By Valerie Eastwood, J.D., LL.M.
The time is NOW! On September 13, 2017, along with 15 co-sponsors—Tammy Baldwin, Richard Blumenthal, Cory Booker, Al Franken, Kirsten Gillibrand, Kamala Harris, Martin Heinrich, Mazie Hirono, Patrick Leahy, Ed Markey, Jeff Merkley, Brian Schatz, Tom Udall, Elizabeth Warren, and Sheldon Whitehouse—Bernie Sanders introduced Medicare for All, single-payer health care legislation in the U.S. Senate. “Today we begin the struggle to transform our dysfunctional health care system and make health care in the United States a right, not a privilege,” said Sanders.
As a health law attorney, I’ve been an advocate for access to services in our federal health care programs, primarily Medicare and Medicaid, for years. I have worked for the federal government and in private practice, representing clinics, hospitals, doctors, suppliers and patients. During all that time, access to healthcare coverage in the US has been in a continuous downward spiral. The Patient Protection and Affordable Care Act of 2010 (ACA) was a temporary fix of some of the worst abuses. The law’s identification of mandatory “essential health benefits” was a welcome ray of light in a very dark area. But those concerned with drafting the ACA and pushing it through Congress knew it was imperfect, that it would quickly need to be reworked and expanded. And many of us believed it was guaranteed eventual obsolescence from the moment that President Obama took the “single payer” option off the table.
For now, the ACA is worth defending; the present Congress is unlikely to pass anything better. In fact, it has been demonstrated that we are at risk for much worse. But had the ACA adopted a single payer system in 2010– “Medicare for Everybody” is an idea most people can understand and likely support – we would not be in our present dire situation. Millions of people are now faced with losing their health benefits, people with pre-existing conditions may be forced to pay hundreds of thousands of dollars more in premiums, the return of “lifetime maximum benefit” provisions will limit care for those who need it most, including children with congenital conditions, and the elimination of the minimal services that were deemed essential under the ACA, including yearly medical examinations, will make us a sicker society and drive up costs. I believe had we adopted single payer eight years ago, most Americans would now understand and accept that their healthcare was a basic human right.
Most of us in the health care field recognize that we will move to a single payer system eventually. Our system of cobbling together health insurance benefits based on employment has no rational basis. It is collapsing under its own weight. It puts millions of people at risk and heightens their fear of job loss. It traps people in their jobs, stifling creativity and entrepreneurship; people who have ideas for start-ups and small businesses cannot risk taking a chance on their dreams because they depend on employer-provided health insurance. Due to deeply ingrained concepts of American exceptionalism, we have trouble working from the example of other industrialized nations. But most of us know that single payer or some form of public/private two-tier universal coverage is at work in those countries and that these systems have high ratings for satisfaction and quality of care. Even President Trump, not known for his insight or veracity, recently recognized that Australia has a much better health care system than the one in the US – it is single payer!
The recent passage of the Republican bill in the US House of Representatives, the American Health Care Act, was a big win for insurance companies and those who profit from our national disgrace. More than anything else, the insurance companies and the politicians they support do not want Americans to internalize the concept of healthcare as a basic human right. Of course, this concept is taken for granted in other industrialized countries. Recent public town hall meetings and protests on Capitol Hill and across the US have demonstrated that people demand reliable access to healthcare for all. If we do not push for a single payer system now, while people are aware and angry about this issue, Congress will continue to tamper and toy with this basic human right every single time it is in session. The American people crave consistency and dependability but there will be no real certainty about anyone’s health benefits. Parents will continue to face agonizing choices in healthcare needs for their children, sick people will continue to take less than their prescribed dosage of medicine in order to stretch the drug over a longer period of time, families’ retirement savings will be at risk since a single surgery or hospital stay can wipe out these savings.
I live and work in Hartford County, Connecticut. Insurance providers are huge employers in this area. I believe these companies can lead in the transition, and serve our country by providing their experience and knowledge in working for solutions rather than defending a status quo that will eventually become untenable. Many people do not realize that our nation’s insurance companies actually administer the Medicare program as contractors to the federal government. These contracts are profitable for the companies and beneficial to the American people. We should harness the expertise and business acumen of the insurance industry in implementing a single payer system that serves all of us.