Bernie Sanders has a healthcare plan. It’s a form of single payer healthcare. It’s a confusing term. It means a single collector of funds, the government, which then becomes the single payer for services and materials involved in healthcare. Bernie calls his version “Medicare For All”.
That’s a good choice for both practical and public relations reasons.
Medicare started in 1966. It’s a mandatory insurance programme designed to primarily cover people over 65. American healthcare has been cobbled together out of a series of historical accidents, the influence of financial interests, and attempts to cover real need. One result was that most healthcare was an employment benefit. The standard retirement age is 65, so that became the entry point.
It’s very popular.
Actually, it’s more than popular. Most Americans, 77 percent of us, think it’s important. That’s four percent more than people who think that the military is important (pdf). Even 71 percent of Republicans think Medicare is important.
It’s well established. Fifty-five million people, 17 percent of the population, are already on Medicare (pdf).
Why do American’s like it so much? It’s efficient. It’s simple, clear, and easy to deal with, especially as compared with the rest of the healthcare system. Even more important, it’s trustworthy. Once you’re in, you’re in, and they’ve provided what they promised to provide, steadily, year after year.
Private insurers can drop you if you change jobs, miss premiums or they go out of business. They change their rates and the services they provide from year to year. Some are reasonable about paying, others routinely turn down claims for specious reasons.
Hillary Clinton doesn’t like Bernie’s plan. According to her, “his plans didn’t add up … they would inevitably mean raising taxes on middle-class families, or that they were little more than a pipe dream.” She’s said that he couldn’t explain it and that he couldn’t really tell people how much it was going to cost. How would it be paid for? Interestingly, this is the tenor of the response of the mainstream media. On the right, this sentiment is stronger, of course, claiming that it will cost twice what Senator Sanders says and it is, therefore, misleading.
Every doctor’s office has a whole slew of secretaries sorting through claim forms to figure what’s covered, what’s not, with a multitude of insurers, each with a multitude of plans, all of which change every year, mostly for the benefit of the companies.
But here’s the thing. Neither Hillary’s approach nor the proposals from the right, move towards fixing the problems. Hers make them slowly worse. Theirs make them instantly worse.
What’s the problem with US healthcare? It’s insane.
It costs more than anywhere else. The current estimate is $10,345 a person. Spending, per person, in other OECD countries is between 75 percent of what Americans pay, to less than half. The US spends a bit more than 17 percent of its GDP on healthcare. The next highest is Sweden, where it’s 11.9 percent of GDP. In other developed countries, it’s between that and nine percent.
All that money might be okay, if people in the US lived lives that were twice as long or even a quarter longer than anyone else. But they don’t. Life expectancy in the US is lower than South Korea, Malta, Slovenia, and Cyprus.
It’s even weirder than that. The US spends $3.2 trillion a year on healthcare. How do you think that gets paid for? “Tax-funded expenditures accounted for 64.3 percent of US health spending.” In fact, “government spending on health care costs in the US was the highest of any nation in 2013, including countries with universal health programs such as Canada, Sweden and the United Kingdom … Indeed, government health spending in the United States exceeded total health spending (government plus private) in every other country except Switzerland.”
Back when Hillary was first lady, she was handed the assignment of coming up with some sort of national health plan. She did. It was complex and incomprehensible. But the real problem was that the profit-makers were not on board. They launched an effective campaign to savage and undermine her proposal. They won. She lost.
When Barack Obama took office, he was determined to take another shot at getting something close to national healthcare. The obvious lesson from the last try was to have the camels inside the tent, urinating out, rather than outside, aiming in. So he came up with a plan, developed by a right-wing think-tank, tried out in Massachusetts by a Republican governor, Mitt Romney, that insured the insurers a place at the table in front of platters with portions even bigger than ones they were already dining from. It passed. After much travail. By the skin of its teeth. And super-sizing the portions for the camels.
The main failure of Obamacare is that it’s not Medicare. Or Medicaid. Every doctor’s office has a whole slew of secretaries sorting through claim forms to figure what’s covered, what’s not, with a multitude of insurers, each with a multitude of plans, all of which change every year, mostly for the benefit of the companies. Consumers don’t know what’s covered and what’s not. Nor can they, really. The multitude and details of possible diseases and physical disasters, and the remedies thereto, are practically infinite, couched in difficult language, and, even with the internet, not easy to access. Also, the system is not really about providing medical care. It’s about insuring that insurance companies, pharmaceutical companies and other major players remain profitable.
To answer Hillary’s complaint, and the media critiques, nobody knows how much healthcare is going to cost. How will it be paid for? There’s $3.2 trillion a year already on the table. It’s only a question of how it gets on the table – taxes, premiums, through the backdoor – and how it gets paid out. Does anyone know why healthcare costs so much in the US? Best guess is that the choices and the practices have profits as their goals, not outcomes. Will turning all the responsibility over to the government improve that? Since the most private run system in the world produced the worst cost to benefit ratios, and Medicare is the most successful healthcare programme the US has, the better bet is yes.
Larry Beinhart is a novelist, best known for Wag the Dog. He’s also been a journalist, political consultant, a commercial producer and director.
The views expressed in this article are the author’s own and do not necessarily reflect Al Jazeera’s editorial policy.