Letter: The Case for Medicare for All

Both sides of the political aisle have been complicit in supporting the profiteering of our health caste system to the detriment of all citizens. The profiteers and politicians care more about their wealth than your health.

There is no free lunch in our health caste system consisting of 28 million uninsured, 65 million Medicaid, 44 million Medicare and 167 million Privately insured people. This health caste system is a reprehensible example of income inequality. The unpaid and underpaid costs of service in the system drive up the costs for Private and government health insurance while healthcare corporate greed pushes the costs even higher.

Medical debt is a costly burden that weighs on millions of patients who seek life-saving care, it's the leading cause of bankruptcy in America and the largest source of personal debt among consumers. The current health caste system excludes 28 million people from coverage, places 65 million children, disabled and nursing home patients in the lowest paying insurance level, isolates 44 million medicare recipients into the highest cost population, and allows private insurance to profiteer on 167 million Americans.

In 1960, health care accounted for 5% of the gross domestic product (GDP) of the USA by 2020 health care accounted for 19.7% of our GDP. Health care costs do not bring revenue into the country; they take revenue from companies and individuals. The increase in health care costs has not been driven by individual provider (doctors, therapists, etc.) costs but administrative costs and corporate profits. Individual providers would benefit from a single-payer system that would allow them to significantly reduce the administrative costs of billing.

The cost of caring for a population is shared by each person in the insured population. When a homogeneous grouping occurs the risks and cost per individual may increase or decrease dramatically. The following data from the Kaiser Family Foundation illustrates the difference in per capita health care spending in 2019 by age group; 0-18 $2,426, 19-34 $3,484, 35-44 $4,694, 45-54 $6,734, 55-64 $10,203 and 65+ $13,016.

There are 245 million persons below the age of 65 with health insurance and 44 million 65 or older on Medicare. When these two populations are combined the weighted average for health care spending becomes $5,800. When the politicians cry about the high cost of Medicare and the need for reform they are being disingenuous at best.

With Medicare for All you level the healthcare playing field and spread the cost over a huge, diverse population. With Medicare for All, you have a single-payer system that will have the power to lower the overall cost of healthcare and improve the quality of care provided. The US healthcare system costs per capita are twice as much as any other developed nation while ranking 37 for quality of care by the World Health Organization.

Congress could significantly lower the pharmaceutical costs for all Medicare recipients today with one simple act. The federal government has already negotiated significantly reduced pharmaceutical rates that are used by the VA, qualifying hospitals, and Community Health Centers. Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to healthcare organizations that care for many uninsured and low-income patients. Congress can mandate Medicare patient eligibility for a 340 B medication discount now instead of playing their current woe is me game.

Medicare Advantage plans are taxpayer-subsidized private insurance plans that escalate the cost of healthcare while generating millions of dollars in profits for insurance companies. Three sources of revenue for Advantage plans include general revenues, Medicare premiums, and payroll taxes. The government pays a predetermined amount every year to private insurers for each Advantage member. These funds come from both the Hospital Insurance (HI) and the Supplementary Medical Insurance (SMI) trust funds. These companies are in business to make a profit. To offer $0 premium plans, they must make up their costs in other ways. The reality is that Medicare for All would eliminate the need for Medicare Advantage plans because the overall cost of healthcare would drop significantly enough to offer all the extra benefits provided by advantage plans to all citizens in the US while still costing less than the totality of the current system.

The Affordable Care Act (ACA) allows low-income individuals and families to access Private health insurance with the assistance of federal subsidies of the premium costs. The Affordable Care Act does nothing to lower healthcare costs and is a boon for the private insurance industry. The ACA does not eliminate co-pays and deductibles which can be significant. While this is a noble endeavor, Medicare for All would create access for all and have the power to dramatically lower the cost of healthcare.

Medicare for All would shift trillions of dollars back into the private employment sector by cutting the cost of healthcare in half. The money saved by industry could be used to increase profits and wages as well as make made in America more economically attainable. There are actually enough dollars to be saved in the current system to pay for Medicare for All while cutting the current cost in half.

Some examples of cost eliminations and revenue reappropriations are; saving $616 billion by eliminating Medicaid, saving $9.7 billion by eliminating the Community Health Center program, save $500 billion in excess administrative costs, $150 billion in medical device savings, $150 billion in excess drug costs, save billions of dollars through government bureaucracy elimination, save billions of dollars by eliminating private health insurance profits.

The Medicaid program is a shared cost program between the Federal government and each State. In Florida, 20% of the state budget provides payments to private insurance companies for providing Medicaid insurance to its citizens. With Medicare for All, Florida would not have this cost in its budget and could reduce the taxes on its citizens or reallocate these funds for other needed services.

Ray Fusco

Manatee County

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