My Turn: Now is not the time to abandon the progressive health care agenda

For the Monitor
Published: 6/16/2019 12:10:19 AM

When the presidential campaign season began, it was encouraging to see so many candidates who expressed concern for the health and well-being of the American people as they came out in full support of improved and expanded Medicare for All.

Sadly, progressive ideals are being subtly undermined by the special interests that might stand to lose out with Medicare for All, even as the American democracy and capitalism could be energized by a healthier workforce enjoying full medical coverage and lower health care costs.

The attacks on Medicare for All have come from many quarters and purposely envelop the issue in the smog of misinformation, which is both caustic and dense. It is obvious that the ooze of dark money, originating from insurance companies, Big Pharma, major hospital systems and vendors of electronic records, is finding its way into so-called health care think tanks, where “scholars” and “fellows” (a.k.a. hacks and lobbyists) lend a pseudo academic scent to the effluent that emerges as policy.

A good friend who works for the Department of Justice confirmed my suspicions that “we have much less to fear from Big Government than from Big Business, which controls Big Government.” We have so many entities in health care that add immeasurably to the cost of care with minuscule contribution to the value of care.

It is important to clarify the fact that Medicare for All is not socialized medicine, where the government runs the financing, the doctors, the hospitals and all aspects of care.

Medicare for All is publicly financed but privately delivered care. Nor is Medicare for All “free care” in any sense of the words. The program is financed through the shared taxation of individuals and employers, but the net cost to everyone promises to be substantially less than individuals and businesses are shelling out today, and for much-improved coverage.

It’s amazing how much loose change can be found when the obscene corporate profits are brought into line and when the care of patients takes precedence over the profit of corporations.

It is worthwhile to review some types of coverage that expanded Medicare for All would replace.

First, it would provide coverage for the 40 million people with no insurance, who are but a minor illness away from bankruptcy and who either use expensive ERs for their care or defer care altogether until an illness becomes less manageable. Approximately 45,000 excess deaths occur in this country each year for lack of insurance.

Next, it would provide dignified coverage for those on Medicaid, who must deal with the socioeconomic hardship that accompanies the need to be on Medicaid in the first place. Add the chaos and insult of a work requirement in New Hampshire, and the indignity is only worsened.

When we reinvent an effective health care delivery system, we start with the premise that health care is a right of citizenship, that each individual will be issued a card that certifies coverage for basic health care needs, including prescription drugs, without the bureaucratic calisthenics to certify monthly work hours or overall eligibility.

Indeed, new and improved Medicare for All should be simplified so that patients have a seamless experience, effectively overcoming all of the barriers that currently prevent patients from being able to access timely and appropriate care.

The financing of care for our honored veterans could come under Medicare for All, while maintaining facilities that can provide the unique health care expertise that they have earned and so richly deserve.

For the 160 million or so Americans who have employer sponsored insurance, improved and expanded Medicare for All would provide relief from the recurrent budget busting premium, copay and deductible increases suffered by patients. Businesses would potentially be able to raise wages and invest in their growth, free of the burden of yearly negotiation with insurance companies.

Medicare for All would also eliminate the uncertainty of ever-changing hospital and provider networks, which currently hamstrings patient choice and creates a situation where patients are merely the chips in a great corporate poker game.

Somewhere in the drivel coming out of the health care profiteers is the implication that we should be content with the galactically insane costs of medication and services, poor access to care, lousy outcomes relative to wellness, hopeless complexity and being held hostage to jobs that we don’t like just to keep our health insurance.

Predictably, the lobbyists for the health care industries have emerged from their vile swamps to bandy about the terms “socialism” and “government run” to convince us that it is in our best interest to be unable to afford life-saving medicines and to be under the constant threat of medical bankruptcy. Their fuzzy message is that we need to rally against universal, cost-effective care in order to continue to have the “best health care in the world.”

To be clear, the path toward Medicare for All requires near-term reinforcement of the ACA, ensuring that those covered by the ACA maintain the scope of benefits and access guaranteed by the law. But even with a healthy ACA, millions will be priced out of coverage and the cost curve will not be broken. And if the Republicans have their way, the predominant form of health insurance will be GoFundMe.

There are those who would yield the progressive agenda in health care, climate change and so many other urgent causes to the centrists so that Democrats can win the election. We will literally be underwater if we accept this notion. Medicare for All and a Green New Deal will potentially save lives and save the planet if enacted quickly and boldly. The centrists are bellowing that we cannot afford either initiative, but the progressives counter that we cannot afford not to enact both.

A new and progressive administration will initially be preoccupied with undoing the catastrophes that Trump and his league of Republican lickspitters have created. It is thus even more critical that progressives, with a platform based upon science and compassion, move forward aggressively with their agendas through the campaign season to bring us together in a shared mission of personal and planetary survival.

(Dr. Robert S.Kiefner lives in Concord.)


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