Health Letter, June 2019
By Azza AbuDagga, M.H.A., Ph.D.
“In a country as rich as the United States, blessed with talented medical professionals, world-class hospitals and research institutes, and an almost unparalleled capacity for technological innovation, the lack of universal health coverage should be a national scandal.” ― Gro Harlem Brundtland (Prime Minister of Norway and former Director-General of the World Health Organization) and Jimmy Carter (former U.S. President), November 2017.
In 2017, the U.S. spent $3.5 trillion (more than $10,700 per person) on health care — a staggering sum that accounted for more than 17% of the country’s gross domestic product and exceeded health care spending by all other 35 advanced industrialized countries that are members of the Organization for Economic Co-operation and Development.
Despite this unparalleled spending, the U.S. has the worst health outcomes out of all these other countries. For example, the U.S. ranked last in 2017 in terms of infant mortality and preventable mortality (deaths that could have been prevented with timely and effective care), and second-to-last on healthy life expectancy at age 60 compared with ten other major industrialized countries. Even after the Affordable Care Act, 29 million Americans remain uninsured and another 44 million have health insurance that leaves them unable to access medical care due to high deductibles and out-of-pocket expenses that they cannot afford.
That is why the call for Medicare for All in the U.S. has gained traction for the first time in decades. According to a 2018 survey by Reuters, over 70% of Americans would support a policy of Medicare for All for the U.S. health care system.
Public Citizen has called for legislation that would guarantee health care coverage for all Americans for more than 40 years. That is why we endorsed the Medicare for All Act of 2019 (H.R. 1384) that was introduced on Feb. 27 by U.S. Representatives Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) and supported by more than 100 democratic co-sponsors. We also endorsed the Senate version of this bill (S 1129) that was reintroduced on Apr. 10 by U.S. Senator Bernie Sanders (I-Vt.) and is supported by 14 co-sponsors.
On Feb. 4, ahead of the introduction of H.R. 1384, our Congress Watch team issued “The Case for Medicare for All,” a comprehensive report authored by Eagan Kemp, who highlighted in the report a wealth of scientific evidence supporting Medicare for All reform. The report debunked common myths and answered key questions about how Medicare for All would achieve health care coverage for everyone in the U.S. while reducing health care costs and making health care coverage more equitable and accessible.
Public Citizen’s report
“The Case for Medicare for All” report started by citing evidence that illustrates how Medicare for All would not actually increase health care costs, contrary to claims espoused by self-interested corporations. In fact, traditional Medicare spending has grown much more slowly than spending for private health insurance even though private insurers serve a younger and healthier population. Additionally, the cumulative change in health care costs for enrollees in private insurance was nearly double that for Medicare beneficiaries from 1987 to 2016. The report underscored the potential for Medicare for All to reduce inefficiencies given that just 2% of the annual budget for traditional Medicare is spent on administrative costs, whereas private insurers spend around 12% of their budgets on these costs.
The report cited estimates from a recent study by economists at the University of Massachusetts Amherst showing that Medicare for All would reduce health care spending by 19% relative to current health care spending. Medicare for All would achieve these savings through reducing administrative costs, negotiating lower pharmaceutical prices and setting uniform fees for hospitals and other health care providers. The report also noted that even a recent study by the Mercatus Center at George Mason University, a Koch-funded libertarian think tank, found that Medicare for All would result in $2 trillion savings in health care spending over a 10-year period starting in 2022.
The report clarified that Medicare for All reform would not increase the national deficit because the U.S. government already pays for two-thirds of the country’s health care spending and funding for the remaining one-third would come from dedicated sources, potentially including payroll taxes, taxes on Wall Street trades, increased taxes on high-income earners and taxes on unearned income. It noted estimates from the University of Massachusetts Amherst study that middle-class Americans would see up to 14% savings in their health insurance spending under Medicare for All compared with their current spending. Therefore, Medicare for All would result in reduced health care spending for individual Americans and for the country as a whole.
The report emphasized that Medicare for All reform would be an improvement over employer-sponsored insurance because a Kaiser survey showed that the cost for the latter insurance has increased by 58% from 2006 to 2016. Additionally, employer-sponsored insurance is plagued by inherent disadvantages for working families, including forcing enrollees to select health care providers from narrow networks and putting enrollees at risk of “surprise bills” for reasons that often are out of their control. The report explained that current Medicare and Medicaid enrollees would fare better under Medicare for All because it would mean no out-of-pocket costs and would offer them improved access to care, including better access to dental, vision, and home- and community-based long-term care.
Given that several studies have shown that Medicare beneficiaries report consistent access to health care and that beneficiaries can schedule timely appointments for primary and specialty care, the report noted that broadening the system to the entire population would not lead to increased wait times. The report added that improved financial incentives for health care providers under Medicare for All would mean better prioritization of care, leading to improved access and a reduction of unnecessary costs.
The report estimated that transitioning the entire U.S. population into a Medicare for All program would take two to three years. Noting that after Medicare was signed into law in 1965, the program enrolled more than 19 million people in the first year, the report anticipated that Americans would be eager and quick to take up the new coverage and fight to protect health care expansions once they are implemented. Therefore, the report concluded that “[w]e are at a rare moment in time, in the window of what might be a once-in-a-century opportunity to boldly reshape our health care system to expand and improve access to care such that we could potentially leap-frog the countries that currently outperform us in health outcomes.”
The way forward
The sentiments and facts stated in our report were echoed by powerful testimonies from the researchers, health care leaders and consumers who testified before the historical first hearing on Medicare for All held on Apr. 30 by the House Committee on Rules.
Public Citizen’s report emphasized, “Medicare has successfully achieved universal coverage for Americans 65 and older since its passage more than 50 years ago.” The House Committee on Rules tweeted a similar comment just hours after the Medicare for All hearing, attesting to the massive public support for expanding Medicare to finally include everyone in America.
Public Citizen is not going to sit idly by as insurance companies and pharmaceutical companies that benefit from the current expensive and fragmented health care system continue to spend more than $500 million a year lobbying politicians to prevent the passage of Medicare for All.
On Apr. 4, Public Citizen and a broad coalition of allies (including Our Revolution, National Nurses United, American Medical Student Association, Local Progress, Healthcare NOW, People’s Action, Ultraviolet Action and others) launched a grassroots campaign to build the people power at the local level to overcome corporate opposition and win Medicare for All. Through its new toolkit at medicare4allresolutions.org, activist webinar trainings and grassroots activities around the country, the coalition is working to mobilize people to encourage their local elected officials in cities, counties and towns from coast to coast to pass hundreds of resolutions supporting Medicare for All legislation.
On Apr. 29, Public Citizen supporters and hundreds of nurses, patients, doctors and workers plastered the front of Big Pharma’s lobbying headquarters in Washington, D.C., with GoFundMe pages and Band-Aids to call out our fragmented, for-profit system that keeps health care out of reach for too many Americans. And we are mobilizing constituents in key districts around the country to urge their members of Congress to co-sponsor and champion Medicare for All.
Public Citizen will continue its long fight for guaranteed health care through Medicare for All until health care becomes a realized right for everyone in America, just as it is in every other comparable country around the world.