Buttigieg and Biden’s Argument Against Medicare For All Does Not Hold Up

By: Nancy Ehrenreich

Although a majority of the American public supports Medicare for All, both the corporate media and centrist Democratic candidates such as Pete Buttigieg and Joe Biden continue to suggest that consumers should reject a single-payer system because it won’t give them “choice.” But the argument that adopting a national health care system would compromise consumer freedom simply doesn’t hold water. In fact, the opposite is the case: Most people have little choice under the current system. And they would have much more under Medicare for All.

Limits on Choice Under the Current System

Lack of choice is one of the most significant flaws in our current health insurance system. Those in employer-based plans can only choose among the limited options their employer offers and face a change in provider every time they change jobs. Medical costs are so high that, for those with modest incomes, even “covered” drugs and procedures — as well as, for some, health insurance itself — can be out of reach. Far too many have far too few choices when it comes to their health care.

Employer-Based Health Plans Limit Choice

More than half of all individuals under 65 get health insurance through their employers. Those workers have no say at all on which companies will insure them. And, while some employers give their workers two or three different insurance companies to pick from, many employees get just one “choice” of health insurance company — and therefore just one network from which to “choose” their providers.

In addition, under an employment-based system, changing jobs inherently means changing health care providers. Thus, career “success” — such as when a worker is promoted to a position in another locale or hired by a competitor across the country — forces them to lose continuity of care. Choosing between foregoing a promotion and losing a greatly appreciated healthcare provider certainly isn’t much of a choice. And even if the employee stays put, an employer can still switch insurance companies from one year to the next. Thus, the physical therapist who was so helpful to you this year might not even be covered by your insurance plan next year. And you will then have no choice but to find another PT within the limited network of your new provider. In contrast, under a Medicare for All system that includes every provider in the country, “all doctors are ‘in network.’”

Under employer-provided health care, even unionized workers who have collectively bargained for very good insurance plans would likely have more choice under a single-payer system For that reason, 1300 members of Nevada’s Culinary Workers Union recently criticized their union’s expression of concern that Medicare for All would deprive its members of choice. Union activists in favor of Medicare for All pointed out that their highly lauded union plan still leaves out some union members — such as workers who lose their insurance coverage when health issues cause them to miss more work than the union plan allows. Here, as is often the case under the costly private-insurance system, it is the most vulnerable who have the least choice.

High Costs Also Limit Choice

Under our current health care system, consumers’ choices are severely constrained by costly deductibles and co-pays that prevent many people from accessing the care they desire and deserve — perhaps most especially in terms of medications. Having a right to choose between paying rent and buying needed medicine, or between buying heart medications and diabetes drugs, is hardly the freedom of choice that most people want.

In addition, cost-prohibitive premiums exclude tens of millions of Americans from health insurance coverage altogether. And when the financially strapped forego treatment and become seriously ill, the emergency services that government provides to those individuals dramatically increase health care costs overall, necessitating higher taxes and reducing the resources that taxpayers can use to pay for their own health care and insurance. The high cost of health care reduces everyone’s choices.

Increased Choice, and Better Health Care, Under Medicare for All

Not only does our current system limit people’s choices, but Medicare for All would increase choice. Under a single-payer system, consumers would have a much bigger network of providers to choose from, as well as the ability to buy more (and cheaper) pharmaceutical products. They would also (as a group) have better health outcomes and spend less money on healthcare — certainly outcomes that all of us would choose to have.

A study by epidemiologists at Yale, recently published in the prestigious medical journal, The Lancet, analyzed the likely impact of the Medicare for All Act introduced in Congress by Senator Bernie Sanders. The study found enormous economic and health benefits from a national health insurance system, concluding that it would cost 13% less than the current system and would save 68,000 lives per year. And even though taxes could go up under such a system, as Bernie Sanders has consistently (and very honestly) explained, those increased taxes would be more than offset by the savings individuals would recoup from not having to pay health insurance premiums, deductibles, co-pays, or outrageous drug prices. In the end, a single-payer approach would reduce overall medical costs. Certainly, if given the option, most consumers would choose to have better health outcomes and a greater chance of surviving serious illnesses — especially if they could get both for less money.

Of course, the very wealthy already have these options and outcomes. But under Medicare for All, the rest of us would. And the sickest and poorest among us would benefit the most.

Because a Medicare for All system would cut out the complex morass of insurance companies and policies that every medical office has to manage, it would eliminate a huge percentage of overhead costs for medical providers. Overhead would also be reduced by eliminating the for-profit insurance companies and the exorbitant profits and executive salaries they currently skim off the top.

Under our current system, overhead costs are passed on to consumers in the form of higher medical bills and insurance premiums. Think about all the providers’ offices you’ve seen where it took a fulltime employee to process all the insurance claims. Because a national system would have just one insurer (Medicare) and a consistent payment/reimbursement system, those administrative tasks would be significantly simplified.

In fact, the Yale researchers concluded that, under a national health plan that “consolidated all insurance schemes into the Medicare framework,” the nation would save approximately $219 billion in overhead costs. Relying on over 50 years of data about the Medicare system, they determined that overhead costs in that system are 2.2% of spending, as compared to 12.4% in the private-insurance system. By recouping over $200 billion in overhead costs to and redirecting it towards a national health care system, Medicare for All would allow more consumers to choose the quality health care services that they desire and need.

The Flaws of So-Called “Choice” Approaches

In contrast to Medicare for All, so-called “choice” approaches such as Mayor Buttigieg’s “Medicare for Those Who Want It” system — under which people would be able to choose either to be part of a government-provided system or, instead, to buy private health insurance — would consign all of us to the worst of both worlds. The efficiencies of having one, universal system of insurance reimbursement would be lost, as medical offices would continue to have to spend wasteful amounts of overhead to handle multiple sets of rules and forms from multiple private companies. Given the multiplicity of networks, even those who opted for the “Medicare” system (which would of course not under this approach be “Medicare for All”) would be precluded from choosing some (“out-of-network”) providers.

Other efficiencies would be lost as well. Under all insurance systems, the sick in any given year are subsidized by those who are healthy. We pay our premiums even in years when we don’t need much health care, and companies use those premiums to pay for health coverage needed by others. The larger a health insurance system is, the more efficiently the insurer can spread costs in this fashion. Thus, the multiple, smaller markets for health insurance that would result if we adopted the Buttigieg approach would significantly decrease the efficiencies that Medicare for All could provide. Even those who opted for a government plan would lose out. Not only would they have fewer providers to choose from and have to pay higher overhead costs, but also that system’s ability to spread costs would be reduced by having fewer insureds in the system.

As virtually every industrialized nation (and many other nations as well) have discovered, the most efficient way for a government to provide all its residents the human right to health care is through a universal single-payer system of health insurance. Under such a system, we will have not only more freedom of choice, but longer and healthier lives as well.

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