Expanded Medicare for All: What It Is and What It’s Not (Part Two)

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The Illinois Single-Payer Coalition-CU (ISPC-CU) is on the move. Following its successful November 16 workshop on improved and expanded Medicare for All (Med4All), held at the Champaign Public Library, ISPC-CU is laying the groundwork for further grassroots action in the local community.

Future plans include continuing to collect signatures on petitions urging Illinois Senators Dick Durbin and Tammy Duckworth to sign on as co-sponsors of the Med4All bill introduced by Senator Bernie Sanders. Earlier efforts conducted by one of ISPC-CU’s co-founders, CU Democratic Socialists of America, paid off dramatically. Approximately 2000 signatures were collected at the Urbana Farmers Market. Open to both organizational representatives and individuals, ISPC-CU hopes to get resolutions in support of Medicare for All legislation adopted by local governmental bodies.

ISPC-CU’s effort are hardly unique. On October 19 of this year, a diverse range of community, faith and labor groups delivered over 2.2 million petition signatures demanding Med4All to the House of Representatives. Currently 75 national organizations and 105 state and local groups have formally endorsed Med4All. To date, moreover, 23 localities, including Cook County, have passed resolutions in support of Med4All.

Perhaps even more startling, given the long history of American Medical Association (AMA) opposition to single payer, is how resistance is declining dramatically in this body. At a June, 2019 meeting, a proposal to remove the organization’s opposition to single-payer health care was narrowly defeated 53 percent to 47 percent. Two months later, single-payer advocates used their muscle to get the AMA to pull out of an industry coalition devoted to stopping single-payer plans.

A poll of 1000 Chicago-area doctors indicates that 56 percent support Med4All. Meanwhile, more doctors are joining activist organizations like Physicians for a National Health Care Program, which now has 30,000 members across the country, and recently added 14 new chapters. Nurses have flocked to National Nurses United, which has long been on the forefront of efforts to bring single payer to the US.

All of this portends well for the future of Med4All, but opposition has also been fierce, and can be expected to become more pronounced. In Part 1 of this article, some of the common myths that opponents have used in arguing against Med4All were reviewed. Other common myths will be tackled here. But before doing so, especially for those who might have missed the first part, a brief review of the substance of Med4All is in order.

What is improved and expanded Med4All?

The current Med4All bills before Congress are Senate Bill 1129, introduced by Senator Sanders, and House Bill 1384, introduced by Representative Pramila Jayapal. Both bills stipulate the creation of a single-payer health care system that would eliminate gaps in the current Medicare program and extend expanded coverage to all US residents. Covered services would include inpatient, outpatient, ER, dental, vision, mental, and long-term care, as well as drugs and medical devices. Service access would no longer be dependent on enrollment in a private health insurance plan or alternate government programs (e.g., Medicaid, CHIP, etc.). Premiums, deductibles, and co-pays would be eliminated.

Myth: Med4All will lead to rationing

One of the most common myths regarding Med4All is that it will lead to rationing. The reality is that severe rationing exists in the current health care system. A recent Harvard Medical School study estimated that about 44,789 people die annually due to being uninsured or underinsured. A Gallop survey concluded that in the last five years, 34 million Americans watched as someone they knew died because they couldn’t afford medical treatment.

Other evidence refutes claims of long wait times for care in countries with single-payer systems. A 2014 Commonwealth Fund study found that wait-time problems were not present in most of these countries. Another study considered whether rationing and long wait times cause Canadians to seek treatment in the US. The researchers found the numbers of such Canadians is so small as to be barely detectable in national health surveys.

Myth: Med4All ignores the problem of displaced workers

With the dramatic reduction in the need for administrative workers in both hospitals and insurance companies once Med4ALL is implemented, the need for a “just transition” for displaced workers is obvious. Displaced worker estimates under Med4All range from around 1 to 2 million workers.

The transition will not mean lost jobs for everyone, however. Insurance industry employees may continue to work in administrative functions, such as working for companies that Med4All may contract with to assist with billing and payments. Given the system-wide reduction of overall administrative costs, including multi-million dollar CEO pay, more funds will be available to expand the numbers of health care providers like doctors and nurses. This means that health professionals who have been relegated to administrative work prior to Med4All would now be able to return to health care delivery jobs. In addition, expansion of certain types of services, including mental health and public health services, may provide new opportunities for some former private insurance industry workers.

Finally, both Med4All bills currently before Congress include multi-year salary replacement funding, as well as funds to cover job counseling and retraining of displaced workers. For example, the Senate bill allocates up to one percent of the total health care budget for such efforts.

The counteroffensive

While advocacy on behalf of Med4All is on the rise, a counteroffensive against it has simultaneously become more vocal and strident. Recently, for example, both Republicans and mainstream Democrats, as well as the corporate media and the pundits it employs, have pointed to a recent study suggesting that the costs of moving to Med4All are prohibitive.

Produced by economists at the Urban Institute (UI), the study suggests a total Med4All cost of $32 trillion over a ten-year period. This figure is similar to that projected in an earlier study by academics at the University of Massachusetts (discussed in Part 1). But unlike the Massachusetts study, the UI researchers did not include a projection of what total health care costs would be absent a Med4All reform. In fact, the costs absent reform would be $35 trillion as opposed to $32 trillion, a total savings to the economy of $3 trillion.

Another point of resistance comes from ultra-wealthy individuals like Bill Gates and Jeff Bezos and their allies, who argue that paying for Med4All by placing a comparatively heavier tax burden on the rich will negatively impact economic growth, since they will have less disposable income for productive investment.

In fact, there have been numerous studies refuting such claims, not least several recent analyses of the effects of the most recent tax cut on investment. It is also worth noting that in the Eisenhower years, when economic growth was high, the marginal tax rate for the wealthiest was 90 percent, while today it is 37 percent. It seems there is quite a bit of room for the rich to pay more without negative effect on the economy. Indeed, to the extent Med4All creates health care savings for individuals and families and provides them with more money to purchase consumer goods, growth in total consumer demand can provide a real boost to the overall economy.

But even if large holes can be poked in the arguments of Med4All’s opponents, health care business interests have deep pockets for a protracted media propaganda campaign and strong lobbying arms in Congress. The only way to beat them is through expansion of the grassroots initiatives already underway both locally and nationally. Here in C-U there is the Illinois Single-Payer Coalition; please consider joining!

Data sources available on request at pat.simpson@frontier.com. You can also use this email to find out more about joining the Illinois Single-Payer Coalition-CU.

Part 1 of this article appeared in the October/November issue of Public i.


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