Biden Ran on a Return To Normalcy, but There's Nothing Normal About the American Health Care System
In poll after poll, Americans have indicated their preference for a universal, single-payer health care system. Compromise and half-measures are not acceptable. Medicare for All remains the goal.
The federal response to the deadly coronavirus pandemic under President Trump has been a public health disaster with nearly 250,000 Americans dead and no clear end in sight.
In sharp contrast, President-elect Joe Biden pledged to mount a serious response against the coronavirus. Biden implored Americans in a recent speech to continue to wear face masks and announced a panel of health care experts to begin to counter a surge of COVID-19 hospitalizations throughout the country.
On the matter of health reform, however, the president-elect offers measures that would merely bolster and even expand the same private health insurance system that has generated increasing profit during the pandemic while depriving the country of the resources necessary to produce an adequate supply of PPE. Physicians, nurses and other frontline health care workers are fighting COVID-19 with their hands tied behind their backs.
Biden ran on returning the country to normalcy, but there was nothing normal about the American health care system even before the pandemic. In fact, our dysfunctional health care system remains an outlier among the rest of the developed world for not providing universal health coverage.
The American health care system devours an ever-increasing share of our economy with health spending accounting for an astounding 17.9 percent of the GDP, the highest in the world. Yet we have little to show for it. Americans suffer some of the worst health outcomes compared to other industrialized nations. Even before the coronavirus hit the U.S., life expectancy was on the decline. Our infant and maternal mortality rates are higher than those of any comparable country, and racial and ethnic disparities in infant and maternal mortality are getting worse.
The quality of American health care isn’t any good either. Shockingly, more than 250,000 Americans die each year from medical errors. That’s nearly as many as the amount of people that have died from COVID-19 as of this writing.
Is that the kind of return to normalcy that Americans want, need, or deserve?
The answer, of course, is no.
In poll after poll, Americans have indicated their preference for a universal, single-payer health care system. An exit poll on election day conducted by Fox News revealed that 72 percent of voters wanted a government-run health care system.
That publicly-funded system, more commonly known as Expanded and Improved Medicare for All, is within our grasp. All we need to do is call out those Senators and Congresspeople who are in the pockets of the private, for-profit health care industry. According to Open Secrets, health care providers, Big Pharma, medical equipment manufacturers, and drug and medical product retailers pumped $178 million into the 2020 election cycle so far. Separately the insurance industry (including but not limited to health insurance) added another $85 million. The new kid on the block, adark-money group called the Partnership for America’s Health Care Future, has been targeting Democrats who support either Medicare for All or the “public option” in its 2020 election year ad campaigns. No wonder legislators continue to ignore the clear desire of their constituents for a health care system that puts the public, not the shareholder, first.
For health care reform advocates who want to purge profiteering from health care, returning to “normal” is not an option.
More than 10 years after the passage of the Affordable Care Act (ACA), 87 million Americans remain uninsured or underinsured. The ACA has not changed the fact that medical bills continue to push millions of people into personal bankruptcy, with Americans having borrowed a stunning $88 billion to pay for medical treatment in 2018 alone. Nor has the ACA halted the inexorable increase in premiums, deductibles and copayments that are blocking access to care for millions of workers and their families who have employer-based group health insurance that is too expensive to use.
Biden’s public option plan, which would enable people to enroll in publicly-funded insurance plans that would compete against private insurers on the ACA’s marketplace exchanges, won’t change this picture either. A 2013 analysis conducted by the Congressional Budget Office predicted that a public option would have “minimal effects” on the number of uninsured. For a real world example, we need only to look at the abysmal failure of the nonprofit health insurance co-ops that were given a similar mandate to compete with private insurance under the ACA. Out of the 26 original co-ops, only three exist today.
The public option is destined to fail as long as private health insurers are allowed to thrive. They will find new and increasingly sophisticated ways to undermine public insurance by cherry-picking the healthiest subscribers for themselves and shunting the more expensive, chronically ill patients to public insurance, compromising the potential savings that universal public financing of health care would yield.
While the historic election of Biden and Harris removed the immediate threat of a draconian take-down of the ACA, it does not augur well for the kind of transformative social change that Americans need right now. The struggle continues. Compromise and half-measures are not acceptable. Medicare for All remains the goal.
by Dr. Jessica Schorr Saxe
|Medicare for All would close gaps in racial inequality in American healthcare.|
The American healthcare system is expensive, inefficient, and plagued by racial inequities.
The COVID-19 pandemic shines a harsh spotlight on those deficiencies, particularly for Blacks and other minorities. George Floyd’s murder has forced the country to give long overdue attention to finally establishing racial justice. Now is the moment for us to definitively address healthcare, along with other critical issues of racial justice.
The United States has performed dismally compared to other developed countries. With 4% of the world’s population, we have had 25% of COVID-19 cases. Cases and deaths rise at alarming rates, while many other countries have controlled the spread. In the U.S., Black and Hispanic communities have borne the brunt of the impact with three times the rate of infection and twice the rate of death. In Mecklenburg County, Black people accounted for 40% of the deaths not connected to long-term care facilities.
The main difference between the U.S. and the more successful countries is our lack of a national health program with universal coverage and coordinated health planning. Several of our failures point out how improving and extending Medicare to everyone might have helped with Covid-19, especially for Black people.
Before the pandemic, millions of Americans were already uninsured or underinsured (insured but unable to afford medical care), with Blacks disproportionately affected. Many people deferred testing or treatment for fear of expense. The is the precise opposite of the response needed to protect us all. People who have been exposed or are feeling sick need to be tested so they can be treated and isolated. Their contacts must be traced and quarantined as needed to prevent spread. Instead, many people are dying and suffering severe illness after delaying care. Many who tried to do the right thing and sought testing and care were stuck with large bills.
The pandemic has worsened our pre-existing condition of insurance inadequacy. The surge in unemployment has predictably resulted in millions losing employer-based coverage. Many will remain uninsured, especially in North Carolina and other states that didn’t expand Medicaid. Even those eventually able to secure other insurance will suffer major disruption as they navigate a new bureaucracy to acquire it and may be forced to change providers and medications.
This is the poison pill of our system: just when individuals most need health insurance and our country most needs them to have it, it’s vanishes into the ether.
Why have Black Americans suffered disproportionately from the COVID-19 pandemic? Multiple reasons include inadequate insurance prior to the pandemic, loss of access due to loss of employment, being essential workers, and having less ability to work from home. Black Americans are also more likely to have underlying conditions that put them at higher risk for complications or and death. These conditions are not due to genetics, but to racism, indirectly through its effects on education, economic security, housing, and exposure to air pollution; and directly through the stress of racism itself.
Medicare is the most popular health insurance in the country. Black Americans should take particular pride in it, as Dr. Montague Cobb, president of the National Medical Association, led Black doctors in supporting Medicare, while the almost entirely white American Medical Association opposed it. Because of the hard work of the NMA and the NAACP, hospitals had to integrate to accept Medicare money.
Just as Medicare led to hospital integration in 1966, Medicare for All can be a major step toward eliminating racism and racial inequities. With everyone in the same system, everyone would be eligible for high-quality care. By cutting the connection with employment, no one would lose their coverage if they lost their job. Everyone could get care during a pandemic, protecting their health and that of the public. People with high-risk conditions wouldn’t feel forced to work just to keep their insurance. And everyone could get their necessary preventive or chronic illness care, pandemic or not.
It’s now more obvious than ever that our employer-based health system has failed us. As the pandemic has so harshly proved, it’s time for Medicare for All.
Dr. Jessica Schorr Saxe is a retired family physician in Charlotte who is chair of Health Care Justice—NC. Write her at HCJusticeNC@gmail.com.
The NC Medicare for All Coalition (NCM4A, www.ncm4a.com), comprised of dozens of NC-based non-profit and grassroots organizations that are dedicated to enacting real solutions to our nation’s healthcare crisis by advocating for Expanded and Improved Medicare For All, is compelled to comment on the inadequate recommendations released by the Biden-Sanders Unity Task Force on July 8. Among the many topics covered in this document is Achieving Universal, Affordable, Quality Health Care. Despite a promising heading - and recent false reports that the Democratic platform now includes Medicare for All, the Democratic Unity Task Force recommendations don’t address the insufficiencies of our health care system during this devastating pandemic, and they fail to offer universality, true affordability, or significant quality improvements. Furthermore, the recommendations are out of step with the wishes of the American people, who overwhelmingly support universal healthcare.
The NCM4A Coalition believes the Unity Task Force recommendations are a series of small incremental changes that don’t address the root cause of our healthcare system failures - namely, that fragmented, corporate-run healthcare, rife with administrative waste, is focused on shareholder profit rather than public health. Our current healthcare system is the most expensive in the world; yet even before this pandemic 87 million people were either uninsured or underinsured, meaning their high out-of-pocket costs kept them from accessing medical treatment.
Now, the US’s record number of coronavirus cases and deaths demonstrates the urgency of moving to a truly universal, publicly financed system, where all people are covered and protected. COVID-19 has also exposed the absurdity and systemic racism inherent in tying health insurance to “white collar” employment. From February to May, at least 5.4 million U.S. workers lost their jobs and employer-sponsored health coverage due to COVID-19. When factoring in dependents on those plans, Kaiser Family Foundation estimated a much higher total of 27 million people stripped of their health insurance in a two-month period this spring -- in the middle of a pandemic, when access to preventive, emergency and therapeutic health care is more critical than ever! In North Carolina, more than half of those who are uninsured are people of color while making up less than a third of the state’s population. Thirty percent of Latinx people in NC are living without health insurance.
The Task Force’s recommendation for helping these newly uninsured workers is to use public money to subsidize the most expensive private health insurance on the market - COBRA. Instead of this fiscally irresponsible idea, the Coalition urges the government to empower Medicare to cover all uninsured people at a fraction of the cost. Yet, this immediate solution to the health and economic impact of the pandemic, detailed in the Health Care Emergency Guarantee Act, is not mentioned in these recommendations, nor is the long-term solution for providing cost-effective, universal coverage: Expanded and Improved Medicare for All. According to dozens of economic studies, including one published in the Lancet, Improved Medicare for All would cost less than our current system over 10 years while covering everyone in the country, eliminating medical bankruptcy, and guaranteeing that people’s lives and savings aren’t destroyed when they become sick or injured.
As Dr. Elaine Greene, MPH, OBGYN, plainly stated at NCM4A’s Black Health Matters Roundtable (available in Spanish here): “Our current corporate, profit-driven system...is broken and in dire need of sweeping reform, and we see that even more clearly in the midst of the coronavirus pandemic. Improved Medicare For All is the only truly single-payer, universal system that enables everyone to get the health care that they need, and if enacted could have a profound effect of reducing racial health care disparities.”
As we face this public health and economic crisis, we have an unprecedented opportunity to create an equitable, efficient, and fiscally responsible health care system that prioritizes and protects the health and well-being of all people in America during the COVID-19 pandemic and beyond. The solution is not a piecemeal approach that serves only select groups, but Expanded and Improved Medicare for All.
- Action NC
- Apoyo NC
- Asheville DSA
- Center for Justice and Reconciliation
- The Coalition for Health Care of NC
- Down Home
- Duke SNaHP
- Health Care for All Western NC
- Health Care for All NC
- Health Care for All UNC
- Health Care Justice UNCC
- Health Care Justice NC
- Health Care for All Y'all
- League of Women Voters (LWV) of the Piedmont Triad
- Muslims for Social Justice
- Muslim Women For
- NARAL Pro Choice NC
- National Association for the Advancement of Colored People (NAACP)-NC
- National Nurses United
- NC Alliance for Retired Americans
- NC Council of Churches
- NC Green Party
- NC Poor People's Campaign
- NC Public Service Workers Union, UE Local 150
- Planned Parenthood South Atlantic
- Southern Anti Racism Network (SARN)
- Southern Workers Assembly
- Triangle DSA
- Winston-Salem DSA