Medicare for All Favors Policy Over Capitalism to Heal America
Farmer Rob wakes up to a severe sore throat. He walks into town to visit his physician with Gus his goat in tow. At her office, Molly provides some simple medicine and assures Rob that he’ll feel better by harvest. He clasps her hand in thanks and hands over Gus as a form of payment.
Tremendous good and bad emerge upon innovating past this simple scenario. US life expectancy has climbed from 55 to 79 years since 1920 owing to the development of high-tech hospital and drug production facilities. These institutions are heroic forces for good until their efforts for revenue outweigh those for patient. The transition likely begins innocuously to pay employees and construct buildings but insidiously escalates as executives realize the potential profits involved.
Our reimbursement system rewards excessive tests and procedures and our consumerism rewards television advertisements for brand-name medicines. Now the patient’s exorbitant medical bill reflects not just his care but also invisible institutional charges, such as executive salaries and posh renovations. Because you nor I keep enough cash on hand to cover such expenses, health insurance has become a necessity.
In theory, a patient pays an insurance company a small amount each month for the insurer to cover his medical bills. The reality falls short. Just like hospitals and drug companies, insurers must pay employees. To do so, they charge monthly premiums and require patients to pay a portion of each bill. But profit reigns again as premiums and co-pays inch higher and insurers often hand-pick their clients to guarantee a healthy clientele. Employer-sponsored insurance may ease some cost but leads to inconsistent coverage as employees shift from job to job throughout a career. This patchwork, caveat-laden system prevents 78 million Americans from owning adequate insurance.
Physicians are not immune to the consequences of innovation either. As the cost of medical care rises, so does that of obtaining a medical degree. As a result, most physicians suffer underneath more than $240,000 of medical tuition debt. My classmates and I set out to heal the world but have been saddled with such financial burden so early in our careers that now money influences our decisions. The same forces that lead to excessive tests and procedures make procedure-oriented specialties more financially lucrative and thus present easier paths to repay debt. It’s no wonder there is a disappearing pool of primary care physicians and their lifelong relationships with patients that teem with compassion and trust. Relationships that we could rely on in times of mass medical panic.
So while innovation presents enormous opportunity, the finances that tag along may cause more harm than benefit. Today America has the most expensive and least effective healthcare amongst the twelve wealthiest industrialized countries. What happened? Innovation outpaced policy and capitalism took hold. By 1945 when Harry Truman had majority support for his national healthcare plan, corporate lobbyists killed it. Today the same lobbies control politics: the drug ($280 million) and insurance ($156 million) industries top the list each year.
Is it possible for policy to compete with capitalism in America? Our history of emphasizing education suggests so. We formed our first public school in 1635 in Boston, just 28 years after colonists settled in Jamestown. Private education exists and private healthcare may have its place as well, but government-funded education is necessary as we’ve deemed it an unalienable right. Because good health must precede receipt of education, shouldn’t we also ensure our population’s health?
Lyndon Johnson thought so and won a compromise for Truman in 1965 by passing Medicare. Since, we’ve run a 55-year trial for how national healthcare could work for the sickest sector of America. We found that its patient satisfaction levels and cost-efficiency surpass private insurance. If national healthcare can work for the age group that spends the most healthcare dollars, adding in you and me won’t break the bank. Today, we have LBJ’s blueprint, we have COVID-19’s reminder of the importance of good health, and we have a growing majority of Americans who support expanding Medicare. We as physicians know best for our patients. We as citizens know best for America. So lean into your relationships — patient to physician, voter to representative, friend to friend — and together let’s make this happen.
Medicare for All’s first act will be to ease the high prices set by hospitals and drug companies. Financial incentive should still encourage innovation, but the government can use its negotiating power to reduce hospitals’ unnecessary tests and procedures and to curb drug companies’ television advertisements. The government can further reduce spending by incentivizing prevention: the fewer diseases that Americans develop, the cheaper the healthcare. These efforts will reduce healthcare spending by $450 billion and a progressive income tax will shift funding from patient to taxpayer. The poor will pay nothing and save the money that would have been spent on healthcare, the middle class will break even, and the rich will pay more. I for one will write my April 15 check with a warmer heart knowing that it will ensure that my neighbors receive the medicine they need.
Second, Medicare for All will trim the costs and caveats of private insurance and automatically enroll every American. Private insurance will largely be reduced, and we must ease the transition by providing subsidies to those whose jobs are lost. Some may choose to buy additional private insurance to cover concierge service or cosmetic plastic surgery, but Medicare for All will assume all basic coverage. By covering all costs for all conditions of all patients, it will save more than 68,000 lives each year and improve many more. Lives affected by broken arms and pandemics, but also by disability-level vision or crippling depression; these ailments can be just as debilitating as the first two.
And finally, Medicare for All will allow physicians a better opportunity at the compassion-steeped lifestyle that their younger selves imagined. A single insurer will reduce the 17 hours a physician spends each week on paperwork needed to navigate billing and claims, fewer unnecessary tests and procedures frees up further time and energy, and greater debt-forgiveness for primary care physicians will unshackle students from choice-limiting debt. Less paperwork, more time, less stress, and more choice will lead to happier physicians and better care.
Amidst my own medical training, I often dream of escaping America’s beleaguered system to the south of France. I dream of healing villagers and being thanked with sprigs of lavender and smooth red wine. Perhaps though the simplicity of this exchange is no dream at all. Perhaps instead we stand in the doorway to a new era of American healthcare. Where every individual has a friendly physician at her back. Where good health unlocks our potential and allows discovery and innovation to abound. Where we have greater resiliency to the next pandemic. And where together we can devote ourselves more truly to the ultimate pursuit of happiness.