Clarifying Prospects for US Health Care

By TOM JOHNSTON

The US healthcare system never provided healthcare for all US citizens. Yet, US healthcare costs have grown much faster than the US economy, putting healthcare out of reach for more and more people. Between 1970 and 2019, the US healthcare system grew in size from about 7% of US GDP to 18% of GDP, according to Kaiser Permanente.

Currently, the US voting public has almost no reliable sources of education concerning the various terms, plans and concepts that are currently being discussed, thereby confusing many. As we witness and even vote for one of the options that Democratic politicians are proposing, it’s important to remember that none propose universal health care. The only proposals currently being offered to satisfy the “right” of all US citizens for healthcare are proposals that offer health insurance for all.

The current US healthcare system consists of the following four groups: providers, private sector insurance companies, employers and government payers.

Providers include medical, mental health, and alternative practitioners, drug companies and hospitals.

Insurance companies include 900 for profit and non profit private sector health insurance companies.

Employers include those companies that offer health insurance as a part of their compensation for employment. In this case, employees must use the health insurance company chosen by their employer, which they can change at will. Because health insurance premiums, co-pays & deductibles have increased by 20% in the last 10 years, more and more employers are discontinuing offering health insurance as a perk or passing along much of the costs to their employees.

Government payers include the Veterans Administration and military (the largest US healthcare providers) Medicare (federal program) and Medicaid (federal program administered by states).

Each Democratic presidential candidate favors differing plans to deliver healthcare for the US population. The invalidation of Obamacare by the Supreme Court would leave US healthcare primarily in the hands of 900 health insurance companies and Medicare for those over 65.

More than 27 million Americans are uninsured and millions more are under-insured. When Americans without health insurance need healthcare, they must pay exorbitant rates, threatening their livelihoods and their lives.

Democratic politicians have proposed a range of fixes to the US healthcare system. Bernie Sanders, for example, has proposed a Medicare for All bill and Elizabeth Warren has co sponsored it. This bill proposes a four-year phase in to enroll all US citizens in an expanded Medicare program. During the first year, Medicare eligibility would be expanded 10 years to include all those above 55. Each following year, all above 45, then 35, then 25 would be added. Those under 25 are included on their parents’ Medicare plans.

The following descriptions outline the options put forward by various Democratic candidates for president:

Single Payer is a general category and Medicare for All is a specific term for the same way of delivering healthcare. Should this proposal pass, instead of 900 private insurance companies, the US government would provide health insurance for all US citizens. The Medicare program now available to all US citizens over 65 years of age is the most cost-effective healthcare provider program in the US, and takes care of the needs of the most health-challenged sector of the US population.

Average yearly healthcare cost estimates for three major population groups are: children 0-18: $3,600, working adults: $6,000; those over 65: $11-18,000. In a recent Kaiser Family Foundation poll, 87% of Democrats supported “Medicare for All,” while 64% of Democrats supported “single-payer” health care. That statistic shows that the different labels used in debating healthcare policy often are not explained and therefore are misunderstood. Even though the present Medicare health insurance program is a type of single-payer program, it does not cover vision, hearing, dental and long-term care that the Medicare for All bill that’s now in Congress would include.

Public Option health insurance would give you an option to choose a Medicare-like plan for your health insurance that would compete with private sector health insurance for buyers. Some think this competition would pressure private sector health insurance companies to lower their rates, since public option plans are likely to be cheaper. Pete Buttigieg’s plan, for example, “Medicare for All Who Want It,” is a version of a public option. Elizabeth Warren announced Nov. 15 that she’d start with a public option plan before transitioning to a Medicare for All type plan.

Universal Coverage is a goal that all US citizens have health insurance coverage. Note that coverage is an insurance word. Coverage does not mean care. The Affordable Care Act contained a provision for states to expand Medicaid and created the individual health insurance exchanges. Both of those provisions significantly cut down on the number of uninsured people, but currently more than 27 million Americans do not have health insurance, and the number of people who lack insurance is rising. Most Democratic presidential candidates would like to achieve universal coverage but debate the best way to get there.

“Socialized Medicine” and “Government-run” health care are terms usually used in the US by opponents of government-supported healthcare. The UK is an example of a nation whose government provides health care directly to everyone in the UK by employing healthcare practitioners and owning hospitals. When I was in the UK, I had an auto accident and the hospital treated me at no charge. None of the Democratic presidential candidates has proposed nationalizing healthcare providers. The single-payer health insurance plans proposed by US politicians would still be implemented by the private sector, but the government would pay the bills. The next installment of this series will address options for funding universal coverage for US citizens.

Tom Johnston, M.U.P., M.Ed., has dealt with multiple health insurance companies as a healthcare practitioner since 1980. An experienced political analyst, he graduated from the University of Michigan in political science and international relations, founded and directed a state-licensed vocational school, was the urban planner for the Pike Place Market in Seattle and served as a US Naval officer.

From The Progressive Populist, March 1, 2020

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