A Deep Dive into Medicare
Updated: Jul 13, 2020
The implementation of a single payer healthcare system has been a long-standing debate in recent politics. Yet while the dispute over exactly how the U.S. will implement such a system remains a heated topic, most citizens can agree on one thing: our healthcare system needs some serious work.
But what exactly is a single payer healthcare system? The proposed idea is a system in which a singular entity, most likely the government itself, will cover the costs of healthcare for all citizens. This means that all citizens will receive access to healthcare, even those who can't afford it. Idealistically, a single payer healthcare system seems like a phenomenal solution to the American healthcare crisis. But from a practical standpoint, implementing a single payer system like Medicare on a national level will be accompanied by obstacles that may or may not outweigh the benefits of Medicare itself.
Medicare History
The origins of a single payer healthcare system can be traced back to the establishment of the Social Security Act (SSA) in 1935. One of the many aspects of President Roosevelt's New Deal program, the law provided retired workers 65 years+ with steady income, as well as other general welfare improvements. The SSA was strongly criticized by many, who condemned it as socialism. President Roosevelt was forced to revise the SSA so as not to include healthcare for the act to be passed. Roosevelt continued to attempt reforms in general healthcare, but most of these attempts fell short even as President Truman entered office and pushed for healthcare reform after witnessing the atrocities of World War I.
Even President Truman's attempts at universal healthcare remained largely ineffective, however. It wasn't until John F. Kennedy passed the SSA Amendments of 1965, a program that established the Medicare and Medicaid programs, that these attempts at healthcare reform finally began to gain momentum. Following that point, the movement for universal healthcare expanded immensely. In 2010, the Affordable Care Act was signed into law, making accessible affordable health insurance, expanding Medicaid, and lowering healthcare costs through support of more innovative care delivery methods. Both strong support for and backlash against the Affordable Care Act erupted, prompting healthcare reform to become one of the leading debates of the modern day.
America's healthcare system has greatly evolved over the past century, but is not nearly close to perfection. Private corporations exploit unsuspecting citizens for money, as prices for essential services and medications skyrocket. We spend more money on healthcare services than the other developed nations, and yet our medical system is much more inefficient and yields less results. According to the US Census Bureau, 27.5 million people, or 8.5% of the population, did not have access to healthcare insurance in 2018. Our healthcare system is in crisis, and we desperately need reform.
Universal Healthcare: The Pros
There are a multitude of countries whose example the United States could follow to successfully enact healthcare reform. New Zealand health insurance covers all injuries sustained in an accident, regardless of whether the injured person was the instigator of the particular accident or not. Many Scandinavian countries that have implemented a single payer system often report a higher happiness rate, less sick days, and thus, a higher productivity rate. When all citizens have access to healthcare, not only do they have the capability to work more efficiently, they have a stronger motivation to do so. Canada has also reported healthcare successes. According to a study by the World Health Organization (WHO), Canada's life expectancy rate of 80.34 years is greater than America's life expectancy rate of 78.6 years due to medical system differences. It is arguable that the long term benefits of a single payer system, then, will eventually come to outweigh the initial transitional costs.
Even with a stronger healthcare system, most of these countries pay the same amount as, if not less than, the American government pays. The critical difference between the two is that all citizens of these other countries are receiving healthcare benefits. According to the National Health Expenditures Accounts (NHEA), the United States spends 17.7% of its GDP on healthcare services. This is contrasted with other developed countries such as the United Kingdom, which spends only 9.1% of its GDP on healthcare services, and Spain, which spends only 8.9% (nearly half of America's percentage of GDP for healthcare!), according to the WHO.
Successes of a single payer system in other countries does not necessarily equate to success in the United States, however. Many cite physicians' concerns as a primary opposing point against the implementation of universal healthcare. While it is true that physicians' pay would be reduced, and some may compensate with a reduction in care, according to a 2017 study, 56% of physicians support a single payer system. According to a Massachusetts study discussed by the Physicians for a National Health Program (PNHP), "Eighty-nine percent believed that it is the responsibility of society, through its government, to provide everyone with good medical care, regardless of their ability to pay. Physicians also favored physician payment under a salary system (56.8%), and would be willing to accept a reduction in fees for a reduction in paperwork (67.1%)". The PNHP is the face of the majority of physicians that strongly support universal healthcare and believe all citizens have the right to access basic medical services. With physicians as a leading voice in this debate, their support for a single payer system speaks volumes.
Their support is very sensible when one considers the government incentives provided through single payer systems. To compensate for the physicians' lack of pay, the government plans on softening student loans, making improvements to local hospitals, providing better education, and other concessions to physicians. These government incentives have already been implemented in countries that successfully use a single payer system. The United States already possesses the technological capabilities to provide hospitals with medical IT infrastructure. Government incentives would not only encourage stronger physician support, but also maintain a high amount of medical workers and discourage them from resigning.
And yet, all the aforementioned benefits of a single payer system are overshadowed by perhaps the largest advantage of all: the pure morality of it. This is America - we pride ourselves on our ideals of freedom and equality. But are all people free if they are chained to a life of suffering simply because they were born into poverty? Are all people equal if the rich can afford unnecessary surgeries while the poor struggle to stay alive? Is it truly democratic to condone the obstacles the poor must endure, turning a blind eye to their hardships in healthcare accessibility? We could have a world where money doesn't dictate your right to a life without pain and illness, a world where no man is left to suffer because he can't afford insurance. A single payer system is, arguably, the embodiment of true American ideals, everything that this country stands for.
Universal Healthcare: The Cons
Medicare, then, seems to be an effective solution to the healthcare crisis. So why do people oppose it? One of the largest opponents against a single payer system are the stakeholders of private insurance companies that stand to lose from the transition to universal healthcare. Large, wealthy, private corporations that have a powerful voice whispering in the ears of politicians stand as the largest obstacle to implementing a single payer system. The most difficult barrier in the face of Medicare is the politics of it.
But politics aren't the only reason people don't like Medicare. Many balk at the idea of quality degradation in their personalized healthcare insurance. If a national healthcare program were to emerge, they argue, it would not be able to provide the same high-quality services that private firms currently offer. All doctors are paid the same amount, leaving less motivation for innovation and productivity within the system. Some even go to say that a reduction in quality care is, in nature, an undemocratic principle. This degradation of quality has resulted as a negative consequence in other countries who have implemented a single payer system. According to a report by the Royal College of Surgeons of England, over 220,000 patients waited over nine months to receive treatment. Long waiting lines to receive treatment are one of the many shortcomings of quality healthcare in a single payer system, but can also be avoided, as evidently seen in Taiwan. According to data from the NHI Administration, the average wait time for cataract surgery in Taiwan is 11 days (as compared to the 10 week wait time in the United States). So how does Taiwan effectively manage to create shorter wait times while the United Kingdom and United States struggle? The answer lies in infrastructure improvements: more hospital beds, more medical technology investments, more clinical utilities provided. This is something that the United States has the capability to produce, especially through the aforesaid government incentives.
Infrastructure advancement is just one way to combat the quality degradation of a transition to a single payer system. The very existence of Quality Improvement Organizations (QIO's) is another. QIO's ensure that no significant reduction in the quality of healthcare services will occur. One of the most well-known QIO's is the National Committee for Quality Assurance (NCQA), which evaluates the quality of healthcare services and hospitals, and finds effective improvements and innovative new methods of delivery. QIO's like the NCQA would mitigate any possible reduction in quality. And while quality degradation remains a threat to higher level healthcare consumers, it is certain that quality improvement will occur in those areas that do not receive healthcare at all.
The other predominant obstacle to a single payer system is the issue of funding. From providing millions with healthcare access to incentives like hospital infrastructure advancement, how would the government fund such a system? It is obvious that single payer is initially extremely costly, especially during the transitional period. Some oppose single payer due to the method of paying these costs: taxes. High taxes are an almost unavoidable obstacle of a single payer system, one of the reasons why taxes in many European countries are so high. An increase in taxes would be detrimental to the lower income families that a program like Medicare would intend to support. One of the best examples of this is the failed Medicare experiment in Vermont. A few years ago, Vermont implemented Medicare as its primary healthcare plan, and while it did indeed provide healthcare to all, taxes were raised significantly. Medicare raised Vermont's income tax by 9.5% and placed a 11.5% payroll tax on all employers, putting a heavy financial burden on its citizens. Vermont's single payer system was eventually discontinued because the federal government didn't follow through with financial aid, leaving the people to bear this heavy burden on their shoulders. Still, the failure of Medicare in Vermont does not equate to failure on a national level, just as its success in other countries does not equate to success in the United States. The government's failure to financially support Vermont's citizens could not happen if Medicare were to be implemented on a national scale because the resulting downfall would be too detrimental to the country. If the federal government funds universal healthcare, they will be forced to follow through with financial aid to its people in order to continue it.
If the federal government eases the tax burden on its citizens, it will have to search for new sources of money. One of the proposed ideas is to reduce the United States defense budget. According to the Stockholm International Peace Research Institute, the U.S. spends $732 billion on defense. And yet, we spend $3.5 trillion on our healthcare budget (even though majority of this sum is directed towards Medicare and Medicaid programs), so proposing to reallocate more funds from the defense to the healthcare budget could be considered slightly preposterous. The government budget simply doesn't have enough to efficiently allocate to a single payer system.
Adapting to Single Payer
In light of this ongoing crisis, the need for a single payer healthcare system is stronger than ever. COVID-19 has highlighted the urge for all citizens to have basic access to healthcare. Without it, this global pandemic cannot effectively be contained.
So, is Medicare really the way to go? It all depends on your stance on things. The idea seems great to those who are optimistic, but the realists know that the path to universal healthcare will not come without difficulty. But whether you are pro- or anti-single payer, the healthcare crisis still remains at large, afflicting millions of Americans. Medicare could spare these people from a lifetime of suffering, or it could exacerbate their conditions. Healthcare reform is crucial to our country, but is this truly the right way to do it?
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