Wednesday, June 14, 2017
By Margaret Flowers, Truthout | Op-Ed
|(Photo: United Workers)|
This piece is part of Fighting for Our Lives: The Movement for Medicare for All, a Truthout original series.
As Republicans come under pressure from the White House to complete the process of repealing and replacing the Affordable Care Act (ACA) so they can move on to other priorities, they are finding that this is one campaign promise that is very difficult to keep. The House version of their American Health Care Act (AHCA) has been so heavily criticized that even President Trump says it is too harsh. Republican Senators are currently negotiating their version in secret to avoid too much scrutiny. So far, the Republicans are far from reaching consensus on how to proceed. The people of the United States, on the other hand, are clear on the solution to the health care crisis that they support and are organizing from coast to coast to make it a reality.
The public demand for a National Improved Medicare for All single-payer health care system in the United States is stronger than it has been in decades. The failures of the ACA to cover everyone and control rising health care costs, combined with the threat of the AHCA, which would add at least 23 million more people to the 29 million currently uninsured and further erode the quality of health insurance, have made it clear that we can't continue with the current health care system. This brings to mind a quote by Winston Churchill: "You can always count on Americans to do the right thing -- after they've tried everything else."
All other industrialized nations have some form of publicly funded universal health care system. Many of them are national insurance systems like our Medicare. Some, like the systems in Canada and Taiwan, are actually modeled on US Medicare. Most of them spend half as much on health care (per person per year) as the United States, and they have better health outcomes. No country has adopted a universal health care system and then gone back to its previous system. They have learned that when a system is universal, it is of higher quality precisely because every person has a stake in making it the best it can be.
Fighting for Our Lives: The Movement for Medicare for All People from across the political spectrum are expressing support for a single-payer health care system in the US, from conservatives like Charles Krauthammer to business leaders, such as Warren Buffett and Charlie Munger, to Senator Bernie Sanders. Given the failure of commercial media to cover single payer fairly, if at all, and given many Democrats' attempts to obfuscate it with a public option, there is confusion about exactly what a national improved Medicare for All system is and what it isn't. So, here is a primer on the basics of the single-payer health care system envisioned in Rep. John Conyers' bill, HR 676: The Expanded and Improved Medicare for All Act, which now has more cosponsors than ever before
National Improved Medicare for All
National Improved Medicare for All (NIMA) is a universal publicly financed health care system. Here are the core elements:
1. National: Every person living in the United States and its territories -- including every health professional -- is in the system. No matter where people travel domestically, they are in the system. No one has to worry about going "out of network" because it is one giant network. This also means that if there is a medical center that specializes in a particular condition, patients can go there if they need to -- no matter where they live.
Including everyone in one giant risk pool spreads the risk widely so that no particular state is burdened more heavily than others with covering the cost of care for its residents. In the US, 20 percent of the population has high health needs, using 80 percent of our health care dollars. Fifty percent of the population is healthy, using only 3 percent of our health care dollars. However, any of us can become one of those in the top 20 percent if we have a serious accident or illness. Having a national system gives us the security of knowing that it is there for us when and if we need it. And including everyone increases the likelihood of preventing and controlling epidemics of infectious diseases.
2. Improved: This plan is an improvement over Medicare -- not simply an expansion of our current Medicare system. First, it is more comprehensive than current Medicare and includes all medically necessary care, such as mental health, dental, vision, hearing, rehabilitative and long-term care, medications and medical devices. Current Medicare excludes long-term care, so seniors are forced to spend down their assets before they qualify under Medicaid for long-term care. That would no longer be the case under National Improved Medicare for All. Moreover, the question of what is "medically necessary care" would be answered by patients and their health professionals without interference from health insurers who are more concerned with profits than the health of their enrollees.
Second, because the improved Medicare for All plan is comprehensive, supplemental health insurance would not be necessary, and would not be permitted to duplicate what is covered by the health care system. This is important for maintaining a high standard of quality: There should not be a private system for the wealthy and a public system for the rest of us....