Medicare for All?

“Legislation which compels you to join in a federal health insurance plan is wrong.  It is also wrong—morally and economically wrong—to ignore the health problems of those who cannot pay the cost of adequate medical care.  Federal aid to local health plans that helps make medical care available to those who need it is right.”

― Dwight D. Eisenhower October 10, 1952

from a speech about Medicare legislation

A Little Perspective

This blog is about investing, DIY investing to take care of yourself, your family and the causes you support with your gifts.  I don't follow or profess any ideology and I don't belong to a political party; so you'll have to put your own judgement aside and just accept that my neutrality in this matter is focused on cost and benefit.  I'm also quite confident that this will be the most divisive article I ever post.

So why am I writing about Medicare For All?  

Simple, if we follow the money and the results, the answer to providing healthcare for all becomes amazingly clear and easy to understand.  

The quote above from President Eisenhower is interesting.  Eisenhower was a great supporter of Medicare, but advocated for a system of federal aid to health insurance companies in order to reduce government costs, improve healthcare for all and run Medicare as efficiently as possible.  What we got from Congress was a mixture of public and private healthcare insurance, not what Eisenhower asked for and also not what Truman asked for.

Establishing Ground Rules

Personally I feel the healthcare industry in America is broken, but not for the reasons most people think.  Let's just agree that changes are needed.  I think its important that we define the things where we can all agree.  Healthcare is too expensive, costs are rising too fast, insurance premiums are rising too fast, too many people have no health insurance, people with health insurance still can't afford good healthcare.  I think those universal themes are easy to agree on. 

When we say Medicare for all, what does that mean, where are the boundaries?  Within the healthcare industry there is a concept known as 'SOC' or Standard of Care.  Every disease and patient condition has a 'Standard of Care'.  When we were kids and got a cold, the standard of care was stay home and mom made chicken noodle soup.  Outside of the Standard of Care are all kinds of very expensive, elaborate and sometimes experimental treatments.  In between each of these three stages of care we can identify a broad spectrum of healthcare services.  While overly simplistic there is the spectrum of healthcare: Mom's soup, Standard of Care, Advanced and experimental treatments.

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I would like to propose that we define healthcare for all as 'Current Standard of Care'.  I add the word current because the standard of care is constantly changing.  That's pretty broad and leaves doctors and patients with a vast number of choices for treating any ailment; because Standard of Care is a progression of treatments that follow one another until a favorable outcome is reached and no other options are available outside of experimental treatments. 

I don't believe this approach or any other is perfect, but as we'll see soon, using this standard of care approach will treat the most people, with the overall greatest level of care at a cost that we can afford as a nation.  And just like other countries with national healthcare systems we can offer insurance for higher levels of coverage to those who choose to pay for it and keep the trial programs open to patients who wish to use this method of care.

Key Issues According to Bernie Sanders

Below are the key points of the Medicare for all debate taken directly from Bernie Sanders web site along with a short response from me.  I'm starting with these points because they seem to be the foundation of most politicians who support Medicare for all and they are important to our investment decisions.

  • Over 30 million Americans don’t have health insurance

  • 27 million is more accurate

  • Medical bills are the number one cause of bankruptcy

  • True, 61% of bankruptcies are due to medical bills, 78% of these had health insurance

  • We spend significantly more of our national GDP on this inadequate health care system than other developed nations

  • True, the US spends $9,237 per capita, or almost 20% of GDP on healthcare costs yet rank 12th in life expectancy.  There is little correlation between spending and health outcomes.

  • We must invest in the development of new drugs and technologies that cure disease and alleviate pain—not wasting hundreds of billions of dollars a year on profiteering, huge executive compensation packages, and outrageous administrative costs.

  • The first part is in fact being accomplished, numerous diseases have been cured in recent years and more are being announced.  The second part is a different argument that suggests US pharmaceutical companies are wasting tax payer dollars when in fact they are mostly funded by investors, revenues from existing products.  The administrative costs are primarily a function of Congress and the rules they insist the FDA administer.  

  • The giant pharmaceutical and health insurance lobbies have spent billions of dollars over the past decades to ensure that their profits come before the health of the American people. We must defeat them, together.

  • In 2018, 406 healthcare companies hired 1,441 lobbyists and spent $281,472,969.  To get to 'BILLIONS' we would have to add up decades of spending on lobbying.  Keep in mind that every industry hires lobbyists to have their issues heard.  Is this buying influence, yes.  So the question to be asked is, why do we allow any industry to buy influence when the job of our politicians is to hear and represent the issues of their constituents.

  • Medicare-for-all, single-payer program

  • Medicare for all assumes that Medicare is the right answer, single payer system defines it as a government run and tax payer funded system.

  • Allow Medicare to negotiate with the big drug companies to lower prescription drug prices