In “Dear Jo” last month, I promised to answer some important questions about Medicare for All raised by fellow Gazette columnist Richard Fein of Amherst, who emailed me his January column, “Medicare for All? Some Questions Legislators Need to Answer.”
Richard, you ask good questions regarding Medicare for All, ranging from what level of taxes would be required to whether people could keep their benefits. Here’s round one of a reply from me. I’ll need to chip away at responding fully since each important question warrants a thorough answer.
Our current health care system is fragmented, expensive and inequitable. What’s worse, for all the money we spend, the system fails us, and the commonwealth has groaning outcome disparities.
Fragmented
Eight separate state-based health insurers each offer commercial plans in Massachusetts. In addition, large employers also use national companies. And there are separate dental and vision care insurers. Each insurer has to cover its own administrative costs, from office space and salaries to advertising and accounting. This fragmentation forces doctors and hospitals to have to deal with separate credentialing, billing and payment systems for each insurer.
Expensive
In 2016, the U.S. spent 18 percent of its gross domestic product on health care, whereas the next highest country (Switzerland) devoted 12 percent of its GDP to health care. Per person, the U.S. spends double on health care compared to similarly wealthy nations, and among U.S. states, the commonwealth is second only to Alaska in per capita health spending.
Inequitable
Most Massachusetts residents get coverage from an employer, but not the same coverage. People in the highest-paying jobs typically get the most generous benefits. But for some, the only option may be lousy coverage.
An accelerating trend in health insurance in Massachusetts is the use of high-deductible plans (individual deductibles over $1,350 and family deductibles over $2,700). From 2015-2017, the percentage of workers in small- and mid-size companies (1-100 employees) enrolled in high deductible plans went from 42 percent to 55 percent.
Faulty
Since most people are relatively healthy, we’re often not aware of limits on our health coverage benefits — that is, until we need the coverage
That’s when the current system fails us again. The 2018 Massachusetts Health Reform Survey found that 49 percent of adults in Massachusetts had difficulty obtaining care in the past year. More than a third had health care affordability problems. Those worse off were of moderate income, where 48 percent reported problems affording their care.
Broken
Despite spending so much more compared to every other country, our national health outcomes frankly are abysmal. A carefully controlled 2017 comparison of health outcomes in 11 wealthy countries like Australia, Sweden and France found that the U.S. has the worst outcomes of all in areas like infant mortality, preventable deaths, and disease-specific survival rates.
What’s more, this disparity in outcomes grows when examined across racially and ethnically diverse communities. For each state, the federal Agency for Healthcare Research and Quality tracks dozens of health quality measures. In Massachusetts, the disparities are stark. The data show that care for white people exceeds or is near the benchmark goal on 71 percent of the measures. For black people it’s 25 percent, and for those who identify as Hispanic, it’s just 17 percent.
This inequity is intolerable. It’s a stain on our current health care system, and a key reason why I support change.
We need a system where everyone is treated the same — with universal coverage, including mental health, dental care, vision, long-term care and more. We need health care considered and financed as a right and common good, rather than purchased individually as a commodity.
The bill I’m cosponsoring, S.683, An Act Establishing Medicare For All in Massachusetts, meets these criteria. The bill sets up a framework for such universal coverage, managed by a board that consists of state health officials, representatives of workers, health organizations, senior and children’s groups, and others accountable to the public.
Such a massive transformation will require careful planning and economic analysis, also taking into consideration the workforce that depends on the current system (such as insurance sales representatives or insurance company staff that process prior approval requests). And it will require painstaking research and planning, careful monitoring and a willingness to make adjustments along the way.
$11 billion in savings
To your question about the dollar cost to taxpayers:
There would be new taxes. The legislation proposes how they’d be apportioned here: malegislature.gov/Bills/191/S683. But in return, we’d pay nothing in premiums, co-insurance, co-pays, and deductibles. And there wouldn’t be a host of hidden health care expenses like the cost to employers of administering health plans for their workers.
Gerald Friedman, an economist at the University of Massachusetts Amherst, has estimated the costs and savings, suggesting that the commonwealth will save $22 billion annually — around 23 percent of current spending — by recouping high administrative costs and negotiating lower drug costs and more reasonable hospital prices.
Friedman also estimates that the added costs would come from covering the remaining uninsured and increasing the low Medicaid rates paid to doctors and hospitals. There would be additional costs of around $11 billion due to people getting care that they previously avoided due to copays and deductibles, but, of course, that would result in a healthier population overall. On net, we would save about $11 billion compared to the current system.
Existing coverage
As we think this through, it’s critical that consideration of Medicare for All not be in a vacuum, but in comparison to what we have now. In our current employment-based system, changing jobs often forces one to change coverage. People in their 40s on average have held 10-12 jobs since they were 18. So even today, people may involuntarily lose or switch coverage relatively frequently.
Similar to questions of how to pay for health coverage, we’ll need to weigh the impact of a paradigm change against the current norm. Once we make the leap, the legislation stipulates that the “Trust shall provide access to health care services that is continuous, without the current need for repeated re-enrollments or changes when employers choose new plans and residents change jobs.”
You’ve asked more questions, and they’re all important. We must consider how this will affect our health, our families’ finances and our economy. It will take a broad public conversation that includes workers, employers, doctors, hospitals, nurses and other health providers, as well as patients and state and federal officials, to move forward.
As we work on this transformative legislation, I’m also mindful of the need to work together to find ways to make more immediate improvements in our current health system. That’s why I’m supporting legislation that would cap high prescription drug prices; extend MassHealth coverage to low-income children, regardless of their immigration status; eliminate co-pays and deductibles for preventive care for people with chronic diseases; expand MassHealth dental benefits and more. As the new Senate chair of the Public Health Committee, I will also have an opportunity to promote public health programs to address the root causes of poor health, particularly the inequities that negatively impact communities of color and immigrants.
State Sen. Jo Comerford represents 160,000 people living in 24 cities and towns in the Hampshire, Franklin, Worcester district in the Massachusetts Legislature.
Read this article at the Daily Hampshire Gazette
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