Monday, February 1, 2016
January 31, 2016
The Real Healthcare Debate Democrats Should Be Having
By Paul Y. Song, MD
Recently, a fierce debate has been ignited within the Democratic Party
regarding the merits and feasibility of a single-payer Medicare-for-All
universal healthcare system. Some liberal commentators have summarily
dismissed Senator Sanders' proposal as politically unrealistic or as
greatly lacking in details while championing a slightly improved status
quo, and other political surrogates have spread GOP-like untruths that
have no place in any honest discussion.
Regardless of ones' individual beliefs on Medicare-for-All, it is
crucial to note some indisputable facts regarding the Affordable Care
Act (ACA) and the current status quo:
1. While the ACA did indeed do some very positive things like end
lifetime caps on medical coverage and do away with discrimination for
pre-existing conditions, it was never intended to cover every uninsured
individual. In fact, after the ACA is fully implemented, the
Congressional Budget Office estimates that up to 29 million residents
will still remain uninsured.
2. The only area of the ACA that both Democrats and Republicans found
mutual agreement on was to exclude our undocumented brothers and sisters.
3. The average insured family still pays an extra $1,017 in premiums
(hidden tax) to cover the cost of care for the uninsured.
4. A recent Commonwealth Fund study revealed that 31 million people
with insurance had such high out-of-pocket costs or deductibles relative
to their incomes that they were UNDER-insured and that 51% of these
adults reported problems with their medical bills
while 44% of all adults reported not getting care because of high
co-pays and deductibles despite being insured.
5. Even after a significant decrease in the total number of uninsured,
there were still 1.7 million medical related bankruptcies in 2014
<http://www.cnbc.com/id/100840148> of which 75% were actually insured,
and this is only expected to get worse.
6. Most individuals in the U.S. cannot afford an annual deductible of
$6,850 and most families of four cannot afford an annual deductible of
7. Despite premiums increasing over 150% over the past 9 years, there
is no federal insurance rate regulation.
8. Despite the fact that average branded drug prices have increased
127% during the past 8 years to the point that 73% of Americans now find
the cost of drugs unreasonable, there was no mechanism to control drug
9. Many states have huge underfunded retiree healthcare liabilities.
California's alone is $150 Billion.
10. Healthcare costs are currently 17.5% of GDP
with over 1% of GDP spent on Prescription drugs alone, and will only
continue to climb as mandatory federal health spending is projected to
double in the next 10 Years.
11. Recent data from the American Journal of Public Health found that
tax-funded expenditures accounted for 64.3% of all U.S. health spending
U.S. health spending for 2013 was $9,267 per capita, with government's
share being $5,960.
12. Prior to the bailout, GM spent more on healthcare for its employees
than it did on steel. Rising healthcare costs are making U.S. companies
less competitive and taking money away from wages and capital investments.
13. Most Americans continue to get employer-sponsored healthcare but
worker's contributions to premiums have increased 212% since 2000 while
wages have only increased 54% during the same period.
14. Healthcare benefits have become the biggest source of labor
So if anything, most health policy experts believe that our current
healthcare system is unsustainable for individuals, businesses, states
and our federal government, and to continue this status quo is what is
The real debate Democrats should be having should not be about whether
single payer, a highly successful proven system in so many
industrialized nations, is the solution, but rather how we can
collectively come together to overcome the corporate forces that
derailed the ACA from providing a public option, drug price controls and
insurance rate regulation, and how we get to the ultimate goal of
Medicare for All.
Back in 2003, then Illinois State Senator Barack Obama said in a speech
to the AFL-CIO, "I happen to be a proponent of a single payer universal
healthcare plan...but first we need to take back the White House, then
the Senate, then the house".
Sadly, when Barack Obama became President and had a supermajority in the
Senate and House, single payer was never even introduced as an option.
In fact, well before the ACA was even written, the pharmaceutical
industry under the guidance of former congressman and Medicare Part D
architect, Billy Tauzin, negotiated a sweetheart deal that would provide
industry support for the administration's health reform agenda in
exchange for no significant reform of the pharmaceutical industry.
At the same time there were over 3,300 registered healthcare lobbyists
for the 535 members of congress who spent more in total than what was
spent on the entire Bush-Kerry election to influence the legislation.
Many of these lobbyists were former congressional staffers including two
former chiefs of staff to then Finance Committee Chairman Senator Max
Baccus. Many legislators from both sides of the aisle received lots of
money, but it was Baccus who received over $1.4 million and held up the
legislation in his committee for so long that Senator Ted Kennedy was
not alive to vote for it.
In the end, despite some positive aspects, the ACA looks like it was
essentially written by the pharmaceutical and insurance industry. It is
not socialism, but rather a $475 billion corporate welfare program that
mandated uninsured Americans buy a product from a for-profit industry
that only makes money by denying care, and this is why we still have so
many of the problems stated above.
Paul Krugman is correct when he says that Senator Sanders'
Medicare-or-All plan is not politically feasible today. As long as we
have Democrats who are consistently beholden to the Insurance and Pharma
cartels, we will definitely continue the status quo. As long as we do
not fight to reverse the awful cloud of Citizens' United and the grossly
disproportionate influence of money in politics, we cannot achieve any
meaningful progress in healthcare or any other critical challenge facing
our country and world.
Far beyond any Medicare-For-All proposal, what the Senator is really
calling for is a transformational movement, much larger than any one
individual, which can come together to fight against the Super PACs and
suffocating corporate influences. His campaign is the personification of
58 percent of Americans currently favor Medicare-for-All once they learn
more about it, and 81% of Democrats already believe it is the best
solution. So, rather than demonize it with lies and scare tactics, we
should be educating more and more people who are disillusioned with
their current healthcare so that more and more of us can demand
something better from our representatives.
Sadly, the biggest major insurers also recognize the benefits and
efficiencies of a single payer system and have begun to rapidly
consolidate through huge mergers, which further eliminates what little
competition consumers have. So the question is not whether we will have
single payer, but whether it will be administered by one ruthless
for-profit entity that will keep all realized savings for its
shareholders while continuing to gauge, deny, and shortchange its
patients. Or whether it will be a Medicare-for-all, which will use the
cost savings of administrative efficiency and bulk purchasing power to
increase coverage and benefits for everyone, to provide the humane and
comprehensive health care system we as a society truly deserve and
already pay for.
Above all, we need to remember that we ARE the party that rejected the
status quo and created a very bold disruptive new program called
Medicare at a time when 44% of seniors were uninsured and 1/3 were
living in poverty. We are the party for the least among us and for those
without a voice. We are the party of "Yes, we can".
/Paul Y. Song, is a board certified radiation oncologist and the
Executive Chair of the Courage Campaign, Co-Chair for a Campaign for a
Healthy California, and Board Member of Physicians for a National Health
Comment by Don McCanne
Currently the two leading candidates for the Democratic nomination for
president are debating whether or not a single-payer Medicare-for-All
universal healthcare system is politically feasible. Paul Song provides
us with evidence that our current system is inadequate and
unsustainable, so the real debate we should be having is whether we
should leave our health care system under the control the industries and
policies that are responsible for much of what is wrong, or if we should
initiate a transformational movement that will include Medicare-for-All
so that we can have "the humane and comprehensive health care system we
as a society truly deserve and already pay for."
This debate is not just for members of the Democratic Party. It is a
debate that the entire nation should be having. It is important that the
debate be informed with facts such as those presented here by Paul Song.
/Physicians for a National Health Program (PNHP) is a nonprofit,
nonpartisan, educational and policy research organization that neither
supports nor opposes any candidate for public office nor any political
party. Although Paul Song is a board member of PNHP, any partisan views
expressed in this article are his own and not those of PNHP./
at 12:23 PM