Of Course We Can Afford Medicare-for-All–We Always Could

If there is anything the coronavirus/COVID-19 pandemic fiasco has exposed, it’s our societal inequities.

When it comes to public health, the most obvious inequity lies in the reality that we spend the most money on healthcare–20% of our national income–of any Organization for Economic Cooperation and Development (OECD) country on the planet, yet we are not the healthiest country.

Most countries offer healthcare as a human right to all its citizens.

But of the 25 wealthiest nations, the United States is the only one that fails to do this.

The response opponents to a Medicare-for-All-type single-payer national healthcare system similar to what Canada practices is “We can’t afford it,” or “How do we pay for it?

Interestingly, though, that claim is seldom if ever proposed whenever we feel the need to increase the military budget, print money to provide $2 trillion in economic relief to keep corporations afloat, dole out perpetual subsidies to the world’s most profitable corporations, or permanently cut taxes on those same corporations and their overlords to the tune of $1.5 trillion.

Those who complain “We can’t afford it” are often the same who also boast about us being the richest nation in the world.

But they can’t have it both ways.

The “We can’t afford it” argument is, of course, a lie.

We have always been able to afford to provide every man, woman, and child born in this country healthcare as a human right.

Consider that over the past twelve years we have spent in the neighborhood between $20-35 trillion on corporate bailouts.

All that time we could have been providing healthcare.

Journalist David Sirota, in his newsletter TMI, writes:

“In recent weeks, we’ve seen health care industry CEOs report paying themselves $2.4 billion as 27 million people were thrown off their health care coverage. We’ve also seen Americans being charged anywhere from $400,000 to $1.1 million for COVID treatment, and facing $2,000 bills for coronavirus tests. And yet, despite data showing that a single-payer system would save big money, surveys still indicate some popular trepidation about the price tag of government-sponsored health care.”

What’s the price tag?

Right now, combining Medicare, Medicaid, insurance premiums, and out-of-pocket costs, we are expected to spend about $52 trillion on health care during the next decade.

But Medicare-for-All would eliminate premiums and out-of-pocket costs, reducing the price tag to between $20 trillion and $36 trillion over the same period.

That happens to be same amount the federal government set aside for corporate welfare since 2008.

After the 2008 financial crash, we granted $700 billion big banks.

The Federal Reserve committed between $16 trillion and $29 trillion to large financial institutions.

Lawmakers recently handed $4 trillion in pandemic relief to large corporations.

As David Sirota points out:

“That money was funneled to Corporate America not just in absence of tax increases– it was delivered while the government was actually cutting taxes.

“The picture gets even more absurd when you slightly broaden the frame and add in another $10 trillion that we nonchalantly spent on other items. 

“For instance, we spent $2 trillion on the Iraq War. We also spent a combined $2.6 trillion on increases in the Pentagon’s already-giant base budget since its first post-9/11 budget. And we devoted about $5 trillion to the Bush and Trump tax cuts.”

Two years ago, Republicans jumped at the opportunity to cite a Koch Brothers-funded Mercatus Center study to prove once and for all single-payer health care is too expensive, despite its economic advantages, and popularity among the public and U.S. lawmakers.

But what those attacks conveniently omitted is the fact that in their attempt to discredit single-payer, the monolithic Kochs accidentally made a case for it.

Vt. Sen. Bernie Sanders was quick to point out:

“Let me thank the Koch brothers, of all people, for sponsoring a study that shows that Medicare- for-All would save the American people $2 trillion dollars. I suspect that that is not what the Koch brothers intended to do, but that is what’s in the study of the Mercatus Center. At a time when the United States spends far more per capita on healthcare than any other country on Earth, almost 18 percent of our GDP, a Medicare-or-All healthcare system would save the average family significant sums of money.”

David Himmelstein and Steffie Woolhandler, health policy experts and co-founders of Physicians for a National Health Program (PNHP), explained:

“The Mercatus Center’s estimate of the cost of implementing Sen. Bernie Sanders’ Medicare-for All-Act projects outlandish increases in the utilization of medical care, ignores vast savings under single-payer reform, and fails to even mention the extensive and well-documented evidence on single-payer systems in other nations—which all spend far less per person on health care than we do. [The] report undercounts administrative savings by more than $8.3 trillion over 10 years. Taking those savings into account would lower Blahous’s estimate from $32.6 trillion to $24.3 trillion.”

Those administrative savings could start by eliminating or significantly reducing the overhead produced in medical billing, on which the United States spends twice as much as Canada.

How much savings?

About $89 billion a year.

Another component: salaries and marketing expenses.

Health insurance companies are, fundamentally, just banks on which insurers spend more than 20% of total expenditures on overhead.

Medicare, on the other hand, spends around 2%.

Transitioning everyone away from private for-profit health insurance to a Medicare-for-All system would save around $200 billion in overhead alone.

But what about taxes? Wouldn’t they skyrocket?

Think about every time we visit a doctor (including via tele-medicine) or walk-in clinic.

If we are fortunate enough to have employer-based healthcare for which we pay premiums, we are also responsible for co-payments, which can vary–sometimes widely–from person to person depending on types of plans employers offer.

Those premiums and co-payments are functionally taxes even though we aren’t accustomed to thinking of them as such.

Under a Medicare-for-All-type system, we would all–ALL–be paying premiums Medicare already charges, without co-payments or deductibles.

This would bring in $210 billion in revenue.

We currently pay subsidies for two insurance columns: employer-provided plans and those offered via private insurers through the Patient Protection and Affordable Care Act (ACA); aka “Obamacare.”

A single-payer model would reduce it down to just one, saving about $161 billion.

Employers would no longer have to factor health insurance coverage in their books, saving them millions.

Unions would no longer have to negotiate with management over heath care coverage and costs.

We could see any doctor at any time without having to worry about how much it’s going to cost.

A hospital stay wouldn’t cast people into debt.

No more “surprise bills.”

As James G. Kahn, M.D., MPH, emeritus professor in the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, wrote inEconomy for All:

“The facts are clear: We can do Medicare for All in a way that reduces overall health care spending, and finance the increased federal financing with a taxation structure that begins to redress the unsupportable concentration of wealth in a few super-wealthy individuals as the vast middle class struggles with stagnant wages and rising health care costs.”

As David Sirota explained:

“In our political conversation, Medicare for All is almost never cast as an efficiency–it is almost always cast as an unaffordable boondoggle. Indeed, during the presidential primary, Bernie Sanders and Elizabeth Warren were hounded by reporters, think tankers and lawmakers about how they could possibly pay for such a big program. To their credit, they played along and both released detailed plans about how they would raise the revenues.

“By contrast, the same reporters, think tankers and lawmakers who spent the primary season attacking Medicare for All and preening as spendthrifts never bothered to ask about pay-fors for all of the aforementioned money for Wall Street firms, defense contractors & high-income tax cuts. All that happened without attendant deficit-neutral tax increases to finance it. We somehow just found the money.” 

Bottom line: We have always been able to afford Medicare-for-All.

It’s just a matter of priorities.

The neo-liberal shift over the past forty years has prioritized Wall Street, the defense industry, and generally any individual or corporation ideologically committed enough to capitalize on the “money=free speech” argument the Supreme Court agreed is constitutional.

That includes health insurance companies.

But as Bob Dylan sang, “The times, they are a-changin’.”

And they really are.

More Americans favor a single-payer national healthcare system now than ever before, and they are sick (no pun intended) of sacrificing their sovereignty and security so another obscenely rich CEO can bilk from them another billion dollars in tax-deferred compensation.

Image credit: www.commondreams.org

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