We hear a lot of rhetoric about universal healthcare, one of the most popular proposals (which I support) being Medicare for All. But what does universal healthcare really mean for the American people?
The simplest definition is a system of healthcare for all paid for with public funds. Providers (which means doctors, hospitals, and everyone else who renders health care to patients within the system) provide the care, and it is paid for with money that comes from taxes.
In its pure form, then, there is no health insurance, there are no bills, and there are no deductibles or copays. You, as a human being in need of health care, consult me, a physician; I take care of you; no money changes hands; the government pays me, using public dollars (tax revenues) for what I do.
Depending on how you view the government, the thought of a government-run health care system may hold more or less (maybe even zero) appeal for you. But in its most basic sense, the essence of what I’m writing about here is public financing of health care, which can occur within but does not require a healthcare system that is operated by the government.
So, for example, the Medicare and Medicaid systems are financed with public dollars, and the government operates the Veterans Health Administration. Right there you can see how a broad spectrum of opinion might be generated on the idea of the government doing things. The VA has its admirers and critics – recently mostly critics, because of failings in looking after the health care needs of veterans, and Medicaid has more critics than there are crystals of salt in the ocean, it seems, while Medicare gets pretty high satisfaction ratings from seniors.
Aside from fundamental mistrust of Big Government by some, there is concern about Big Waste by the feds. Well, Medicare is, by any measure, less wasteful than just about any private health insurance enterprise, in that it spends a higher proportion of every dollar on health care, with less going toward administration and zero going to profit. The role, or lack thereof, of profit in the health care system and the way we finance it is an essential part of the consideration of “socialized medicine.” That could be the subject of a very long essay all by itself, but if you believe the profit motive is bad in this context, I submit that universal healthcare is the only way to eliminate it.
Some doctors are suspicious of a system that would essentially make them government employees – and they aren’t the only ones. Many of us like to quote, derisively, the imaginary expression, “I’m from the government, and I’m here to help you,” as if those two things couldn’t possibly go together, and anyone who says such a thing should be viewed with a mixture of amusement and paranoia.
But we don’t have a problem with firefighters being government employees. Or the Coast Guard. Or air traffic controllers. Or any number of other people we trust with our lives. So we certainly shouldn’t assume that doctors who are government employees would be in any way inferior. The patients in the VA system do not, as a rule, have a problem with the quality of the doctors but with the system that lacks the capacity to care for them.
As a nation, we recognize that shortfall, and we are demanding it is remedied. If we had a system for everyone that had inadequate capacity, how quickly do you think we would demand – and get – action to solve that?
Many who deride socialized medicine look to the United Kingdom’s National Health Service and say people wait weeks or months for elective surgery, and Americans won’t tolerate that. Three things you should know about that: First, Americans with no health insurance don’t wait weeks or months for elective surgery. They wait forever. And that is unacceptable in the wealthiest nation in the history of the world.
Second, the satisfaction of the Brits with the NHS is higher than our satisfaction with our non-system, regardless of any of the (exaggerated) claims about their waits for elective surgery.
Third, per capita spending on health care in the UK is half what it is in the U.S. I am entirely unwilling to believe we couldn’t create a system that covers everyone with what we’re spending, with high quality and no long waits for anything.
[What we have now, instead, covers 85 percent of our population, many with woefully inadequate health insurance that has ridiculously high copays and deductibles, and leaves 15 percent.
If you think we can’t do that, I must ask you why.
Two possible answers come immediately to mind. The first is that we are a lot dumber than the Brits, and although that is possible, I don’t think so. The second is that we cannot do that without eliminating all of the waste associated with having a for-profit health insurance industry, in which many dollars intended to be spent on healthcare are, instead, spent on administration (twice what the government spends for Medicare administration), and profit, and seven-figure executive salaries.
If you guessed that the second possibility might indeed be a big part of the problem, go to the head of the class.
I must now ask you to consider a simple question: If you work for a living and have employment-based health insurance, it’s called a benefit of employment. That means you worked for it. You earned it. And every dollar that you earned that is spent on health insurance premiums is, in principle, a dollar that should be spent on health care.
Looked at the other way, every such dollar that is not spent on healthcare is a dollar wasted. So, every dollar that a health insurance company diverts to profit, to eye-popping executive salaries, and excessive administrative costs is a dollar wasted. Looked at even less charitably, every such dollar spent on those other things is a dollar stolen from you.
The solution? Eliminate the health insurance industry. If we do that, we must have a new way to finance health care. What would that be? Re-read the first two paragraphs. And now you know the answer to the question posed in the title of this essay.
Utopia or dystopia? Neither. It is, plainly and simply, what we must seriously consider if we hope to have a system for financing and providing health care that works for everyone, rather than the absurdly fragmented and wasteful non-system we have now.