Coronavirus: A good argument for Medicare for All – March 18, 2020

first published in The Seattle Times

Special to The Times
As an obstetrician-gynecologist and member of Physicians for a National Health Program, I have long supported sweeping changes in how health care in the U.S. is financed, from challenging the cost and gate-keeping roles of health-insurance companies to the price gouging by big pharma. COVID-19 has laid bare the weaknesses in our system and the urgent need for Medicare for All. We cannot nationally isolate or personally buy our way out of this outbreak.

As Washingtonians shelter at home and our economy plunges into recession, the problem with a health-insurance system based on employment becomes increasingly clear. Workers are financially incentivized to avoid screening and show up for work despite symptoms. The threat from loss of wages for small businesses and gig workers as well as those on unpaid sick leave raises the negative impact of insurance payments, copays, premiums and the ability to self-pay. GoFundMe reports that a third of its campaigns are done to pay medical bills. The Trump administration’s talk of sending $250 billion directly to millions of Americans is a desperately needed temporary fix that will explode the deficit and ignore the demands for structural changes.

To make matters worse, the Trump administration’s public-charge rule, recently upheld by the U.S. Supreme Court, allows federal officials to refuse immigrants green cards if they use social-safety-net programs. Add to that the tens of thousands of migrants and asylum seekers housed in the more than 200 immigrant prisons and jails in the U.S., not to mention our general prison population, and we have a vast pool of vulnerable, disenfranchised people who suffer from lack of access to adequate nutrition, health care and housing. Poor communities are most susceptible to infectious disease and to a lack of resources to screen and treat. Recently, 700 public-health experts called on the federal government to maintain safety programs, to fund local health centers in underresourced areas, and to be sure that testing, vaccines and treatment be available regardless of ability to pay.

Even before this crisis, millions of U.S. citizens suffered financial disasters due to medical bills, were forced to declare personal bankruptcy, or forego needed care. Some polling shows there is support for Medicare for All, even in populations that are “satisfied” with their health insurer. Often not reported is that Medicare and Medicaid recipients are even more likely to be “satisfied.” The myth that most citizens are “happy” with their private insurance belies the fact that the private health-insurance industry restricts our choices, dictating which physicians, hospitals, treatments or medications we can use. Under Medicare for All, every physician would be in-network, and physicians and their staff would not spend hours battling with insurers.

Ironically, despite the fact that we spend much more money on health care than other first world countries, we are not the healthiest. U.S. infant mortality is 5.8 per thousand live births, in Canada 4.5 and Britain 4.3. The “mortality amenable to health care,” i.e., deaths that could have been prevented by medical intervention, also reveals distressing numbers: 112 per 100,000 in the U.S., but 78 in Canada, and 85 in the U.K.

Medicare for All would restrain drug prices and dismantle wasteful administrative costs, freeing up billions of dollars for health care. This isn’t about restricting care, but rather developing a more effective and fair way to pay for it. Traditional Medicare spends about 2% on administration, less than one-sixth the cost of private health insurance companies.

The Democratic Party needs to solve the critical, fundamental political and moral question: How can we guarantee that no one is locked out of the health-care system due to cost while providing quality care to all? More than 2,500 physicians have signed an open letter supporting Medicare for All. Our patients desperately need an end to the inhumanity of our health-care system exposed once again by this devastating pandemic.