Call it what you will, but single-payer health care is what we need

Bill Walczak

The Republican FearFest was at full throttle last week, with numerous Trumps and others using their convention to declare that electing the Biden-Harris ticket would result in anarchy, the loss of the suburbs – and socialism, which Nikki Haley claimed was Biden’s “vision for America.” Trump himself said that Biden was “a Trojan horse for socialism.”

Socialism has had many different meanings over the years, but today it generally means government control of a system. In the US, the post office, the military, the court system, roadways, fire and police departments, and public schools would be examples of government control over systems.

When Republicans talk about socialism, they mainly bring up our health care system. Obamacare is a particular target, despite the fact that the idea for Obamacare came out of the right-wing Heritage Foundation. Republicans initially embraced the Heritage Foundation idea. Indeed, Mitt Romney’s term as Massachusetts governor was notable for his health care reform bill, also based on the Heritage Foundation idea, which became known as Romneycare.

The Romneycare model was adopted by President Obama in the Affordable Care Act, which became known as Obamacare. The Republican Party then turned against it, declaring it to be “socialism.” The RNC speaker and Florida businessman Maximo Alvarez was especially wary of Medicare-based health care for all, saying: “I’ve seen ideas like this before, and I’m here to tell you, we cannot let them take over our country.”

The idea of a health care system that cares for all Americans was part of Franklin Delano Roosevelt’s New Deal, but because of strong objections from some labor unions, Roosevelt decided that Unemployment Insurance and Social Security would be the first socialist support systems to be introduced to America during the Great Depression.

Truman, LBJ, Nixon, and Clinton all preceded Obama with their own efforts to insure all Americans, and all the while, opponents to a national health insurance system, especially the American Medical Association, spewed the word “socialism” as the reason Americans should not have it.

Still, cut components of a socialized medicine system were passed over the years to care for elders (Medicare), low-income people (Medicaid), our federal and state Public Health organizations, Native Americans (Indian Health Service), those in our active military, and veterans (Veterans Health Administration). In fact, nearly half of all health care dollars in the US today are spent by government offices.

The idea of a government being responsible for ensuring that medical care is available for all its residents originated in 1883 in Germany, followed in the next two decades by ten other European countries. Today, the United States stands alone among developed countries as the only one without a comprehensive system of medical care for all its residents.

Much of the time, the term “single payer system” is used, meaning that, whether health care services are controlled by the government or not, the government is responsible for paying for it. This would include Canada, where the system is private, but the payment is public, and Great Britain, where both the system and payment are public in the well-regarded National Health Services.

When Alvarez talked about being wary of the idea of health care for all, he was saying be wary of the health care system that virtually every other developed country in the world has.

I spent 42 years running a health care organization and became a quick convert to single payer. If the purpose of our health care system is to ensure that our American population is as healthy as can be, and that our system is as efficient as it can be, we have failed miserably.

Despite spending $3.6 trillion (2019 data) for medical care (over $11,000 per person), far more than any other country (17.7 percent of our GDP, vs. the 12 percent of the next highest country, Switzerland), the US is ranked 24th by the World Health Organization in life expectancy. We rank 37th in the world’s countries’ health systems, in the WHO’s estimation.

Additionally, the Commonwealth Fund ranks us 11th among 11 developed countries for health outcomes, equity, and quality. And the National Institutes of Health ranks us at the bottom of 16 comparable high-income countries in health outcomes and lifespans.

So give us an “F” when it comes to outcomes vs. expenditures.

America has a deeply fragmented and arcane insurance system in which millions of families depend on employment for their insurance. So if there’s a recession or pandemic and millions of people get laid off from their jobs, they lose their health insurance, too. And though there is an individual mandate (residents in states like Massachusetts are required to carry health insurance), the insurance purchased through the state’s Health Connector can require many thousands of dollars in deductibles and copays.

We have no business mandate — a requirement that employers offer good health insurance to all employees. This means that the taxpayers subsidize large corporations like Walmart, which keeps its prices down by not offering benefits like insurance to all their employees, thereby leaving that responsibility with the taxpayers, since many employees of companies like Walmart qualify for Medicaid.

In the US, out of pocket expenditures for health care is $366 billion per year (10 percent of medical expenditures). The result of such a system is that 66.5 percent of personal bankruptcies in the US (19 percent in Canada) are due to medical debt.

We also have bizarre rules in this country. Take colonoscopies, for example. According to Obamacare, preventive procedures are supposed to have no out-of-pocket cost, but insurance companies have decided that “preventive” means not finding anything. If they find a polyp, then this clearly preventive procedure (to take out something that could cause cancer, thereby preventing the cancer) turns into a “diagnostic” procedure, and you pay for anything not covered by insurance, such as the deductible. That was $1,700 for my last colonoscopy, which found one easily-resolved, 1 millimeter polyp.

Prevention, which should be the centerpiece of a rational health care system, is not an important part of the American system of care. If it were, we’d have a lot more focus on nutrition and fitness, and the social determinants of health.

This is our health care system. Compare it to our peer countries, where you get a card when you’re born, and keep it until you die. It covers nearly everything you need, and health outcomes are significantly better. Call it socialized medicine or call it the way health care is typically delivered in the developed world. I’ll take any one of those systems over the broken and costly one we have.

Bill Walczak is the co-founder and former president/CEO of the Codman Square Health Center. He lives in Dorchester.