Kamala Gone, But “Medicare-for-All” Not Forgotten.

Posted on | December 5, 2019 | 3 Comments

MIKE MAGEE MD

As the number of Democratic contenders for the Presidency begins to dwindle, the “Medicare-for-all” debate continues to simmer. It was only ten months ago that former candidate Kamala Harris’s vocal support drew fire from not one, but two billionaire political rivals. Michael Bloomberg, looking for support in New Hampshire declared, “I think we could never afford that. We are talking about trillions of dollars… [that] would bankrupt us for a long time.” Fellow billionaire candidate Howard Schultz added, “That’s not correct. That’s not American.”

Remarkably, neither man made the connection between large-scale health reform’s potential savings (pegged to save 15% of our $4 trillion annual spend according to health economists) and the thoughtful application of these newly captured resources to all U.S. citizens without discrimination. Bloomberg’s own 2017 Health System Efficiency Ratings listed the U.S. 50th out of 55, trailed only by Jordan, Columbia, Azerbaijan, Brazil, Russia. Yet he seemed unable to connect addressing waste with future affordability.

Schultz was similarly short sighted. While acknowledging that the manmade opioid epidemic, mental health crises, and income inequality are “systemic problems” and at levels “the likes of which we have not had in a long time”, he failed to connect the cause (a remarkable dysfunctional and inequitable health care system) with these effects.

As I outline in “Code Blue: Inside the Medical Industrial Complex” (Grove Atlantic/2019), today’s greatest risk to continued progress and movement toward universal coverage and rational health planning is sloppy nomenclature. To avoid talking past each other, we need to define the terms of this debate while agreeing on common end points.

“Universal health care” is an end point goal that reinforces the principle that health is a human right rather than a privilege for the most entitled. It is an expression of national solidarity and reflects a shift in our culture.

“Single payer” is one strategy or tactic often associated with the Canadian health care system. However, the Canadian system is not technically a “single payer” system, in that provision of insurance (set to national standards) and the delivery of the care are the responsibilities of individual provinces, not the national government. A more accurate label for their system would be “Single Oversight/Multi Plan”.

Canada has choice and also maintains an active private health insurance market that provides supplemental health care plans purchased by 70% of citizens to cover roughly 30% of health costs including optical, dental and drugs which are not covered by government plans. Private insurers in the U.S. in the future might play a similar role.

The Canadian government’s role is focused on formalized government health planning as well as insurance standards and oversight. It also outlaws DTC drug advertising and sets prices annually for all essential drugs. The national government is the guardian of universality and (often overlooked) simplicity. Providers provide. Provincial government pays. Patients concentrate on health and wellness, and are not plagued by insurance gamesmanship and endless bill bickering on the local level.

The U.S. has no such government-directed, national health planning apparatus. Service levels and reimbursement vary widely across an endless array of private and public offerings that have devolved into a “free-for-all.” Our profit-driven, scientific research community regularly diverts resources from health planning and patient care, and our insurance system harbors an enormous number of health system middlemen to support “non-real” work (16 positions for every one physician – half with no clinical role).

What we do have are $4 trillion already committed (albeit badly misallocated), a remarkable array of educational institutions, a dedicated network of public health schools and practitioners, under-utilized nurses and pharmacists, and a testing ground of 50 different states.

The true impact of spiraling health care costs and their secondary effects—including stagnant wages, income inequality, a lack of job mobility, high rates of medical bankruptcy, the closure of rural hospitals, an inability to invest in infrastructure repairs, and our growing national debt – is staggering. We are the only developed nation in the world that spends more on health care than all other social services combined.

Warren Buffett, a man who knows something about sustainable growth, said recently: “The health care problem is the number-one problem of America and of American business. . . . Medical costs are the tapeworm of American economic competitiveness.”

For far too long, our leaders have focused on how to make American corporations wealthy. But let us be clear – there is another way. We could have the courage and the will to reapply our more than ample health care assets and reject the status quo. We could vote in change on a large scale. We could elect leaders willing to honestly address a simple, long overdue question that is at the very center of Code Blue: “How do we make Americans healthy?”

Comments

3 Responses to “Kamala Gone, But “Medicare-for-All” Not Forgotten.”

janice mancuso
December 5th, 2019 @ 2:54 pm

“ ‘Universal health care’ is an end point goal that reinforces the principle that health is a human right rather than a privilege for the most entitled. It is an expression of national solidarity and reflects a shift in our culture.”

I think I’m getting too weary to believe change of this magnitude is possible in the US right now. (And if we don’t right the ship in the very near future, it may be too late.) “National solidarity” and shifting the culture seem like non-starters these days. We, as a nation, can’t even agree on facts…about anything. Climate change, responsible gun ownership, health care, whether or not DJT committed an impeachable offense, etc

But as long as there are still optimistic people like you leading the charge, I will endure and continue to do my part. Sometimes it’s okay to slump though…

PS We need an inspirational, intelligent, high-minded, unifying candidate to secure the Dem nomination, preferably someone who is not 70+ years old.
Mike Magee
December 5th, 2019 @ 4:38 pm

Thanks, Janice. There is change in the air. As I mentioned,at a Code Blue presentation locally last week, questions centered on this very issue – all the way, or incremental. Increasingly, I split the difference. A complete flip I believe is difficult to pull off because what we are asking Americans to do is to change their historic culture (one built on self-interest, hyper-competitiveness, the absence of traditions of solidarity and belief in good government, and a celebrity obsession). Health care as fundamental to building a nation and its culture from scrap was what drove the military’s decision in the re-build of Germany and Japan to start with a health plan – in part because they recognized that all other social determinants would be enhanced in the process leading to a tradition that could support a stable Democracy. This is essentially the same challenge we as a country (having wandered so far off course as to elect Trump) are faced with today. Changing culture is a tall order and requires voluntary movement and evolution of support. So in this context, I believe central oversight combined with a voluntary public option for all comers is the way to go. If we choose to go this route however, I think its essential that it be open to all, that insurance be a requirement and mandated as such, that Medicaid expansion (or combination with the new public offering) be required in all states without exception, and that a complete benefit package as delineated in the ACA be required (no skimpy substitutes). In other words, the public offering must be muscular, nationwide, and accessible to all comers. Best, Mike
Kamala Gone, But “Medicare-for-All” Not Forgotten. – Health Article – Health & Wellness Blog
December 10th, 2019 @ 7:24 am

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