It’s almost universally agreed that the U.S. method of delivering medical care, which is wildly expensive and inefficient compared to other countries while leaving millions of people behind, needs an overhaul. But what should that look like?
The idea of creating a single-payer health insurance system, popularized today as Medicare for All (MFA), is gaining traction. Election-year Democrat Bernie Sanders of Vermont has put forward one version in the Senate, and Washington Democrat Pramila Jayapal has introduced another in the House of Representatives.
Will either of these plans deliver the goods? Will Democrats in Congress really fight for them? Bottom line, what will it take for working people to win meaningful reform?
Spoiler alert: it has something to do with profits.
Two proposed solutions. Both pieces of legislation, Sanders’ and Jayapal’s, would establish a single, federally administered program to provide universal coverage. Private insurers would not be allowed to duplicate coverage offered under the government plan, but could offer supplemental services.
Both bills — in their current, unadulterated state — are sweeping in scope. They include everything from hospital stays and normal primary care to prescription drugs and vision, dental, and hearing services. And patient co-pays and deductibles would be gone.
Jayapal’s proposal goes further. For one thing, it would take effect for most people in two years instead of four. It explicitly covers long-term care services like nursing homes, a provision disability rights advocates organized for. Sanders then amended his version to include this.
But neither Jayapal nor Sanders has dared to touch the powerful pharmaceutical industry except to stipulate that the government should be permitted to negotiate for better prices. And Jayapal doesn’t even hint at how her new system would be paid for.
Rumpus among the Democrats. Jayapal and Sanders are up against powerful forces in their own party who have no intention of letting MFA become Democratic policy.
In order to get a hearing for her bill, Jayapal cut a deal with House Speaker Nancy Pelosi by giving Pelosi support for a regressive funding rule. Pelosi is unlikely to become a single-payer ally. However, she recognizes MFA’s popularity and has her finger in the wind for the 2020 elections, like all the congressional Democrats.
Outright opponents of MFA among the Democrats include Minnesota Senator Amy Klobuchar, who condemns it as unrealistic. Klobuchar, Pelosi, and other mainstream Democrats want to expand Obama’s Affordable Care Act (ACA) instead. But tinkering with Obamacare won’t solve the fundamental problems of a patchwork healthcare plan that does nothing to curb costs and doesn’t even aim for truly universal coverage.
Democrats like Klobuchar and Pelosi know who butters the party’s bread. In 2018, pharmaceutical giant Pfizer spent more than $11 million on bipartisan lobbying. In 2017-2018, Blue Cross-Blue Shield gave about a million and a half dollars each to Democrats and Republicans.
Their largesse pays off. Under Obama, for example, profits for the 10 largest insurers almost doubled, spiking from $8 billion in 2008 to $15 billion in 2015, after two years of the ACA taking full effect.
With opposition coming from their own party, leading MFA supporters and 2020 presidential hopefuls are already beating a retreat, showing willingness to give private interests a seat at the table.
California Senator Kamala Harris publicly denounced private health insurance, but an aide “clarified” that she is in fact open to private insurers coexisting with MFA. Massachusetts Senator Elizabeth Warren wants “accountability” from insurance companies. New York Senator Kirsten Gillibrand declared for “at least one not-for-profit public option” to give the for-profit insurance industry healthy competition.
And New Jersey Senator Cory Booker flat-out said “no” to eliminating private insurance.
Defenders and opponents. Organized labor is weighing in on the healthcare debate.
The 185,000-member National Nurses United (NNU) has come out in favor of “a single-payer, national health care system which guarantees care for all regardless of their ability to pay.” The union endorses Jayapal’s bill.
Other labor organizations are also on board, including the Amalgamated Transit Union, American Federation of Teachers, American Postal Workers Union, International Association of Machinists and Aerospace Workers, and Service Employees International Union.
Even though polls show many Republican voters favoring single-payer, there is zero support for it among Republicans in Congress. Active opposition also comes from pro-business groups like the Partnership for America’s Healthcare Future, so-called. “The costs of Medicare for All would be enormous and would force hardworking families to pay more, including through massive tax hikes,” it insists. “Single payer health care plans would cost taxpayers $32 trillion over ten years.”
But U.S. healthcare spending in 2018 was already at $3.65 trillion. At $32 trillion over a decade, MFA would not exceed that amount.
Still, the question of who should foot that bill remains. Bernie Sanders proposes a progressive tax targeting the super-wealthy. Reasonable enough — but why is U.S. medical care so disproportionately expensive in the first place? Healthcare is labor intensive and inherently costly, but every advanced capitalist country with a national health program pays far less per capita. Britain spends a third of the U.S. amount.
What’s needed? A statement by the NNU sums it up: “A system based on generating profits will never prioritize patient need.”
Having the right to medical care means unobstructed access. That means no financial hurdles. And that means that the cost must be borne by corporations and the super-rich through taxes, not by already strapped working people.
After more than two years of Donald Trump, many people are listening hopefully to Democratic talk about MFA, a Green New Deal, and breaking up tech goliaths like Amazon and Facebook.
But we have been down this road before, many times — with Democratic pledges to end wars, pass the Equal Rights Amendment for Women, guarantee labor rights, protect the environment, get rid of poverty, and make racial justice real. We know how this story ends.
Maintaining private industry is only the first of even more compromises to come. In the end, MFA will be an unrecognizable caricature of Sanders’ and Jayapal’s proposals.
Private profit is by its very nature an obstacle to quality care for everyone, of every color, gender, and sexuality, including every immigrant. It must be entirely eliminated from the picture.
The answer is a grass-roots fight, ideally union-led, to nationalize the entire medical industry, including Big Pharma, with healthcare employees in control of the system, collaborating with patients.
That’s the prescription for meaningful change.
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