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The American Healthcare Debate

Larry Beinhart's Body Politic


Last Updated: 12/26/2017 1:32 pm
Larry Beinhart
  • Larry Beinhart

Bernie Sanders has a healthcare plan. It’s a form of single-payer health care. Single-payer is a confusing term, however. It means that there is a single collector of funds, the government, which becomes the single payer for health-related services and materials. Bernie calls his version Medicare For All. It’s a good choice for both practical and public relations reasons. 

Medicare started in 1966. It’s a mandatory insurance program designed to primarily cover people over 65. American health care has been cobbled together out of a series of historical accidents, the influence of financial interests, and attempts to cover real need. One result was that most health care was an employment benefit. The standard retirement age is 65, so that became the entry point.  

It’s very popular. Actually, it’s more than popular. According to a January 2017 AARP report, Americans, 77 percent of us, think it’s important. That’s 4percent more than think that the military is important. Even 71 percent of Republicans think Medicare is important.

It’s well established. Fifty-five million people, 17 percent of the population, are already on Medicare.

Why do Americans like it so much? It’s efficient. It’s simple, clear, and easy to deal with, especially as compared to the rest of the health care system. Even more important, it’s trustworthy. Once you’re in, you’re in, and they’ve provided what they promised to provide, steadily, year after year. Private insurers can drop you if you change jobs, miss premiums, or they go out of business. Private insurers change their rates and the services they provide from year to year. Some are reasonable about paying, others routinely turn down claims for specious reasons. 

Hillary Clinton, as she wrote in her recent campaign memoir, What Happened, doesn’t like Bernie’s plan. According to her, “his plans didn’t add up...they would inevitably mean raising taxes on middle-class families, or that they were little more than a pipe-dream.” During the campaign, Hillary said that Bernie couldn’t explain it and that he couldn’t really tell people how much it was going to cost. How would it be paid for? Interestingly, this is the tenor of the response of the mainstream media. On the Right, the criticism is more pointed, of course, with claims that single payer will cost twice what Bernie says and therefore his plan was inherently misleading. 

But here’s the thing. Neither Hillary’s approach nor the proposals from the Right move toward fixing the problems. Hers make them slowly worse. Theirs make them instantly worse. 

What’s the problem with US healthcare? It’s insane. 

Our healthcare costs more than anywhere else. The current estimate is $10,345 per person per year. Spending, per person, in other developed countries is between 75 percent of what Americans pay, to less than half. The US spends a bit more than 17 percent of it GDP on healthcare. The next highest is Sweden, where it’s 11.9 percent of GDP. In other developed countries, it’s between that and 9 percent. 

All that spending might be okay, if people in the US lived lives that were twice as long or even a quarter longer than anyone else. But they don’t. Life expectancy in America is lower than Korea, Malta, Slovenia, and Cyprus. 

It’s even weirder than that. The US spends $3.2 trillion a year on healthcare. How do you think that gets paid for? According to a 2016 American Journal of Public Health study, “Tax-funded expenditures accounted for 64.3 percent of US health spending.” In fact, “government spending on health care costs in the US was the highest of any nation in 2013, including countries with universal health programs such as Canada, Sweden, and the United Kingdom. Indeed, government health spending in the United States exceeded total health spending (government plus private) in every other country except Switzerland.”

Back when Hillary was first lady, she was handed the assignment of coming up with some sort of national health plan. She did. It was complex and incomprehensible. But the real problem was that the profit makers were not on board. They launched an effective campaign to savage and undermine her proposal. They won. She lost. 

When Obama took office, he was determined to take another shot at getting something close to national healthcare. From Hillary’s attempt at healthcare reform Obama learned an obvious lesson: It was better to have the camels inside the tent, urinating out, rather than outside, aiming in. So he came up with a plan, developed by a right-wing think tank, tried out in Massachusetts by a Republican governor, Mitt Romney. The plan provided insurers a place at the table in front of platters with portions even bigger than ones they were already dining from. It passed, after much travail, by the skin of its teeth, and super-sizing the portions for the camels. 

The failure of Obamacare is that it’s not Medicare. Or Medicaid. Every doctor’s office has a whole slew of administrative personnel sorting through claim forms to figure what’s covered, what’s not, with a multitude of insurers, each with a multitude of plans, all of which change every year, mostly for the benefit of the companies. Consumers don’t know what’s covered and what’s not. Nor can they, really. The multitude and details of possible diseases and physical disasters and the remedies thereof, are practically infinite, couched in difficult language, and, even with the internet, not that easy to access. Also, the system is not really about providing medical care. It’s about ensuring that insurance companies, pharmaceutical companies, and other major players remain profitable. 

To answer Hillary’s complaint, and the media critiques: Nobody knows how much health care is going to cost. How will it be paid for? There’s $3.2 trillion a year already on the table. It’s only a question of how it gets on the table—taxes or premiums—and how it gets paid out. Does anyone know why health care costs so much in the US? Best guess is that the choices and the practices have profits as their goals, not positive health outcomes. Will turning all the responsibility over to the government improve that? Since the most privately run system in the world produced the worst cost-to-benefit ratios, and Medicare is the most successful healthcare program the US has, the better bet is yes.  

The original print version of this article was titled:
"Larry Beinhart's Body Politic: Let the Camels in the Tent"

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