If you go outside at 8 pm on any given night, you can hear people howling. I often join in too. We’re voicing our support for health care providers and other heroes—the women and men working on the front line of this pandemic. But we know that howling isn’t enough.
An EMT made that point in a message she sent me recently. I had written to thank her for her service.
“Please thank us by ensuring that the same people who drive the ambulance can also afford to go the hospital if they get sick,” she said. “Many of our firefighters can’t afford medical care if they get sick or injured off the job.”
Her request: Medicare for All.
It’s a bold plan, but that’s what this crisis demands.
In the midst of an even deeper downturn, FDR called for “bold, persistent experimentation.”
For the last 80 years or so, our nation has conducted a different kind of experiment—tying health insurance to employment. That arrangement was not deliberate or logical; it’s mostly an accident of history.
The link between insurance and employment took hold during the Second World War, when the federal government both froze wages and made benefits tax-free. That prompted many employers to offer health insurance as a means of attracting workers.
This model was flawed even before the current crisis hit. Workers often lose or change their jobs. Employers don’t always provide insurance. And many people find themselves locked in jobs (or even marriages) they don’t want for fear of losing coverage.
The result: more than 72 million Americans go without enough health insurance—or any at all.
The pandemic is making that problem even worse. As many as 35 million people are projected to lose coverage this year.
It doesn’t have to be this way. It’s not this way in other parts of the world.
Many of our competitors have managed to cover more of their population at lower costs and with better outcomes. Few turn to the United States as a model for health insurance.
The U.S. does lead the world in health care spending, shelling out roughly twice as much per person as other industrialized countries. Yet half a million families go bankrupt each year—and more than 35,000 Americans die—because of the cost of care.
Those numbers will undoubtedly rise as the coronavirus continues to wreak havoc. If we’re serious about cutting health care costs and expanding coverage, we should not go back to “normal” when the pandemic ends.
Instead we should improve Medicare and expand it to all. That means adding benefits for dental, vision, hearing, and long-term care; increasing reimbursement rates for Medicare providers in rural and other underserved communities; and lowering the age of Medicare eligibility to 0.
A public option, as some candidates favor, would be better than the status quo. But the people most likely to enroll will be sicker and more expensive to treat, making that pool less competitive.
The most efficient and least expensive way to deliver real reform is to create a single, universal risk pool. A study recently published in The Lancet projects annual savings of $458 billion and more than 68,000 lives.
We can’t achieve those savings or implement that plan overnight. But we can get there—if we’re willing to take on the special interests that stand in our way.
Harry Truman proposed national health insurance in 1945. Republican opponents screamed “socialism,” just as they did when Medicare and Medicaid were enacted 20 years later, and just as they do today.
These attacks, which now come even from some misguided Democrats, are neither accurate nor constructive. The U.S. already provides universal health care, in the most expensive place possible: the emergency room.
That’s a federal guarantee, not a socialist plot. It’s part of the Emergency Medical Treatment and Labor Act, a law signed by Ronald Reagan.
But as a paramedic can tell you, the ER is not the best spot—and certainly not the cheapest—for primary care. We can save money and save lives by listening to our health care heroes and fixing this broken system.
Let’s keep howling until that happens.
— Andrew Romanoff is a Colorado Democratic U.S. Senate candidate