In light of the media’s recent attention to single payer healthcare and the release of Bernie Sanders’ proposed plan, Students for a National Health Program (SNaHP) would like to rectify public misconceptions of and clarify our stance on Medicare-for-All.
Several themes have recently emerged in online and print media in arguments against Medicare-for-All type reform. The first is the notion that, in order to cut costs, “Foreign single-payer systems pay doctors less”. While doctors from the US are some of the highest paid in the developed world, their reimbursement is not nearly as reliable as that of physicians abroad. In the US, physicians often have trouble collecting payments from private insurance companies and patients alike. Medicare, on the other hand, reimburses at a reliable rate, and while some have attempted to argue that expanding Medicare to the entire population would reduce physician income, studies of the Canadian transition showed that physician incomes actually rose after transitioning to single payer.
The true cost savings of Medicare-for-All come from Medicare’s superior efficiency, not from cuts in physician incomes. Medicare administrative overhead was approximately 2% in 2011; the current rate of administrative costs among private insurers varies between 12-20%. Instead of delegating valuable resources to hiring the hundreds of billing specialists required to manage insurance claims from innumerable private contractors (as shown in a comparison of health care administrative costs between Canada and the US), hospitals under a Medicare-for-All system would be able to use funds for needed medical care. Making billing manageable for small practices would allow for independent providers to spend a greater proportion of their time with patients and less time on accounting. This transition to a Medicare’s simpler administrative structure estimates savings of $476 billion per year alone.
The next argument that deserves more thorough discussion is the notion that countries with national health programs “pay pharmaceutical companies less.” We have long recognized that pharmaceutical companies will be among the first to protest single payer because the government’s purchasing power will cut into their profits. And some have argued that allowing the government to negotiate drug prices would hurt innovation. However, pharmaceutical companies spend more money on marketing than on R&D while also generating enormous profits, and there is little evidence to suggest that lower drug prices would lead to less innovation (nor is there evidence showing single payer health models are less innovative).
Finally, various sources have also argued that physicians are not in support of Medicare-for-All. While there have not been many surveys of physician opinions on single payer, what data exists suggests the opposite conclusion. For instance, one 2008 survey of 2193 US physicians showed that 59% of respondents supported Medicare for All, with only 32% opposing. Meanwhile, Physicians for a National Health Program, a single issue organization advocating a for single payer, has a membership of over 20,000 physicians, medical students, and other health professionals.
We believe that the media has failed to address the overwhelming arguments in support of healthcare reform. First, the public likes Medicare. Six out of ten Americans say Medicare is working well for most seniors while more than three-quarters say Medicare is a very important program, ranking just below Social Security (meanwhile, “customer satisfaction with [private] health insurance has reached its lowest level in a decade…”). Seniors’ contentment with Medicare is for good reason: according to a 2014 Commonwealth Fund comparative health systems analysis, single payer systems (what Medicare exemplifies) outperform the US on nearly all measures of health, including access, efficiency, equity, healthy lives and cost.
Also, mentioned nowhere in recent articles by Vox, the Washington Post, and others is the fact that Americans want to expand Medicare. According to a recent Kaiser Health Tracking Poll, nearly 6 out of 10 say they favor the idea of Medicare-for-All (including 34% who say they strongly support it). Another 2015 Gallup poll found that 51% of Americans support the notion that government should ensure health care coverage. And in Massachusetts (the “Obamacare-test drive” state), 72% of patients at safety net hospitals favored National Health Insurance over the Massachusetts reform.
Beyond the fact that Medicare-for-All would allow us to contain our spiraling healthcare costs lies an even more crucial point: what Medicare-for-All promises, and what our current system fails to deliver, is universal care for ALL Americans. Despite public opinion that Americans have universal care, our current system leaves nearly 30 million Americans without insurance and another 31 million underinsured with trouble paying their medical bills. The extent of this problem is so vast, in fact, that the majority of personal bankruptcies are still filed as a result of medical debt. Additionally, as it stands now, a quarter million Americans adults will die over the next ten years due to issues related to uninsurance. As future health professionals, we see the financial challenges our patients face, and many of them forego care due to costs. Beyond the wards, we and the vast majority of Americans can personally name family members or friends who are directly affected by the choice of providing for their families or for receiving overdue, necessary medical care.
Lastly, we would like to address recent comments made by Hillary Clinton’s campaign against Bernie Sanders’ health plan, saying he wants to “dismantle Medicare”. Quite the contrary, the “Medicare-for-All” plan would provide health insurance to ALL Americans under the model of Medicare, with significant improvements. While Medicare currently imposes out of pocket costs on seniors, many single payer plans (including Sanders’) would eliminate co-pays and deductibles and make care affordable for all. We applaud Senator Sanders for laying the groundwork for making Medicare-for-All a part of the conversation and urge him to continue to provide necessary details about his policies so that the country can have the debate it needs. We further urge Secretary Clinton to reconsider her attacks on universal healthcare as contrary to the values which she professes. Given her stated support for universal coverage, we respectfully request she rethink her opposition to the only plausible mechanism for achieving it.
We support open and honest debate on healthcare reform and appreciate the media’s recent attention to this issue, but it is important that this discussion be based in facts rather than misinformation. At the end of the day, our health reform is going to reflect how we view the health of our country: do we view healthcare as a commodity that should be left to market forces much like that of cars or a pair of shoes? Or do we see healthcare as a invaluable right much like education and security? As future physicians, we believe that healthcare is a human right that should be available to all Americans, regardless of ability to pay. We want to work in a system where we can focus on taking care of the sick rather than spending endless hours fighting with private insurance companies. While improving and expanding Medicare to all will not solve all of our healthcare system’s problems, it provides a solid foundation upon which to build a truly equitable, just, and healthy society for all Americans.
Students for a National Health Program (SNaHP) represents over 1000 medical and health professional students from over 50 US medical campuses. Since its inception in 2011, SNaHP has been a non-partisan active voice in the single payer health reform movement.