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THE DAILY ASTORIAN • FRIDAY, MARcH 8, 2019
OPINION
editor@dailyastorian.com
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PRO-CON
Should America join other rich nations
and provide universal health care?
AP Photo/Meg Kinnard
Vermont Sen. Bernie Sanders addresses supporters at a ‘Medicare for All’ rally in Columbia, S.C.
PRO: Medicare for all is
doable; most Americans want it
CON: Americans are in no mood
for another health care upheaval
W
P
ASHINGTON — In Can-
deal with the paperwork and issues that
ada, everyone in the country
are caused by having a range of insurers,
is guaranteed access to health
each with their own payment rules and
care by the government.
practices.
The same is true for France, the
These interest groups will use all
United Kingdom, Germany, Nether-
of their political power to protect the
lands and every other country that we
income they get under the current sys-
tem. The pharmaceutical industry will
think of as comparable in terms of lev-
els of wealth, democracy and economic
fight measures to rein in their prof-
its in the same way the tobacco indus-
development.
In spite of providing universal care,
try fought public health advocates who
these countries also all spend much less
sought to curb smoking. The same is
on health care than the United States.
true for the medical equipment industry.
In Canada, per person spending is 60
And doctors and dentists will fight
percent what it is in the United States. In like crazy to preserve a pay structure
Germany spending per person is 56 per- that puts most of them in the top 1 per-
cent of wage earners.
cent and in the United Kingdom just 42
This will also be true of insurers
percent of what we spend.
And these countries all have
faced with a more efficient sys-
tem that will put most of them
comparable outcomes. People in
out of business.
other wealthy countries not only
While a well-designed path-
have longer life expectancies and
way can get us to Medicare for
lower infant mortality rates, they
all, even we can’t do it all at
also have comparable outcomes
once.
when looking at more narrow
Dean
For beginners, we can look to
health issues like treatment for
Baker
lower the age of Medicare eligi-
cancer or heart disease.
bility from the current 65 to 60
The basic story is that we
spend roughly twice as much per
or even 55 in an initial round. We
person as people in other wealthy coun-
can also allow people of all ages to have
tries and we have pretty much nothing
the option to buy into a public Medi-
care-type system.
to show for it in terms of better health.
We can also look to start getting
This is the context in which critics of
our costs down. This means lower-
Medicare for all are telling us it is not
ing drug prices, both by negotiating in
possible.
If the argument is that it won’t be
the same way as other countries, and
easy, the critics have a point. The reason directly funding research so that newly
we spend twice as much for our health
developed drugs can be sold as cheap
care is that big actors in the industry get generics.
twice as much money here.
We should do the same with medi-
Drug companies get away with
cal equipment. And we can subject our
charging us twice as much for drugs
doctors and dentists to the same sort
of foreign and domestic competition
as they do in other wealthy countries.
that workers in other professions
The same is true for medical equipment
companies who charge far more for kid- face.
ney dialysis machines and MRIs than in
These steps can get us on a path
France and Germany.
to Medicare for all, on which we will
And our doctors and dentists get paid quickly be extending coverage to mil-
twice as much on average as their coun- lions of people, while substantially
terparts in other wealthy countries.
reducing the cost of care for everyone.
In addition, we spend more than
We are smart enough to be able make
$250 billion a year paying insurance
the same sort of guarantees on provid-
ing health care as every other wealthy
companies to administer our chaotic
country.
system.
Doctors’ offices, hospitals and other
Dean Baker is co-director of the cen-
providers spend tens of billions more on ter for Economic and Policy Research, a
progressive think tank.
administrative personnel who have to
AEONIAN SPRINGS, Va. — Con-
We believe the right solution is to give
servatives and progressives agree that people more choices of more affordable
everyone should be able to get health health coverage and have states, rather than
insurance and have access to quality health the federal government, target resources to
those who need help.
care. But the divide over how to accom-
plish that goal is wide and deep.
We’ve seen with the Affordable Care
Progressives believe the government
Act how difficult it is for a centrally con-
trolled system to work. The ACA dictated
should make decisions about allocation
the rules for health insurance policies in the
of the resources in our health sector while
individual and small group markets, includ-
conservatives believe these decisions
ing the rich benefits package. Then premi-
should be controlled by individuals and
ums doubled.
families.
Currently, many people have a choice
The sales pitch for Medicare for all
of buying an expensive Obamacare plan or
is appealing — universal coverage, free
going uninsured.
access to doctors and hospitals, and no
Between 2015 and 2018, 3 million peo-
insurance premiums, copayments or
ple dropped insurance, according to the
deductibles.
Kaiser Family Foundation. California spent
But then come the tradeoffs: Washing-
ton bureaucrats would decide what
$100 million last fall trying to boost
enrollment in its exchange, yet it
services are covered and how much
saw the number of new enrollees
doctors and hospitals would be
shrink by nearly 24 percent.
paid.
The problem is cost. The costs
Everyone would be required to
of premiums and deductibles can
give up the coverage they have now
be prohibitive, especially for those
— including 173 million American
Grace-Marie
who don’t get subsidies. One dad
who get health insurance at work
Turner
trying to provide coverage for his
— and taxes would be much higher
family faced premiums of $4,000 a
to finance $32 trillion in added gov-
month for an Obamacare policy in
ernment spending over the next
Virginia last year.
decade. For comparison, federal revenues
The solution is to offer people more
last year totaled $3.4 trillion.
choices of plans that meet their needs and
“If you look at polling data, it’s great
that they can afford — which a properly
until you tell them taxes would double and
functioning market could provide.
they’d have to give up their employer cov-
erage,” Sen. Bill Cassidy, R-La. noted
States have decades of experience in
recently.
overseeing their health insurance markets.
The American people don’t want such
One part of the ACA provides an option
for State Innovation Waivers to allow states
a major upheaval. They rightly don’t trust
to reallocate existing resources to take bet-
politicians and their broken promises such
ter care of those with preexisting condi-
as former President Barack Obama’s —
tions, for example.
“If you like your doctor you can keep your
In the several states that requested ACA
doctor. If you like your health plan you can
innovation waivers, premiums went down
keep your plan.”
and enrollment went up.
At least this time, they are being up
States are helping their health insurance
front: They would outlaw private health
markets to recover, offering better choices
insurance entirely.
California senator and Democratic pres- and lower costs to families struggling to
idential candidate Kamala Harris supports
provide for their families, and with bet-
ter protection for those with pre-existing
a government-run single payer system and
conditions.
said of private health insurance: “Let’s
Devolving control to states and ulti-
eliminate all of that.”
mately individuals is the right solution, not
What they aren’t saying this time is that
“free” access to care comes with a big price more centralized Washington control.
Grace-Marie Turner is president of
tag. In other countries with government-run
the Galen Institute, a public policy orga-
health systems, care is rationed, waiting
nization she founded in 1995 to promote
lines are long, and access to the newest
free-market ideas in the health sector.
medicines and treatments is restricted.