payer Medicare for All model realistic, it would save the government $450 billion a year, save employers $100 billion a year, save families $2,400 per year and save 68,000 American lives each year. No co-pays, no premiums, no treatment denials. From a Washington Post report on the study:
The study concludes, a single-payer system akin to Sanders’s plan would slash the nation’s health-care expenditures by 13 percent, or more than $450 billion, each year. Not only that, “ensuring health-care access for all Americans would save more than 68,000 lives.”
In their breakdown of the numbers, researchers applied the existing Medicare fee structure across the entire health-care system and found it would save about $100 billion annually. Keep in mind that this basically represents less money going to doctors and hospitals, a major sticking point for medical groups that oppose Medicare-for-all. But those declines would be more than offset by several hundred billions in savings from reduced administrative and billing costs, Galvani and her colleagues estimate.
The lack of patient billing under a Medicare-for-all system would also eliminate the roughly $35 billion a year that hospitals now pay to chase down unpaid bills.
The authors estimate an additional $219 billion in savings from reduced “administrative overhead” that the current decentralized system creates, including “the elimination of redundant corporate functions and the truncation of the top-heavy salary architecture of health insurance corporations.” For instance, the plan would replace dozens of health insurance executives, many of whom make well over $20 million a year, with one administrator paid the same salary as the current Secretary of Health and Human Services.
Finally, letting the national Medicare system negotiate pharmaceutical prices would save about $180 billion…Add it all up and here’s what you get: a new system that would cost about $3 trillion a year, instead of the $3.5 trillion that is being spent now. “
Given the vastly superior health outcomes achieved in developed countries employing a form of universal healthcare and at significantly higher costs, one would expect that there would be significant public support for Medicare For All. And, a recent CBS survey found this to be the case.
No Political Support? What About Public Support?
The second objection raised by centrists and the media is that Medicare For All does not enjoy the political support needed to become law. They have that half right. There is a lack of political will in Congress, but if you look at the American public, you find a completely different story.
CBS has conducted the most recent polling on the approval levels for different kinds of healthcare plans. The results are instructive on many levels. First, the level of support for single-payer, government run healthcare is overwhelming. By over a 2-1 margin Americans favor government run, health insurance for all. That is not a small margin.
What’s more, while the margin among Democrats is over 10-1, among Independents the margin is well over 2-1. Even 34% of Republicans favor healthcare for all. With this kind of bipartisan support, one would think that politicians from both sides of the aisle would be lining up to sponsor legislation to make it the law of the land.
So, If Medicare For All Is So Popular & Cost Effective Why Is It Unfeasible?
On Christmas Eve, we published a post that laid out exactly why we don’t get universal healthcare. The post described the extraordinary level of insurance, hospital and pharmaceutical lobbying conducted to misinform legislators, the alt-fact “education” campaign fueled by industry and “research” foundations created by 1% billionaires.
Click here to read the full post.
There is a reason we don’t have a healthcare system that makes sense and it can be summarized in one word: greed.
For two reasons, we close with a video from JFK. First, he paints a very human picture of the choices faced by Americans who are uninsured or under-insured. He sensitively depicts what life is like for vulnerable individuals struggling to make ends meet, Americans who have worked their entire lives only to reach the autumn of their lives and be one medical emergency away from poverty.
Viewer alert: JFK was speaking in the 60s and so there is an unsubtle sexist thread running throughout and a bit of manifest destiny to boot. But this was 1962 and when JFK is focused on the need for universal healthcare and the proper, moral role of government in our lives, he sounds like Sanders or Warren….only almost 60 years ago. It is time to get this right.
Paul & Roxanne
What debate? It was a highly engineered, tightly controlled descent into chaos produced by CBS Gnus.
Social media may control the drama, but corporate media always control the perceptions needed to create the drama. This debacle was an example of social engineering at its finest. CBS, almost single-handedly, created the rumpfk tapeworm caricature as a ‘thing’ that could be believed to be real.
The new goal of the totally compromised and co-opted media is to now ‘protect’ capitalist social engineering by creating a dog fight in the middle of the street by tossing 10 pieces of red meat at 20 hungry mutts and then yelling at them for the ensuing free-for-all.
Meanwhile, with no small amount of preening, CBS paraded the opulence of the upper 5 percent with shots of the ‘Ford Theater” hall and the elegance and dignity of the dressed-to-the-nines commentators, whose combined price tag could have easily fed 10k poor families for a full year.
The three women moderators were pathetic, casting themselves as serious and stern mother hens who would scold their children if they erred in failing to conform to the behavior necessary to win the prize for most well-behaved.
The not-so-subtle assault on the two Jewish males was more than evident, only slightly less demoralizing than the vigor of all but Steyer to bark and yap at the bigger dogs, all too eager to nip at their heels.
The complexity of the questions made them impossible to answer with the sound-bite time limits, and assured the highly manipulated outcome. Sanders held off the chihuahuas pretty well, while Bloomberg appeared truly befuddled by the mayhem. Warren, Klobachar and Pete took the bait, Biden could not find the bait, and only Steyer remained un-phased, and ‘won’ the reasoned morsel of logical discussion that remained.
But Steyer and Sanders did successfully link the failure of the disease-care industry and the ongoing demise of national citizen health to the climate catastrophe now in full ‘bloom’ as spring approaches in the northern hemisphere, with Greenland’s faltering ice and the methane-laden permafrost of Canada and Siberia awaiting.
This morning, the barracuda pundits employed by the corporate empire are ripping and tearing away, as if their six- and seven-figure incomes need boosting, what with all the propaganda yet to be delivered.
Paul, this debate-abacle exemplifies your analysis of why important things never get done.
They are not intended to get done. The ‘people’s business’ is a farce, the barker’s cry at the grifter’s carnival of temptation, lust and addiction.
Now, more than ever, we are so screwed.
It would be so easy to do a real debate. Topic A- each candidate gets three minutes. Topic B- each candidate gets three minutes. Topic C…you get the idea. Turn off everyone’s mike except the candidate whose turn it is.
They clearly don’t want an informed electorate casting votes based on a candidate’s ideas and demeanor.
To add to the spectacle last night, they had a chorus of millionaire’s booing. No one could figure out who they were supposed to be supporting, they were probably friends of Bloomberg. The tickets cost $1750 and up. That is one way to keep the rabble out.
It looks like maybe there was a reason for a functioning government, and universal healthcare or Medicare For All, global pandemics. The idiot president, withheld information, to protect his re election prospects, and his trade deal. At least in India, where they actually have the remnants of a democracy and an informed populace, there were protests.
Thank you Paul for a very thorough exploration on why (improved) Medicare for All is so attractive, (and, in my view, inevitable, barring a total descent into fascism). It is remarkable how Bernie has, in just four years, has pushed the Overton window on the healthcare issue. For this alone, he deserves the respect and gratitude of Americans. Your one word analysis of why the current “system” exists is spot on: greed.
I stuck with the “debate” last night. A few glasses of wine helped. Some observations: 1) In the back of her mind, Warren knows that she has no chance anymore and is making nice with Bernie, in her own way. 2) Biden’s dementia is accelerating at an alarming rate. If, in some alternate universe he were to become the candidate, he would not make it to November. 3) The three eternal runners-up–Mayo Pete, Klobocop, and Steyer–made their last ditch pitches. It will be interesting to see when and how they exit their delusions and either support Bernie or hang with the corporate Donorcrats until the end. 4) There is still a small chance that Bloomberg could succeed in stopping Bernie by sheer force of his billions. I replayed several times a part where, referring to his donations to Donorcrats, he said, “I bought, uh got them”. Man, it doesn’t get any more clear than that!
This cartoon says it all. https://flagpole.com/comics/this-modern-world/2020/02/19/and-they-re-off
I’ve never seen a Medicare for All discussion of opening up health care to energy medicine, ayurvedic medicine, Chinese medicine, Tibetan medicine – all of which focus on cause while allopathic focuses on symptoms. I believe overall health care costs would be reduced by inclusion of the above listed medicines. During my lifetime millions of Americans have switched to using the above listed alternatives. Pharmaceuticals are fossil fuel based.
Although I wouldn’t dispute the claim that the current US healthcare system offers what one might call ‘the worst of all possible options’, in many places in your presentation you imply that the Sanders’ ‘Medicare for All’ proposal is typical for all other developed economies and that universal healthcare is only possible through such a system.
The actual number of countries that utilize a ‘Medicare for All’ national single payer system, but with a mix of publicly and privately owned healthcare providers (doctors offices, hospitals, clinics, etc.) is actually rather uncommon. (Notable examples include Canada, Taiwan and South Korea). A number of additional countries utilize a model in which most healthcare providers are public employees and the associated institutions (hospitals, clinics, etc.) are also publicly owned (true ‘socialized medicine’). Examples here include such countries as Norway, Sweden, Spain, Kuwait and Great Britain. (It should be noted that in many of the scandinavian countries the administration is done on a regional, rather than a national level and is as such not truly a ‘single payer’ system).
In quite a few other countries that offer universal healthcare (including a number listed in your graph of healthcare cost as a percentage of GDP, e.g. Japan, Germany, Switzerland and France) utilize a mixed system of public and private insurance with multiple payers – that is, a form of ‘Medicare for those that want it’. As such, it is possible to provide universal healthcare at lower cost than is seen in the US without going to a single payer system.
See: The State and Healthcare: Comparing OECD Countries, 2010
By H. Rothgang, M. Cacace, Lorraine Frisina, Simone Grimmeisen, Achim Schmid, C. Wendt
It should also be noted that even with universal healthcare, very few countries have eliminated out of pocket costs as would be envisioned in ‘Medicare for All’. For example, average annual out of pocket cost in in the UK is $632, in Canada $690, in Sweden $875 and in Switzerland $2,326. (US average is $1,103).
Thank you for this, William. When you are covering literally 2 dozen topics, several of which are immensely complex the kind of deep dive you obviously have take is outside my pay grade. But that is no excuse for oversimplifying a complicated policy. I really have to think about how best to address this. The list of topics that could easily be oversimplified is endless and the capacity to do the kind of ‘in the weeds’ analysis you offered is simply not there. But I appreciate the correction and need to think more deeply about how to manage it. One challenge is, that even if i did do the kind of deep dive that might be more accurate, I’d lose 90% of the readers halfway through. If you have suggestions, please email me directly. Thanks