The audience waves signs as Sen. Bernie Sanders (I-Vt.) speaks during an event to introduce the Medicare for All Act of 2017 on Wednesday, Sept. 13, 2017. (Photo: Bill Clark/CQ Roll Call)

Time to Replace Deadly 'Wile E. Coyote Healthcare' With Lifesaving Medicare for All

Medicare For All is a call to sanity.

Medicare For All legislation is being introduced on Thursday by Bernie Sanders in the Senate and Pramila Jayapal in the House of Representatives. This legislation affirms life--not because it ensures an ongoing "domestic supply of infants" (to borrow a newly-coined phrase) but because it guarantees that every infant, as well as every child, adult, and senior, will receive the medical care they need when they need it.

Instead of sacrificing lives to a free-market insurance God, this legislation saves lives while retraining people in my old industry for the life-affirming jobs of the future.

Life is complicated, but the argument for Medicare For All is straightforward: it will save lives and money while increasing productivity, human emotional flourishing, and physical well-being. It will make a popular and successful program available to everyone, while making it even better by providing vision and dental coverage and eliminating copays and deductibles. Medicare For All is supported by more than two-thirds of voters, and 22 studies have concluded that it will save money.

A study in the medical journal The Lancet estimates that "ensuring health-care access for all Americans would save more than 68,000 lives and 1.73 million life-years every year compared with the status quo." (Emphasis mine.) In the midst of so much death--from Covid-19, addiction, alcoholism, and suicide--the passage of Medicare For All legislation would be an affirmation of life.

Wile E. Coyote Healthcare

I worked in the for-profit health insurance industry for many years, so I know something else: its value proposition is just as simple as Medicare For All's. Health insurance companies make money by denying care. It's that simple. That's their open secret. Premiums are set based on expected costs. If they deliver less care at less cost than expected, they win. More often than not, that also means you lose.

That's the part they don't tell you. That's the part that Medicare For All eliminates.

Here's something else they don't tell you. As Wall Street investors buy up more and more of the healthcare delivery chain, as well as its financial institutions, the more our so-called "healthcare system" resembles a Road Runner cartoon. For-profit providers try to maximize profits by driving up unit costs and the volume of services delivered. Like Road Runner, they zip through the medical landscape, racking up charges as fast as they can. The health insurance companies come up with increasingly complicated rules and contraptions to catch these Road Runners, no matter how much needed medical care is denied in the process.

I know. I used to design some of these contraptions. They weren't just unnecessarily complex. They were also weapons, catching innocent bystanders between the Road Runner and his adversary's rocket or giant flying boxing glove or whatever else the mail has brought from the Acme Company. The encroaching of for-profit insurance into Medicare, including Medicare Advantage and the "ACO Reach" program, is yet another attack on our health and safety by for-profit, Acme-style schemes and contraptions.

Medicare For All puts an end to that. By eliminating private health insurers from the process, it also eliminates all the complicated processes they insist upon, like utilization review, prior authorization, lists of approved and disapproved providers, retroactive charges and unexpected claim denials. That also means that patients will no longer have to spend countless hours dealing with insurance company bureaucracies.

A Copernican Shift

At the hospital level, the new legislation replaces this cartoonish system with something called "global budgets." This, too, is simple at its core. Instead of using elaborate systems to track diagnoses, treatments, and supplies--a system that is routinely gamed by all involved to the detriment of patients' health--each hospital will negotiate a budget that covers all its expected costs for the coming year. (Hence "global," meaning it covers everything.) If costs change suddenly--because of a pandemic, natural disaster, or other unanticipated events--the budget can be adjusted accordingly

This is not just a change in administrative processes. It is a philosophical change in the way health care is financed. Instead of using "incentives" to manipulate behavior, an institution is given the funds it needs to keep providing services for the next year. It's a Copernican shift away from the faux free-market ideology of the current system, toward a much simpler approach: giving hospital the resources they need to deliver care.

A Just Transition--That Kills No One

The legislation being introduced provides for a smooth transition from current insurance to the new Medicare For All system. It also provides for a just transition for workers who would be displaced by the elimination of our current labor-intensive system.

Medicare For All opponents often argue that it should be opposed because it would take away health insurance jobs. That's something the new legislation addresses with retraining and outplacement. In any case, that argument has always been more bizarre than it seems, because it trades the lives of some for the livelihoods of others.

Here's the arithmetic: One industry tracker reports that the health and medical insurance field employs roughly 600,000 people. Other estimates range as high as one million jobs or more. But this system kills people. If we take a high-end estimate--say, 1.2 million people employed in health insurance- and divide it by the number of needless deaths this system causes each other, we're sacrificed one human life annually for every 17 or 18 jobs. That's a scenario more appropriate to Shirley Jackson's The Lottery than it is to a modern health care system.

Instead of sacrificing lives to a free-market insurance God, this legislation saves lives while retraining people in my old industry for the life-affirming jobs of the future.

Equity for All

The new law also establishes an Office of Health Equity to ensure that healthcare is equally available to all population groups, including those groups that have disproportionately carried the burden of disease and death. Those categories include, but are not limited to race, ethnicity, Tribal affiliation, national origin, primary language, immigration status, age, disability, incarceration, homelessness, and socioeconomic status.

The Office will also be directed to review barriers to health care access, including income, education, housing, food insecurity (including availability, access, utilization, and stability), employment status, working conditions, and conditions related to the physical environment (including pollutants and population density); as well as lack of trust and awareness, transportation, geography, and other factors.

The importance of this can't be overstated. In a nation that was supposedly founded on the right to "life, liberty, and the pursuit of happiness," the lack of health equity denies those foundational rights to everyone.

Life Over Death

Our people are tired. We have seen so much death and suffering. Covid-19 alone has killed one million people in this country. For perspective, it has killed "nearly as many Americans as every U.S. war between 1775 and 1991--nearly 1.2 million people--according to data from the Department of Veterans Affairs." More than 150,000 people have already died of it in 2022.

And that's not the only suffering we've experienced. American life expectancy was already declining before the pandemic came along. The so-called "deaths of despair" from suicide, alcoholism and drug overdose were already surging, and overdose deaths continued to break all records in 2021.

People are looking for something positive in their lives. During the 2020 Democratic primaries, polls showed that more than two-thirds of voters (69 percent) supported providing Medicare to every American. Among Democratic voters, whose enthusiasm will be critical to the Party's prospects in November, that figure is 88 percent. Medicare for All could electrify this race. Instead, there is talk of ending the public health emergency (PHE) provisions that were enacted to cope with the pandemic. The Kaiser Family Foundation reports that more than 15 million enrollees, nearly half of whom were children, were added to government health programs since that program began. The Democratic Party should expand healthcare, not allow it to collapse on millions of vulnerable people.

Medicare For All is a call to sanity. It is a call to morality. Most of all, it is a call to reaffirm life in the midst of loss and sorrow. In challenging times, it calls us to be our best selves.

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