My Turn: Look past ‘socialism’ — single payer systems work

Medicare for all is not socialism. Medicare, or some modified version of it, turns out to be the only sensible way to organize an inclusive health system in a developed economy.

A public health system run by a large number of competing, for-profit insurance companies can never deliver even low-level health coverage at reasonable cost to the whole population. Their incentives and responsibilities to their shareholders require that they either refuse coverage to high-risk clients with pre-existing problems or they raise rates to cover the expected expenses. This makes coverage unaffordable to the poor and undesirable to the young and healthy.


The net result is what we see — an upward spiral of insurance rates and hospitals overloaded with emergency cases without coverage. Hospitals are stuck with these expenses unless they can somehow get these uninsured clients onto Medicaid.

And all this insurance coverage plus the expenses by hospitals and medical offices to secure payment from the insurance industry costs hundreds of billions of dollars per year. None of this money actually cures any medical problem at all but it does make our health system the most expensive and one of the least successful in the developed world.

We only got into this mess because we have a knee-jerk reaction to the word “socialism.”

Check any of the other systems. You find a public health system with minimum paperwork providing a low-level, slow but somehow adequate health service for the whole population. Public health services are focused more on prevention because their reimbursement does not depend solely on providing treatments.

Then there is a way for wealthier people to buy their way up into faster, higher level systems provided by private, for-profit insurance companies. Some, such as Britain and Australia, have developed their own hospital schemes with their own rosters of specialists.

So, there is no longer need for the insurance companies to lobby the government — another enormous expense which is now passed on to their customers. Nor do they have to go out of business. Their business model must be adapted to what they would normally prefer anyway — dealing with people who can afford their products. They can usually get refunds from government for the services they actually provide to clients who would otherwise be in the public system. The rates are naturally lower than their own expenses but they are realistic and known in advance from published data.

Also Medicare For all does not have to be free. I have Medicare A&B and have about $300 per month deducted from Social Security payments. I can buy extra coverage from the insurance industry if I feel the need. I also pay co-pays of about $40 per visit and some doctors do not take Medicare at all. Co-pay ensures that people do not abuse the system.

So, a single-payer, Medicare-type system can work at very low friction, low cost for the poor with maximum stress on prevention before cure. The insurance companies can get on with their business either as add-ons to the public system or setting up their own health services with hospitals, etc.

Yes, there would be some need for budget expenses but not as much as the far right would have you believe. The Medicare system is running now and can easily be merged with Medicaid to cover everyone.

The final proportion of GDP spent on health would drop over following years as the prevention efforts at the bottom end start to pay off.

The general health of the country would be improved. Emergency visits to hospitals would be reduced.

Enormous amounts of paperwork and accounting would be eliminated.


What is not like about about all that?

Jeremy Hewett is a resident of Kailua-Kona.