The US Supreme Court has a chance to do the people of America a big favor, perhaps atoning at last for its shameful betrayal of the electoral system in 2000 when a conservative majority stole the Florida, and national election, for George W. Bush, and for the liberal-led and equally shameful betrayal of fundamental property rights in the Kelo v New London case that, in 2005, upheld the public theft of private homes in Connecticut on behalf of a government-backed resort development. The court can atone for these betrayals by declaring the ramshackle, corrupt, hugely expensive and cynically misnamed Affordable Care Act to be unconstitutional.
The act, pushed through a Democratic Congress by President Obama in 2010, is a disaster, a cobbled-together set of measures that was fatally corrupted by the insurance lobby and other parts of the nation’s medical-industrial complex, which leaves millions uninsured, continues to tether workers to their employers like indentured servants, and undermines the Medicare program, which should be the cornerstone of a real health reform.
By killing this monstrosity of political expedience and lobbyist strong-arming, the Supreme Court’s conservative wing could give us a good chance to finally move the country to a real national health reform which would reduce costs substantially, provide quality health care to all, and finally drive a stake through the heart of the health insurance industry, the real “vampire squid” of American capitalism which has been sucking money out of American’s wallets and driving many into bankruptcy for decades (family health crises are the major single cause of bankruptcies and homes foreclosures in the country).
How can it be a good thing to kill a program that at least eliminates things like the denial of insurance coverage because of “pre-existing conditions,” or the throwing people off of coverage when they get seriously sick?
Because these reforms have come at the cost of keeping the insurance industry central to the whole health financing process, when all it is in reality is a blood-sucking middleman that makes its money by figuring out ways to deny care to those it is supposedly “covering.”
By killing the whole “Obamacare” law, the court will throw the system back into crisis mode, forcing the public and the political system to finally consider the only real answer: expansion of the Medicare program to cover everyone.
There is a reason why the US is the only major modern developed nation in the world (with the exception of Switzerland, which is an interesting case about which I have written earlier) that relies on the private insurance industry and employer-based coverage and that it also spends more on health care both per person and as a percentage of GDP of any other nation (20% of $14.6 trillion in 2010!) , while being well down on the rankings in terms of health statistics such as life expectancy and infant mortality.
The reality, which both the political leadership and the corporate media have studiously avoided discussing, is that if the US were to shift to a system in which every person was covered by a well-funded Medicare program such as is currently available to every citizen over the age of 65, the total cost of healthcare for the nation — currently about $2.9 trillion per year — would be massively reduced, as would the cost of health care for nearly all individuals, with the exception of those politicians and wealthy executives, and perhaps a small group of workers in highly unionized professions, who have their entire family insurance coverage paid for by the taxpayer or by their companies.
The reason extending Medicare coverage to everyone instead of just those who have reached 65 would be cheaper is quite obvious. The older people are, the more their medical care costs. In fact, even within the Medicare program, 90% of the $475 billion in costs, or about $428 billion, is for medical care for the 10% of the Medicare population who are the oldest. The other younger Medicare recipients require far less medical care. This is even more true for people who are under 65. People in middle age typically have far fewer visits to the doctor, far fewer hospitalizations, and are in general far healthier than those over 65. The only exceptions to this inverse relationship between age and cost of health care are infants and small children, who can require more care, including childbirth itself, than older children, and women who have children, who obviously require more care than younger or older women, or women who choose not to have kids.
Politicians have refused to consider Medicare-for-all as a reform option because of course it would require raising taxes, which in the US has become a political death wish, but that’s simply because no political leaders have had the courage–and no corporate news organization has shown the ethical integrity — to point out that raising the Medicare tax from its current 1.5% on employee and employer, would mean that employees and employers would at the same time be relieved of paying for private insurance coverage, doctor’s bills and hospital co-pays, prescription drugs, etc.
The savings that most people would see in getting rid of the private costs of health care, and the savings employers would see in no longer having to pay for private insurance coverage for their workers, would dwarf any tax increase needed to fund this expansion.
Furthermore, as I have pointed out earlier, there would be other huge taxpayer savings that would happen instantly with the adoption of universal Medicare such as they have in Canada. Among these: $100 billion in Veterans care (who needs the socialized Veterans Administration system when all veterans would have their care covered under Medicare?), $100 billion a year in federal subsidies to state Medicaid programs, which cover (sort of) the health care for the poor, plus the other $50 billion that state taxpayers pay for at the state level (another $50 billion goes to pay for nursing home care for the indigent), plus several hundred billion in “charity care” which is either directly paid by state and local agencies (with taxpayer funds) to public and private hospitals that cover those indigent patients who don’t qualify for Medicaid but who cannot pay their hospital bills, or that is simply “cost shifted” into higher costs and ultimately higher premiums for insured patients. As well, it is estimated that some 20-30 percent of the nation’s entire $2.9 trillion annual health care bill is spent on administrative costs, most of which is part of the effort by the insurance industry to deny or reduce coverage, or by the insurance industry and the other parts of the system to collect payments from patients or employers. Nearly all of that absolutely wasted $2-300 billion in non-care expenditure would simply vanish in a Medicare-for-all system, which devotes only about four percent of its budget to administrative costs. That is to say, in other words, that by adding everyone to Medicare, taxpayers would automatically save — immediately — $650-750 billion in current costs.
Add to that the over $1 trillion in private insurance premiums paid annually by US workers and their employers, and by the self-insured self-employed, all of which would no longer be needed, and you’ve eliminated some $1.7 trillion in health care costs, or more than half the nation’s total medical bill, which would allow for a quite substantial increase in Medicare payroll taxes while leaving almost everyone feeling quite a bit better off, and much more secure.
We know all these above savings would be real. Canada, which has Medicare-for-all, devotes 10% of GDP to health care for its citizens, making it one of the most expensive systems in the world, except for the US, which currently devotes an astonishing 20% of GDP to health care, and which, once Obamacare goes into full force in 2014, will be devoting an even higher percent because of the lack of cost controls in the system.
And remember, while the US spends twice as much as Canada as a percentage of GDP, our “system” still leaves over nearly 50 million people with no real access to health care, with too much income or assets to be able to qualify for Medicaid, but still unable to afford see a doctor or to pay for a critical medical test or for needed medicine. Canada, at half the cost, leaves nobody out in the cold.
You’ve never read an analysis like this in a corporate-run newspaper or seen it presented on a corporate radio or TV news or public affairs program. They all get far too much in advertising revenue from the Medical-Industrial Complex. You haven’t heard it on public broadcast networks either, which have been happily taking money from the same industry sources-p-like Johnson & Johnson, Aetna, and Merck for example, or foundations like Robert Wood Johnson, for years. Michael Moore laid it out in his wonderful film Sicko, which did a beautiful job of debunking the US media’s disinformation about the Canadian and French and British health care systems, but that film has been suspiciously absent from late-night TV film programs, despite its great reviews and awards.
But the Supreme Court’s current hearing considering several conflicting appellate court rulings on the constitutionality of “Obamacare” offer us hope that we will finally get to hear this argument about Medicare-for-all, because if the court’s ideologically right-wing majority tosses out Obamacare, and says that the federal requirement that people have to buy insurance if it isn’t provided by their employer is illegal, the whole Rube Goldberg edifice collapses, and there will basically only be two remaining choices: letting tens of millions of Americans die of easily curable diseases because they cannot afford health insurance or medical care and the government won’t pay for them, or expanding the Medicare program to cover everyone.
Obviously, the moneyed interests that hope to continue to earn profits off the public by denying us care, will continue to try and buy Congress and the president. And obviously the majority of American businesses, led by the US Chamber of Commerce and the Business Roundtable, will continue to advocate for an employer-based health insurance system because of the control it gives them over their workers. (How many unionized workers will dare to strike if they are going to have their health care benefits cut off while they’re walking a picket line? How many non-unionized workers will demand a raise or challenge an unsafe working condition if there’s a risk of being fired and losing health coverage for a family?) If the American people look squarely at those two options, and given the large number who have learned over the past four years that almost anyone can suddenly find her or himself jobless and without health benefits, it seems clear which option the vast majority of us will demand: Medicare for all.
Dave Lindorff is a founder of This Can’t Be Happening and a contributor to Hopeless: Barack Obama and the Politics of Illusion, forthcoming from AK Press. He lives in Philadelphia.