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Learning to accept Medicare For All

The Kaiser Family Foundation reports that 53 percent of Americans support a Medicare For All single payer national health care system. This editorial is not for these people. Instead, it is written for the 43 percent of Americans who oppose the proposal.

The object here is to change these people’s minds.

The way we hope to do this is not by arguing that Medicare For All would provide better health care access, improve public health or control soaring medical costs. Opponents of Medicare For All have heard and rejected all of these claims.

Instead, we will take a different tack.

Our argument is not that Medicare For All is a better system, but that, in all practicality, it is inevitable. As such, we say it is better to embrace the plan than needlessly fight it.

The facts for this argument turn up in an unlikely place, the Wisconsin Hospital Association 2019 Workforce Report.

What the report shows is that the nation’s health care system is headed for disaster. It says that America’s 80 million Baby Boomers are growing old and gray. The number of U.S. citizens over 65 years old will increase by 48 percent by 2032. Within this group, 75 percent will have multiple chronic diseases. This growing number of older and sicker people will be increasingly expensive to take care of. Ninety-five percent of U.S. health care spending is spent taking care of people’s chronic conditions.

While America will need more health care, it will lack the people needed to provide it. The current hospital workforce is aging and a large portion, especially licensed practical nurses, will retire when patient numbers will peak. The Bureau of Labor Statistics reports there are currently 635,000 unfilled medical jobs in U.S. health care. This health care worker gap will grow worse.

This is a perfect storm of trouble. More patients over 65 means more Medicare payments that don’t cover the full cost of care. A labor shortage means paying more for health care workers, increasing costs. Together, these two trends mean hospitals, as well as other health care providers, must scramble for money.

The result will be unaffordable health insurance. Hospitals typically accept Medicare payments below their costs, but, to show a net income, overcharge commercial health insurance customers (companies and individuals) to make up the difference. Thus, according to the Rand Corp., Wisconsin hospitals in 2017 charged their commercial insurance customers 279 percent what they charged Medicare. Predictably, this percentage will swiftly increase. Here, in Wisconsin, large group commercial insurance premiums paid by employers have tripled since 2000. Going forward, this rate of increase will only speed up. Businesses will no longer be able to pay increased premiums. They will unload more of the cost of health insurance on workers. These workers, however, will lack resources to pick up the higher costs of premiums, co-payments and deductibles. The system will crash. It has to.

One answer to this problem would be to end Medicare. That’s not on the table, however. A second answer is for the federal government to increase Medicare reimbursements. This is possible, but, in doing so, the federal government would have to increase taxes and then hope that local doctors and hospitals would reduce charges and, in turn, hope a second time insurance companies would lower their premiums.

Here is where Medicare For All makes sense. With everyone on Medicare, health care providers would no longer get to overcharge commercial insurance customers. There would be no such customers. The government would pay everybody’s health care bills at prices it would set. Such a system would require a tax increase, true, but this would buy a halt to runaway medical inflation. Everyone would pay Medicare rates.

Realistically, under any scenario, the nation must raise taxes to pay for health care. Under Medicare For All, however, these taxes would purchase control over an out of control system, rather than trusting that medical providers and insurance companies will, against their self interest, voluntarily lower their charges.

So, go ahead, hate Medicare For All, but recognize it as a necessary evil to deal with a health care system that’s guaranteed to implode. Grudgingly accept it, but accept it nevertheless.