Why This Isn’t Time For Public Option Or Medicare For Some

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Above Photo: From healthoverprofit.org

This has been a tumultuous week for healthcare reform. First there was the pleasantly quick defeat of the American Health Care Act in the House of Representatives Friday afternoon. Then, that evening, Senator Sanders spoke at a town hall in Vermont with Senator Pat Leahy and Representative Peter Welch where he announced that he would introduce a Medicare for All bill. Medicare for All and Bernie supporters lit up social media with their excitement over the announcement. This should have been great news, but it wasn’t exactly.

Over the weekend, more information was revealed in a series of interviews with Sen. Sanders. Sunday, he said on CNN that single payer legislation wouldn’t have the votes, so the first priority will be to improve the Affordable Care Act (ACA) with a public insurance, called a public option, and possibly lowering the age of Medicare eligibility to 55.

There are a number of reasons why this isn’t the time for tinkering with the ACA. We have a healthcare crisis now and the means to solve it. The ACA is fundamentally flawed and cannot be tweaked into a universal program. And Sanders’ proposals are exactly the same ones used in 2008-10 to divide and weaken the movement for National Improved Medicare for All. We can’t be fooled into going down that path again.

The Current Crisis and its Solution

Right now in the United States, almost 30 million people have no health insurance. On top of that, tens of millions of people who have health insurance can’t afford health care. When people experience a serious accident or illness, they face a stark choice: seek care and risk financial ruin or go without it and risk disability or death. Hundreds of thousands of families go bankrupt each year due to medical illness and an estimated 29,000 people die each year due to lack of access to care.

Think about how the country galvanized when 3,000 people were killed in the attacks on 9/11 or when the 2,000th soldier was killed in Iraq, but that amount of death happens ten times a year or more in the US and we hardly hear a peep of outrage.

Health outcomes in the United States are not very good. A recent study found:

“Notable among poor-performing countries is the USA, whose life expectancy at birth is already lower than most other high-income countries, and is projected to fall further behind such that its 2030 life expectancy at birth might be similar to the Czech Republic for men, and Croatia and Mexico for women. The USA has the highest child and maternal mortality, homicide rate, and body-mass index of any high-income country, and was the first of high-income countries to experience a halt or possibly reversal of increase in height in adulthood, which is associated with higher longevity. The USA is also the only country in the OECD without universal health coverage, and has the largest share of unmet health-care needs due to financial costs.”

Yet, of all of the industrialized nations, the United States spends the most per person on health care, in some cases double the amount and those countries cover everyone. We are already paying for universal comprehensive health coverage, but we aren’t getting it because the bottom line of the system in the US is profits for a few rather than health for all.

The US has the most complex and heavily bureaucratic system in the world because it is a market-based system with a few public programs to try to fill in the gaps. A third of our healthcare dollar goes to administration for the hundreds of different insurance plans with their differing coverage, networks and rules. And we pay the highest prices, by far, for health services and pharmaceuticals because there is no rational system to set a fair price.

To begin to solve the healthcare crisis in the US, we need a system that is based on health and the money to pay for it. The proven solution is a universal not-for-profit, publicly-funded system that provides all medically-necessary care. House Resolution 676: “The Expanded and Improved Medicare for All Act,” which has 72 co-sponsors, is the model for that system. This would address the fundamental causes of the healthcare crisis.

The good news is that not only do we have the money to pay for this system, but there is also widespread support for it. For decades many independent polls have shown more than 60% support by the general public, plus more than 80% support by Democratic Party voters, rapidly growing support by Republicans who earn under $75,000 and majority support by health professionals.

Why a Public Option and Medicare for Some Plans will fail

Steve Bannon, President Trump’s chief strategist, had an interesting statement in the New York Magazine recently. He criticized the Republican’s American Health Care Act (AHCA) because it was “written by the insurance industry.” That same criticism can be made of the Democrat’s ACA, which was basically written by Liz Fowler, a former executive for WellPoint. She also oversaw the regulations’ process.

The ACA is fundamentally flawed because it treats health care as a commodity, not a public necessity. It has achieved the best that it can do, and similar to other attempts at the state level that don’t address the roots of the crisis, it is starting to deteriorate with stagnant coverage and rising premiums and out-of-pocket costs.

Attempts to improve the ACA with a public insurance or Medicare for some will bring coverage to a few more, but they will similarly fail over time because they will not change the system or control healthcare costs.

Sen. Sanders and others are pushing a public option. This would be a public insurance that people could choose instead of private insurance. It sounds good in theory but has not worked in practice because it draws the sickest patients and struggles to cover their care while keeping premiums and out-of-pocket costs affordable. Private insurers are experts at attracting the healthiest enrollees. In fact, I have argued that a public insurance is just what the private insurers want (though they are unlikely to admit it) because it serves as a relief valve to take sick people off their hands. That leaves private insurers to focus on the young, employed and wealthy, from which they can collect premiums and who won’t need much in the way of health care.

Sen. Sanders is also raising the possibility of lowering the age of Medicare to 55, just as Alan Grayson suggested in 2010. This is another gift to the insurance industry because it takes a group that is more likely to have health problems off of their books. It will place more of a burden on the Medicare system without bringing the cost savings needed to cover health needs. I call this Medicare for some to contrast it with Medicare for all.

The basic reasons that Medicare for all works are because the administrative simplicity of one universal plan provides over $500 billion a year in administrative savings and its ability to negotiate fair drug prices means over $100 billion per year in savings on pharmaceuticals. The savings offset the cost of paying for care and getting rid of out-of-pocket costs that currently keep people from seeking necessary care.

Rather than wasting time and effort on a public option or Medicare for some, which will still leave people out and maintain the high costs of health care, we need to mobilize to win national improved Medicare for all. Like other industrialized nations, we need to create a universal high quality health system. It doesn’t make sense to leave anybody out when we have the resources to achieve it and public support for it. The only thing lacking is support from members of Congress. But as we witnessed last week with the defeat of the AHCA, changing the minds of members of Congress is within the power of the public.

The public option and Medicare for some are being used to divide and distract supporters of Medicare for all in order to weaken them and make them believe they are asking for too much, just as happened during the health reform efforts in 2008-10. We can’t be taken off track again.

What is the real purpose of a public option or lowering the age of Medicare when neither is an effective nor a lasting solution? It is only because the Democrats are unwilling to take on the powerful health insurance and pharmaceutical industries. The problem is that we can’t solve the healthcare crisis until we do.

  • Steve1027

    What a disappointing half-measure! I do disagree with the assessment on the way forward from a public option. I understand that it’s a mechanism to socialize the costs of more expensive, sicker patients while the private insurers take all the ‘profitable’ patients. However, where do the activists and masses fit into this equation? I would hope that we would be able to engage in a grassroots movement to get as many healthy young people on the public option as possible. Although we’re not going to get a public option until at least 2021, I won’t be underestimating the potential for people like Margaret Flowers to bring people into a public system in order to undermine the private insurers. Although we’d only get it as a ploy to delay Medicare-for-all, I think we should at least remember there is stuff we can do with a public option, if we are defeated at first. Sure, there’s no point in the grassroots pushing for anything other than Medicare-for-all, but we should be ready to act if our rulers only hand us a public option.

  • Aquifer

    Ready to act – the point is we should not take what the “rulers hand us” – if they do not give us what we need, then we change the rulers and we make it very clear to them that that is what we will do – starting next year at our first opportunity …

  • Aquifer

    Great piece! Thank you Dr. Flowers!

    “The public option and Medicare for some are being used to divide and distract supporters of Medicare for all in order to weaken them and make them believe they are asking for too much, just as happened during the health reform efforts in 2008-10. We can’t be taken off track again.”

  • mwildfire

    The thing is, we’re still endlessly fighting on this front–and can’t win, whether we up our odds by compromising and accepting better coverage for some, or insist on a better system that covers everyone…for the same reasons we can’t maintain decent environmental protections passed in the 1970s, let alone update them or deal with the climate crisis that threatens our very survival…or maintain even weak union provisions, or challenge the endless carnage of empire. The universal prescription to change our representative if they refuse to represent us, consider running for office ourselves, seems willfully blind to me. The problem isn’t that Congress is filled with a bunch of whores who will turn tricks for their industry sugar daddies. It’s that the Capitol is a whorehouse–turning out the current whores will inevitably bring in a fresh batch, the tab paid by the same sugar daddies, because THEY control the system. We have an electoral system literally based on bribery, and the SCOTUS has blocked any meaningful reform. As long as most voters base their choices on campaign ads (which they say they hate, but they base their voting choices on the ads, especially the negative ones they say they especially hate), it’s a simple matter for the moneymen to put obedient minions in office. It actually enhances reelection chances if they sell us down the river, because when they sell us, they get money for the sale, and can use that money to win our votes next election. This even applies to issues the public gets worked up about–how many actually look up how their own reps voted, and remember the next election season? There are always a very few exceptions who vote in the public interest; they usually don’t last long, as industry targets them, but even when special circumstances allow them to hang on, like Sanders, they are mere voices in the wilderness, making debates more interesting but losing the ultimate vote 100% of the time. So what’s the solution? Perhaps, after sufficient public education, a general strike could make fundamental changes. More likely, our best hope is in being ready to pick up the pieces on a local level after the collapse current policies make inevitable.

  • Jon

    And one more time, I will say that if we just self-organized into a single payer system for those outside of Medicare, repaying providers with a fixed salary, using Medicare, which works well, as reference, we could make huge progress, bypassing BOTH Congress AND the predatory insurance companies. I don’t expect it to cover all needs all the time, but we have to begin somewhere. What is there to lose by trying? We can adjust and add to it as we progress. Why the refusal to consider it in depth? Let’s get some responses other than an abrupt dismissal!

  • DHFabian

    Maybe. The important thing is to clear up the confusion. Medicare alone is for middle class retirees. Low-income elderly and the disabled rely on dual-coverage, Medicare/Medicaid, with Medicaid covering prescription and treatment costs, as well as the Medicare premium. Without Medicaid, they essentially have no health care, but Democrats and liberals have not extended their support to Medicaid.

    “Single-payer” is widely understood as universal health care. This is not possible in today’s US. Twenty years into our war on the poor, it would make no sense to provide actual health care to the poor just to dump them back on the streets. Lack of adequate food and shelter take a very heavy toll on human health.

  • DHFabian

    I think the bigger problem is that we haven’t defined who “we” are. We’re actually deeply divided, rich vs. middle class vs. poor. I think that what the discussion comes down to is that people want free or low-cost coverage for all who are currently employed, though we would have to fine-tune that definition.

  • Steve1027

    Who is saying we need to merely accept what the rulers hand us? Not me, I’m saying that if they give us a public option as a way of delaying MFA and shoring up the private insurance industry, we need to react by mobilizing as many young people as possible to get on the public option. I’m not talking electoral politics here–just something the grassroots can do if we’re faced with another Obamacare-like effort to prop up the insurance industry. Idk, I personally don’t like ruling out the grassroots. Maybe I could be more clear with my language–anything other than Medicare-for-all is unacceptable. Personally, I think the democrats would love to only pass a public option–that means more money in their coffers after engraciating the relevant industries. I’m saying if these people with much more power than me and you pull it off and only pass a public option, we have to be ready for that contingency.

  • Mary Nelson

    The U.S. Military is a single-payer system of so-called national security, paid for by taxes on ordinary people who aren’t wealthy enough to evade taxes.
    How would a single-payer system of health care not similarly play into the hands of the Corporate State, of the massive, growing, wasteful movement of wealth from the people and the planet into the coffers of the already obscenely wealthy? Sincerely.

  • Steve1027

    Thats a very interesting proposal and I like how proactive it is.

  • Aquifer

    I already know my response ….