Healthcare and health insurance: Two different subjects that are far too often conflated by politicians and media outlets. Keeping the two separate is critical to making sound decisions, whether on government policy or who to vote for. It’s unfortunate, because the two are easy to separate; healthcare is the advice and treatment of one’s health and wellbeing, and health insurance is how to pay for healthcare. In the U.S., both are rife with problems.
Hence the cry of “Medicare for All” from the 200+ candidates running for Democratic party presidential nomination. There’s talk of single-payer, Medicare buy-in, an ACA “public option,” but they speak of “healthcare for all” when they really mean “health insurance for all.” These candidates forget about solving the problem of healthcare cost and access, instead focusing on revising payment methods. It’s one of the critical errors of the Affordable Care Act, and a huge blind spot when discussing Medicare for All.
As my colleague, Craig Hasday, mentioned in his last post, the Congressional Budget Office (CBO) just released their initial 67-page analysis of Medicare for All and determined that “the transition toward a single-payer system could be complicated, challenging and potentially disruptive.” It also says “government spending on healthcare would increase substantially under a single-payer system” and that it “would increase the demand for care and put pressure on the available supply of care.” What understatements! And the CBO analysis doesn’t take into account the budgetary impacts of any specific bill or proposal – for me, there’s something perversely humorous about the Congressional Budget Office not including budgetary impact in their analysis.
In 2017, California (the state where I live) analyzed the budgetary impact of a single-payer model in our state and the cost came in at $400 billion – nearly four times the entire 2018 state budget. The analysis suggested getting the federal government to pay was critical to start any such program (a common solution here and in Washington, D.C…. get someone else to pay).
In a CNN interview, Colorado Senator Michael Bennet (one of the 200+ presidential candidates) tells Medicare for All proponents they “need to level with the American people” over the realities of this kind of healthcare policy, citing a cost of $30 trillion over the next 10 years and pointing out that roughly 180 million Americans would lose their privately insured, employer-sponsored coverage.
So, before we decide on which candidate to consider, or which version of Medicare for All we could support, we need to make sure that both healthcare and health insurance are considered, AND that there is an effective means to pay for it. A thorough evaluation, honest discussion and reliable cost and payment projections – seems the least we can demand before we start tinkering around with 1/6th of the U.S. economy.