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 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 $13,700.
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 prices.
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 negotiation strife.
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 really unrealistic.
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 this fight.
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 Program