As we ramp up activity for the 2020 election, one of the big issues on the table continues to be “Medicare for All,” a somewhat misapplied short-hand label for universal single-payer health care.
In millions of online discussions, you’ll hear all the reasons why it won’t work. We can’t afford it, doctors will refuse to work, the U.S. is too big, etc.
It’s important to understand the larger picture here, because there are a couple of things standing in our way that we aren’t talking about…and as usual, those things are the real root of the problem.
Paying for it
The first objection you always hear is “how are you going to pay for that.” I want to shoot that down quickly so we can move on to the bigger issue.
You pay for it the same way everything else in this country is paid for. By congressional appropriation. I don’t want to veer off into a discussion of modern monetary theory (#MMT) here; there are plenty of folks out there more qualified to do so than I am. If you really want to understand that whole picture, I give my highest possible recommendation to the material written by economist Ellis Winninghame at his website.
The key points for our purposes are this:
- Taxes don’t fund the federal government.
- Taxes don’t pay for federal health programs
- Every dime the government spends is created on demand. Before it spends that dime, it creates that dime by “spending it into existence.”
- There is no fiscal constraint preventing the implementation of a universal single-payer health care system.
- The only thing necessary to “pay for it” is the political will of the United States Congress. If they want to, they can. Full stop. Why they don’t is part of what we’ll discuss below.
There are a host of observations regarding USP that are always offered up, and I want to address those quickly before moving on to the Big Point Here.
All of the objections to USP that don’t come down to “I’m a stupid bigot and I don’t want this minority group to have health care” come down to “I don’t want to pay for it.”
This is absurd. You already are paying for it, not only through insurance premiums but through inflated costs designed to protect the profit margins of organizations required by law to provide a certain level of care. The primary example of this is US emergency rooms; while not required by law in the strictest sense, ERs in the US must provide services to anyone who walks in or they are ineligible to bill Medicare and Medicaid patients. (NB: What we really want is much more accurately termed “MedicAID for All,” rather than Medicare, which has gaps and requires supplemental insurance and has deductibles and so forth, which Medicaid doesn’t.)
This massive misunderstanding is driven by decades of propaganda from drug companies, large medical organizations like the ones that likely own your local hospitals and clinics (e.g. Intermountain Health Care in Utah or Spectrum and Ascension in western Michigan), insurance companies, and other profit interests. There is, again, a bigger picture to this that goes beyond the scope of this article; suffice it to say that the idea that “my tax dollars” are required to fund universal health care or any other federal spending is a long-standing and pervasive myth that is now collapsing due to the diligent efforts of a small group of economists – Alexandria Ocasio-Cortez is probably the highest-profile of these, but Stephanie Kelton (an advisor to the Sanders campaign), the aforementioned Ellis Winningham, Steve Grumbine at Real Progressives, and many others – to educate the general public on macroeconomics.
But the economic aspect is only one part of the picture, and in the senses I discuss above it’s not the most important part.
The bigger problem
The bigger problem, the one we’re not talking about, is this:
We don’t have enough doctors, nurses, technicians, and other specialized personnel in this country to staff a proper health care system.
There are many reasons for this. Some of those reasons tie into the issues I’ve already mentioned – people who want to go into medicine can’t afford to do so because of the cost of education. People who want to go into medicine are afraid to do so because of the cost of sometimes (but not always) frivolous lawsuits. People who want to go into medicine don’t feel like they have the “free” time in their lives to spend eight or twelve years in school attaining a specialized doctorate.
We’re not talking about this. Oh, we talk about shortages of doctors in rural areas and what have you, but we haven’t connected these dots to the bigger picture.
All of this, of course, comes back to the problem of capitalism. The only solutions that can work involve some pain and lag time as educational and social welfare reform take place and create the opportunities for those who want to do medicine, to learn how.
Part of this is also our entrenched social values, that “protestant work ethic” that we tend to be so proud of. Because of this ethic, we’ve steadfastly refused to accept, advance, and implement automated mechanical solutions that could make the lives of medical practitioners easier and more efficient. Doctors spend thousands of hours every day, wasted hours, filling out paperwork for insurance companies, fighting against decision-makers whose only vested interest is in profiting from illness. A significant part of this lack of innovation lies within the same issues I’ve described above.
We have, by refusing to recognize the inherent conflict of interest that exists in for-profit health care, painted ourselves into a corner. We will spend significant time, at least a couple of decades, building our resources back up to a level that can realistically support a universal single-payer health care system.
Conclusions and prescriptions
The reality is, however, that we don’t have time to wait. We can not and must not allow these self-inflicted shortcomings and shortages to dissuade us away from USP. Rather, we must go into this new paradigm with the open and realistic understanding that simply declaring a new system and putting it in place is not a magic bullet, will not automatically transform our health care system into that of Canada or Finland or Switzerland or the UK, and may even result in short-term declines in quality of care as a severely understaffed health care system deals with a massive influx of desperate new patients, many of whom have never had consistent access.
We’re going to have to dig in, get used to the idea that there is no quick fix, and accept that we’ve got a long-term process to go through in order to fully realize the great potential of USP and its concomitant benefits to genuine freedom of individuals.
The generations that came before us were willing to make incredible sacrifices to ensure we could enjoy a better standard of living than they did.
Now it’s time for us to do the same.