Last week, Sen. Elizabeth Warren (D-Massachusetts) unveiled how to pay for the universal guaranteed lifetime health care bill known as Medicare For All. Sen. Bernie Sanders has previously issued options to fund his version of Medicare For All. While both plans offer an ambitious vision for the future of health care in the United States, powerful special interests led by the drug and insurance industries have quickly criticized these proposals.
Readers may remember that my health care activism was inspired by my two decades of experience as an emergency physician, and my daily exposure to patients with and without insurance who made critical health care decisions based on their ability to pay rather than medical necessity. This year, my energy has been split between working my clinical shifts in the Emergency Department and directing the Committee to Protect Medicare and Affordable Care, a nonprofit organization of several hundred physicians across 25 states who are dedicated to ensuring a future of affordable health care for our patients.
It is through the nonpartisan lens of a clinician and advocate that I view the current health care debate in the Democratic primary, and the wider national discussion over the future of health care in America.
While the funding of such proposals should be dissected and will be debated in the U.S. House and Senate and in the court of public opinion, Medicare for All’s overarching principles align with the needs of the tens of thousands of patients I’ve cared for over the past 20-plus years. Simply put, Medicare for All will reduce medical costs for tens of millions of Americans – people Big Pharma and insurance corporations have gouged for decades.
Since 1985, health care spending in the U.S. has risen from $442 billion or $1,833/person, to $3.492 trillion or $10,739/person, an increase of 6.7 percent a year – triple the 2.4-percent rate of inflation and more than double wage growth, at 3.1 percent.
I see my patients struggle with ever-increasing co-pays for their visit to the emergency department and a huge expansion in high-deductible plans placing more of the burden of health care costs on my patients. The cost of a vial of insulin has increased over the last 10 years from around $90 in 2009 to nearly $300 in 2019.
I remember the mother who sat in our Emergency Department parking lot for two hours watching her child struggling to breathe before coming in because of the $250 co-pay, an expense equal to two weeks of groceries for her family. I have discussions with patients nearly every shift about the costs of medically necessary tests because of high-deductible plans.
For one patient, a single mother earning $30,000 annually, her over $10,000 deductible was like having no insurance at all. I spent 15 minutes convincing her that she needed a blood test. And if that test came back positive, she’d need a $1,000 CAT scan to rule out a life-threatening condition.
And emergency physicians see diabetic patients all the time because they’re skipping their doses to make a vial of costly insulin last as long as possible.
High cost is forcing patients to ration their health care in the United States every day. They ration because, despite living in the wealthiest country in the world, we spend nearly twice as much on health care as the rest of the industrialized world. For all of the spending, one would expect outcomes in the U.S. to be better than those of other countries. But despite spending nearly twice as much as comparable countries, outcomes in the U.S. are no better, and are frequently worse.
While the Affordable Care Act (ACA) did provide expanded Medicaid for over 13.1 million low-income Americans, and the uninsured rate for adults ages 18-64 decreased from nearly 20 percent to around 12 percent, the underinsured rate is at the highest level ever particularly among individuals on employer-sponsored plans. Over the last two and a half years, the Trump administration has eroded the protections of the ACA in ways too numerous to list in this space.
So, while there may be questions associated with health care plans proposed by Warren, Sanders and many of the other Democrats running for president, the current system is not working for the vast majority of individuals. Those who feel confident in the plan they have provided by their employer are likely in for a rude awakening when the bill comes due. While all of the plans proposed would improve on the status quo, Medicare For All is the only plan that would cover 100 percent of individuals and decrease costs for the most individuals.