Framing the Healthcare for All Discussion

As an avid newswatcher, a progressive liberal, a 62-year old white American, father of two children, son of two parents one of whom died from cancer, with both my mother and mother-in-law living in assisted living with Social Security and Medicare paying most of their bills, I have some skin in the medical system of America.

The arguments I hear in favor of Universal Health Care, or Medicare for All as it is becoming known, are not the ones that resonate with me and apparently don’t resonate with enough Americans to bring about change to our current system. In this document I will use the rebuttal format to share some different thinking so that it might be used by those with a wider audience, to inspire them to see the need for, and value in, Universal Health Care.

Argument #1: We cannot afford Universal Health Care
We cannot afford not to have universal health care and we can afford to have better universal healthcare than any other nation on earth. We do spend too much on healthcare and universal healthcare is the way to reduce those costs without reducing services.

In the United States we spend more than 17% of our gross national product on medical costs. Using our 2017 GDP of 19.39 trillion dollars and applying the 17% to that, comes up with about 3.2 trillion dollars spent on medical care that year. For those that say we can’t afford that 3+ trillion dollars in medical expenditures, we already are spending that amount. We could spend less and get more.

In Canada, Germany, France and the United Kingdom, the average is about two-thirds of what we spend, at 11%. Those are the savings not of providing less care, but of paying less for it. They don’t pay insurance companies profits, they reduce the amount doctors and hospitals get to charge, and they reduce the amounts they pay for pharmaceuticals and medical devices.

Suppose we cut 20% from our medical expenditures, going with 13.5% of GDP as the target, and replaced medical insurance costs in payroll with a tax that was 20% lower than the amount charged in 2017? Why 13.5%? We want better healthcare than the rest of the world, and that includes dental and vision care, too.

As for that 20% that is no longer going to healthcare due to savings in overhead and insurance costs, it goes to the employers and employees. With a 20% reduction in payroll expenses, employers and employees would both have lower costs. Corporate profits and personal payrolls would rise. Fuller pockets would head out to dinner, to the shopping centers, and online to purchase more goods. The economy would prosper.

Due to increased income levels, income tax collections would increase. We could pay down some of that debt we keep accruing.

Win for the people. Win for corporations. Win for the government (which is the people, after all).

Argument #2: Universal Health Care will put all those people that work in the insurance industry out of work.
Bullfeathers. Universal health care will put the CEO’s out of work, or at least out of their high compensation packages. There will still be a massive amount of billing to be processed and the government will need to either hire that out to existing companies or create those processing centers anew. Redundancies at the top levels will be diminished but the work will still need to be done. Part of the process of sorting this out will be defining what an acceptable level of profit is, like a public utility, or if they are to become non-profit corporations.

Argument #3: Obamacare failed and so will Universal Health Care.
The Affordable Care Act, which became known as Obamacare, was doomed to fail. The lobbyists of the medical groups thwarted the efforts by writing the law to their advantage with the Democrats at fault as much as the Republicans, accepting their portions of $3.5 billion in lobbying expenditures and allowing this to happen.

By keeping the insurance companies in the system and allowing varied degrees of coverage, it was in essence leading the sheep to slaughter.

By maintaining the Medicare Modernization Act of 2003 the inability of our government to negotiate prescription drug prices remained in place, protecting the pharmaceutical companies from the free market.

Obamacare was not Universal Health Care. It was not single payer and we don’t need single payer, we need single buyer. With one buyer of medical services, prescription drugs and devices, prices can be negotiated dramatically.

Argument #4: Negotiating Prices will Stifle Innovation.
You denigrate and disrespect the minds at work in America. Negotiating prices on new drugs, procedures and devices will not stifle innovation, it will inspire the brilliant minds within American industry to discover and manufacture devices of greater value.

These same companies already accept lower payment from virtually every other industrialized nation than they charge Americans, in their home country. Humira, for example, costs about $3500/month in the U.S., but less than $1000/month in Norway. Advair sells for over $300/month in the U.S. and for less than $50/month in Germany, France, Australia and the U.K.

If the pharmaceutical companies are willing to sell at those prices elsewhere, they should sell at the same favorable rate in their own home country. These are unpatriotic companies, putting America last.

It may well be that the pharmaceutical companies get to renegotiate the prices with other countries based upon them charging less here in America. If those other countries are looking at the companies overall profitability, this would be a valid factor in those negotiations.

To further encourage innovation in the pharmaceutical and medical device markets we need to ease the process of getting new drugs and devices approved. Patents can remain in place, but prices must be negotiated based upon actual cost and value.

Argument #5: Universal Healthcare will have massive waiting lists and “death panels”
No, it won’t. We are America and we will do it better. We will spend more per person than other countries and we will have more practitioners in place to handle appointments and services. Again, do you not believe in the exceptional ability of the American people?

Argument #6: I like my private insurance and want to keep it.
You may. Your private health insurance will be on top of your Universal Health Care in both cost to you and payment to your doctor or hospital. Reimbursement of costs will be made to your provider or directly to you in the approved amounts. Your private insurance will only have to pay the amounts over and above those already covered. Your cost for private health insurance will be lower than it is today.

Argument #7: But I like my doctor and want to keep them.
You may. It will be up to your doctor whether they want to keep you as a patient. They can accept the payment the new system provides or they can charge an additional fee. At that point it is up to you to decide if you really prefer them and to what degree.

Argument #8: What about malpractice insurance, if doctors get paid less (and they will) how will they afford malpractice insurance?
Universal Healthcare Coverage in America will continue to have private hospitals, doctors and other providers. Part of the new system will be defining loss benefits and coverages with the singly buyer covering those loss payments as incurred. Should any given doctor or hospital incur too many losses they would be limited or entirely barred from practice.

Important Point #1: We are already paying for the uninsured.
Estimates point to about $1 trillion per year incurred in emergency room costs by uninsured patients. They may have the flu, been in a car accident, or have a life-threatening disease but they don’t have insurance so they go to the emergency room, where by charter and moral obligation, they are treated even though the hospital knows they will not receive payment. Because of this, the hospital has to charge more for the services they provide to people that do have insurance or can afford to pay out of pocket.
If you pay for your health care, you are paying for the uninsured people already and those costs are higher than if they received treatment outside of the emergency room at a lower cost facility.

Important Point #2: Why do insurance companies pay less than the uninsured?
This is truly one of the great inequalities of the current system in America. Insurance companies negotiate rates for everything – hospital stays, drugs, devices and physician services – down to Medicare or lower levels yet, when a person of any means but without insurance walks in the door, they pay full price. Similarly, even those with insurance but before deductible is fulfilled often pay the full price.

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