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Jonathan Baird: Medicare-for-All – excellent and attainable



For the Monitor
Thursday, October 05, 2017

With the latest Republican attempt to repeal and replace Obamacare going down in flames, health care policy is at a crossroads. We can either act to improve Obamacare and move in the direction of universal coverage or we can backslide into an abyss where we leave millions more without access to any health care.

I believe Bernie Sanders showed the way forward when he recently proposed his Medicare-for-All bill. Sanders had 16 Senate co-sponsors, including such perceived 2020 presidential contenders as Kamala Harris of California, Elizabeth Warren of Massachusetts, and Cory Booker of New Jersey. This was drastically different from the experience Sanders had in 2011 when he introduced a similar bill. Then he had no Senate co-sponsors.

Not surprisingly, even as the bill was released, Republican and some Democratic naysayers popped up. It is entirely predictable that something genuinely progressive would draw heavy fire. Any plan of consequence would automatically be subjected to intense scrutiny and criticism.

The idea that Democrats would propose a visionary, bold plan is actually novel. For so long the Democrats have been the timid party, unwilling to stake out more than minimalist, incremental change.

Say what you will about the Republicans but they cannot be accused of timidity. They, without hesitation, try to move forward a maximalist, extreme right-wing agenda, no matter how humanly destructive that agenda is.

Sanders’ bill proposes extending Medicare to all Americans, regardless of their age. It would be phased in over a four year period. Initially, in the first year, everyone under 18 and over 55 would be covered. Medicare now covers those over age 65. In the second year, it would expand to cover those over age 45. In the third year, it would cover those over age 35 and in the fourth year, it would cover everyone else.

The Medicare-for-All plan would also be far more comprehensive than current Medicare. It would include dental, vision, and hearing care.

Dental care in America is an unspoken scandal and as an issue it deserves far more attention than it has received. The fact that an estimated 130 million Americans have no coverage for dental care is a national disgrace. Nearly 50 million Americans live in places where it is difficult to access dental care. With this record, you might think we were some backwater Third World country instead of the great nation we are.

One-quarter of U.S. adults age 65 or older have lost all of their teeth. About 17 million low-income children do not see a dentist each year. Only 45 percent of Americans age 2 and older saw a dental provider in the past 12 months.

Untreated dental problems can have very serious health consequences. Medicare-for-All would be a revolution in dental care, greatly improving access. Sad to say, but there are many people living with rotting teeth and dental pain who cannot afford any care.

Medicare-for-All would put an end to co-pays, deductibles, and the need to fight with insurance companies when they fail to pay for charges. In this plan, health care would be a right, not a for-profit business, and it would be guaranteed to all Americans.

Medicare-for-All would build on the success of the Affordable Care Act. Under the Affordable Care Act, more than 17 million Americans have gained health insurance. This has cut the number of uninsured to an all-time low. Among other things, through the Affordable Care Act, millions of low-income Americans in 31 states gained coverage through expanded Medicaid. Young people up until age 26 can stay on their families’ health plans. The Affordable Care Act also protected against exclusions for pre-existing conditions and lifetime limits. All these gains are essential.

At the same time, there are still an estimated 29 million Americans who lack any health insurance. Many are underinsured or have to pay exceedingly high co-payments and deductibles charged by private insurers. It does not disparage the Affordable Care Act to acknowledge both its strengths and weaknesses. It was a step but health care for all requires new steps.

There is no contradiction in fighting to maintain existing gains and advancing progressive reforms while struggling toward Medicare-for-All. Those who say it will not pass now are correct but they fail to see that Sanders’ bill opens the conversation. It may be years before Medicare-for-All can be enacted but Sanders’ bill puts it on the national agenda and starts a critical dialogue. When there is a Democratic president and a Democratic Congress, the bill could pass.

The fact that there will be no instant results is hardly a reason to avoid this fight as this fight is worth it.

Certainly, the biggest question about Medicare-for-All is how it will be funded. There is no exact plan yet, although Sanders released some proposals: a 7.5 percent payroll tax on employers, a 4 percent individual income tax and an assortment of taxes on wealthier Americans and corporations. At this stage, I think it is okay that no funding formula is nailed down. There is a need for more creative discussion about funding formulas.

Those predisposed to oppose the idea will focus on the funding and it is impossible to deny that the issues are real. The challenge is immense. Still, there is much evidence that a single payer system can ultimately get runaway spending under control.

Medicare could set fees and pay health providers in much the same way it does now. Billing could be much simpler. There could be a single billing form and a single fee schedule. The administrative costs of Medicare are at 2 percent while the administrative costs of U.S. private insurers averages 17 percent. This would save much waste and excessive administrative cost.

I know there are some who will see Medicare-for-All as some extreme socialist plot. Honestly that is such a parochial view. Nearly every industrialized country besides the United States guarantees universal access to health care. Think Canada, England, France or Germany. They all spend less on health care and have far better outcomes than we do. Medicare-for-All would lead to less out-of-pocket cost for the average family.

To quote Bernie Sanders:

“We remain the only major country on earth that allows chief executives and stockholders in the health care industry to get incredibly rich, while millions of people suffer because they can’t get the health care they need. This is not what the United States should be about.”

Polls show that support for single payer began increasing around the start of the 2016 campaign. More people now believe that health care is a government responsibility. A June 2017 poll from the Kaiser Family Foundation found 53 percent support for the idea of single payer health care.

I see Medicare-for-All offering the Democrats both an attainable long-term goal and an energizing vision that can garner huge grassroots support and unite disparate factions. For a party lacking coherent identity, that is no small positive. The effort will likely take years but it certainly can happen.

(Jonathan P. Baird of Wilmot works at the Social Security Administration. His column reflects his own views and not those of his employer.).