Six years ago, Time Magazine devoted an issue to the cost of health care in the United States.  

“Bitter Pill,” by Steven Brill, marked a pivotal moment in the national discussion concerning health care.

Until its appearance, many of us willing to consider extending Medicare, as a practical matter, to all Americans had sometimes to wonder if we were just “cock-eyed optimists.”

“Bitter Pill” changed that.

Brill did not advocate Medicare for All. His purpose was to describe the “Alice in Wonderland” nature of the health-care industry in the United States, where:

  • •We spend nearly one fifth of our gross domestic product on health care. Most developed countries spend about half that. All that spending yields medical outcomes no better than outcomes achieved in those other countries.
  • •In any region of the nation, high in a listing of the most prosperous businesses will be the larger “not-for-profit” hospitals.
  • •Our fellow citizens charged the most for health care are those who can least afford to pay for it – the uninsured and the underinsured.
  • •There is little discernible reason apparent in the bills cranked out by “chargemasters” to individuals after a hospital stay. What is predictable is that the charges will be high and no ordinary individual has much of a chance to decipher them – let alone argue them down.
  • •The increasing cost of health care far exceeds general inflation.
  • •Improvements in technology and delivery do not result in lower prices, as they do in other high-tech industries. Instead prices steadily increase.
  • • Lobbyists for the health care and pharmaceutical industries, over the years, have spent more than three times what lobbyists for the defense and aerospace industries have spent and more than four times what the oil and gas industries have spent. What has all that lobbying gained? The emphasis in Washington remains not on why health care costs so much but on who will pay for it.

So how is Medicare a way out of this rabbit hole?

Ask Alice when she is10 feet tall and she might well answer that it would not be — if health care is regarded as a “right” to be paid for by making an already untenable federal deficit more untenable. This is essentially the proposal currently before the Congress.

Ask Alice when she is small and she might well answer that it is already demonstrable that Medicare obtains, by far, more value for each health-care dollar spent than any private insurer – and with far less administrative cost. 

Alice could tell you that Medicare could obtain even more value if it was not constrained by Congress to protect certain congressional pets – such as the inflated value paid by law for wheelchairs.

If Alice received mailings from AARP, she could tell you that seniors would pay less for prescription drugs if Medicare directly negotiated cost with the drug companies and not a Part D private-plan administrator. 

So why should not Medicare be “unleashed” by Congress to benefit all Americans?

Why, without altering the entitlements to retired persons and the disabled, should not all Americans be able, though not required, to purchase health insurance through Medicare?

Is it because the health care industry as a whole could not survive on what it would receive from Medicare alone?

Well, the right combination of national and regional oversight, such as is already in place, could work to ensure that earning-margins for providers remain in the curly single digits – the kind of return that for-profit businesses covet.

Basic Medicare coverage is the standard by which health plans are measured.  Many private plans do not measure up.

In a nation where a reported 60% of all personal bankruptcy proceedings are related to medical bills, making Medicare purchasable could do much to free individuals from fear that a health crisis might devastate their financial well-being.

Making Medicare purchasable for employers to provide health care for their employees could make cost less burdensome -- thereby enabling more entrepreneurship and capital investment.  

Medicare Purchasable for All could reduce significantly the amount of GDP spent on health care without reducing quality.  

Medicare’s advantage is that no not-for-profit medical institution could turn a Medicare patient away.  Its disadvantage is that there could be no absolution from paying the existing 2.9% payroll tax to fund Medicare for seniors and the disabled.

The purpose would not be to eradicate the private health-care insurance industry.  The purpose would be to make high-quality health care both available and economically sustainable. 

Within the Medicare context, there is already a place for private insurers.  Witness the Part C Medicare Advantage offerings, the hundreds of Prescription Drug Plans, and Medicare Supplemental Insurance – all offered by private insurers in cooperation with Medicare. 

Medicare Purchasable for All would not be a government give-away.  

It is a revolutionary concept – in the way the Tennessee Valley Authority was in the 1930’s.

The TVA put into effect what the philosopher John Dewey (who once taught high school in Oil City) proposed -- “plural and experimental methods in securing and maintaining an ever-increasing release of the powers of human nature in a service of freedom …”

The TVA was not just about hydro-electric power.  As purposed by Franklin Roosevelt, it was “clothed with the power of government but possessed of the flexibility and initiative of a private enterprise.” 

The TVA constructed sixteen giant dams, eliminated floods, made 650 miles of streams navigable, created inland lakes and hundreds of thousands of acres of parks and recreation grounds, planted two hundred million trees, generated power for homes and factories, improved agriculture by restoring fertility to sterile soil, revived old and created new industries, and stimulated education and culture.  The TVA accelerated progress, in a region encompassing parts of eight states, by perhaps half a century.   

Medicare Purchasable for All could cause dramatic change for the better -- if we have the ingenuity and courage to transform voluntarily our health-care economy from profiteering to a regulated sustainability to benefit all.


Michael Hartley writes from Wayne Township.

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