How a Pandemic Makes the Most Compelling Case for ‘Medicare for All’
“The weaknesses in our system have been exposed, the fact that our system depends on being insured and being able to afford it,” says Marcia Angell, MD, a physician, former editor in chief of the New England Journal of Medicine, and corresponding member of the faculty of global health and social medicine at Harvard Medical School.
As of Thursday, April 2, worldwide detections of the virus had approached 1 million with dwindling supplies available for treatment. And as doctors and nurses put their lives on the line to treat not only patients sick with COVID-19 but patients with other health problems, the idea of our current health-care system being the best health-care system is eroding far and wide.
"The weaknesses in our system have been exposed." —Marcia Angell, MD, faculty of Global Health and Social Medicine at Harvard Medical School
Donald Moore, MD, a primary care physician and longtime Medicare for All advocate, says patients would benefit most from a Medicare for All system. He believes this because for the past five years he hasn't accepted commercial insurance.
"So many people think that they want to hold on to their insurance, that what they have is as good as it gets, that they can't do any better," says Dr. Moore, who has an independent practice in Brooklyn. "I can tell you, as a doctor, I know you could do better because I'm the one who used to take the bad insurance that you have."
A common critique of Medicare for All is that such an ambitious and costly program is too much for the federal government to handle. But experts like Dr. Moore and Dr. Angell say Medicare provides precedent enough to show it's well within our capabilities as a nation. Medicare for All is an adaptation of the United States' current Medicare system. Medicare is a single-payer (that payer is the government) health-care system that everyone, regardless of income, becomes eligible for when they turn 65. Younger people with disabilities and people with end-stage renal disease are also eligible. Though the current form of Medicare would need some tweaking before it became Medicare for All (buh-bye, co-pays and deductibles), Dr. Moore says it's already a great model for what health care looks like when it reaches huge swaths of the population. According to November 2019 data, 61.2 million people use Medicare each month.
"I can tell you as a doctor, I know you could do better because I'm the one who used to take the bad insurance that you have." —Donald Moore, MD, primary care physician in Brooklyn
The reason Medicare for All is the most popular alternative to our current health-care system is that the benefits cannot be cut and the package is the same for everyone, Dr. Angell says, no matter how much you need and how much you use. This, in particular, is relevant given the fact that jobless claims soared to a record 6.6 million in the last week in March, meaning many whose employers provided their health insurance are no longer insured or have to pay out of pocket for insurance plans.
There are other options, though. COBRA, the Consolidated Omnibus Budget Reconciliation Act, is a way to keep the insurance plan you were on with your employer, albeit paying for it entirely by yourself, which is likely $600 or more per month. Recent laws have confirmed uninsured people won’t have to pay out of pocket for COVID-19 testing, and the Affordable Care Act or Medicaid (a state and federal program, somewhat like Medicare) can help insure unemployed people if they are of a certain income level, though every state handles Medicaid differently. While COVID-19 testing and treatment is of obvious concern, other health-care treatment can’t be forgotten.
Outside of COVID-19, medical costs can be a huge burden, with research from a 2019 study in the American Journal of Public Health showing that more than 60 percent of people who file for bankruptcy do so because of medical debt.
"As health-care costs increase, all businesses, including all big businesses, are saying, 'We can't afford health insurance, you need a better system,'" says Dr. Moore. "Big businesses can't afford it, the city can't afford it, and definitely the small business and the individual can't afford it. As a society, we can afford it, as a country we can afford it—and most countries do afford it."
More than 60 percent of people who file for bankruptcy do so because of medical debt.
Dr. Angell says the United States spends about 2.5 times the average per capita as compared to other member countries of the Organisation for Economic Co-operation and Development (OECD)—36 of the wealthiest countries in the world. At the same time as we spend more money, we get much less for it.
“Without [Medicare for All], not everyone is covered, you have to be in the private sector, you pay growing deductibles, copayments, and employers are trying to get out of it by not covering the inflation,” says Dr. Angell. “Medicare for All is much cheaper and you get more. It can’t be tailored according to how often you get sick or if you have a chronic illness.” It’s also infinitely more efficient, she says.
Under the current system in the United States, with such high costs for health care out of pocket, it's easy to wonder: Where does all the money go? “We have fewer hospital beds, fewer doctors and nurses than other countries, and we provide more outpatient tests and procedures like MRIs because these are the money makers, so when you add in a pandemic, we are just not prepared for it,” says Dr. Angell.
A 2018 survey from the American Hospital Association showed that hospitals in the U.S. have about 2.8 beds per 1,000 people, compared with other countries: Italy has 3.2 beds per 1,000 people, China has 4.3 beds per 1,000 people, France has 6.5 per 1,000, and South Korea has 12 beds for every 1,000 people.
Health care in the U.S. is treated like a market commodity instead of like a public service, says Dr. Angell, where all the pieces are working more or less independently of one another and often in competition.
“There’s a chain that starts with employers that hire insurance companies and they decide what people are going to pay and who will be covered, and they have marketing departments and billing agencies and all kinds of satellite businesses feeding at the same trough as the health-care dollar makes its way from the employers through the insurance through multiple businesses trying to make part of that dollar for their overhead and other costs,” says Dr. Angell. “Each level as you go along, money is skimmed off the top until it’s hard to say what amount actually goes to the provider for health care.”
So what’s the up side here? You might be wondering if there is one. At the very least, the current pandemic has put the fragility of the health-care system on display, one where those who can afford to get treatment get it. Case in point: Rich celebrities touted on social media that they had somehow secured access to COVID-19 tests while the rest of the country wondered why there still aren't enough tests for the rest of us.
While progressives in politics continue to fight for Medicare for All, the pandemic could very well help the cause and turn people’s heads in the direction of at least thinking it would be better for them and for everyone. When life is more important than money, we all win.
Additional reporting by Kara Jillian Brown.
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