“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Martin Luther King was clear: healthcare is a human right. Unfortunately, one might not think so when looking at a nation where obtaining basic, affordable medical care is such a struggle for so many. Luckily, groups are organizing all across the United States to realize the professed ideas of a nation — Martin Luther King himself would have been in the lead. In Vermont, serious steps have been taken to realize a more humane system. Here in Texas, the battle is being waged locally by Health Care For All Texans (hcfat.org,) a leading group pushing for a single-payer-style healthcare system in the state — and so also the United States. This is one of the all-important issues: the policy issues that you can count on one hand.
Single-payer healthcare is a system in which everyone enters into a single insurance plan run by the government — hence the name. It then becomes a simple matter to receive health-related treatment: you simply walk into a clinic — no cumbersome billing process required. Among its essential features, single-payer dramatically lowers health costs by allowing for a huge increase in bargaining power for healthcare recipients. In addition to this effect, current government plans like Medicare have trivial overhead costs: 2-3%; compare this to the 15-25% overhead of private insurers. This is because private firms invest heavily in advertising and measures to avoid risky patients, among other things — they must “compete” with each other in an age-old sector that only advances in so far as new ways to avoid payouts are discovered.
And, of course, single-payer is universal health coverage.
The issue is of profound importance. The human suffering each year we go without this kind of coverage is unimaginable. In 2013, the American Journal of Public Health estimated that 45,000 deaths per year are associated with lack of health insurance (a C.N.N. article on the topic is worth reading.) We all understand what is at stake here, though probably not well enough — it’s difficult to think about.
Access to healthcare in a society is a human right, but the issue’s importance transcends its placement alongside other human rights. This is because the current system is enormously problematic. The private system is hugely expensive: The United States spends roughly twice as much per person on healthcare as other countries. In fact, the United States healthcare system is far and away the most expensive in the world — and without the health outcomes to go with it. According to a June 2014 study (“Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally”) by The Commonwealth Fund that tracked the health outcomes of 11 similar countries: “the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.”
Our current healthcare system is also the biggest driver of the national debt. Medicare is already picking up many of our most costly citizens: those of retirement age. According to the Congressional Budget Office, Medicare and Medicaid accounted for roughly one-quarter of all federal spending in 2013. This is expected to go up as healthcare costs continue to skyrocket. According to a Congressional Budget Office estimate in 2011, federal health expenditures are projected to increase from 5.6% of G.D.P. in 2011 to 9.4% in 2035. In fact, studies that project “out of control” national deficits in the coming decades are essentially just tracking increases in healthcare spending (pictured above) — it’s that important. Discussions about the national debt should be seen as discussions about increasing healthcare costs. If we do not get healthcare costs under control, we will continue to bankrupt the nation by redistributing national wealth upwards to private insurance companies and the medical industry — two sectors that certainly don’t need any more help.
In addition, single-payer decouples healthcare from one’s place of employment. Coupling employees’ health insurance to employers means employees have to think twice about leaving the company or changing their employment status. This is a huge negative impact on the labor market: it drives down wages and it keeps workers full-time that may want to simply be part-time, a situation that’s already seen some alleviation due to the Affordable Care Act.
There’s a huge precedent for single-payer: The U.S. would be joining the Persian Gulf states, Canada, Scandanavia, Japan, and Southern Europe, among others.
Single-payer is popular not only internationally, but domestically as well: According to a recent C.B.S./New York Times poll last month, 43% favor a single-payer health care system — 50% oppose. This might sound bad, but remember: this is in spite of the near total media blackout on the topic of single-payer. When asked about the option to opt-in to Medicare no matter your age–the likely path to single-payer for the United States–59% were in favor; only 34% were opposed.
Quite simply, America’s future is tied to the induction of a single-payer system. It’s even the American way: there can be no meritocracy without single-payer healthcare; human health plays by a different set of rules — indeed, many lose their faith over this important reality.
Consider Heath Care For All Texans. Single-payer is something that we’re going to have to take, and we absolutely should take it now.