Vermont Sen. Bernie Sanders may not be able to achieve his ultimate goal of a single-payer, universal health care system any time soon. But his outspoken support for what he calls “Medicare-for-all” has already moved the ball forward on this important public policy issue.
Indeed, just last week, Sanders’ primary opponent, Hillary Clinton, announced she now supports a major step towards a single-payer system, by opening up Medicare to more Americans. As Clinton explained it, the concept would allow Americans as young as 50 to buy insurance coverage through Medicare. Think of it as the restoration of the public option, which President Obama supported but eventually abandoned as he sought to get his signature health care bill, known as the Affordable Care Act, through Congress in 2009 and 2010.
The idea is hardly a new one. In fact, many of the political leaders who founded the Medicare program in the 1960s had always intended to extend its coverage to more and more Americans over time. Medicare, after all, is the most efficient means of providing medical insurance coverage that we have in the U.S., with nearly 95 percent of its expenditures going to actual medical services. Under private insurance, at least a quarter of every premium dollar goes to unnecessary administrative costs and shareholder profits. That means as much as $600 billion annually— money that could be providing actual care to Americans— is drained away in corporate profits and overhead that would be avoided under a single-payer system, like Medicare.
This was, and remains, the fundamental flaw with the Affordable Care Act, more commonly known as Obamacare. By maintaining the system of private insurance, Obamacare has created an overly complex system that is taxing the patience of many of its beneficiaries. Here in Minnesota, the MNsure system, set up as part of Obamacare, has frustrated users from Day One with a clunky website, lackluster customer service, and this year’s monumental delay in the issuance of subsidy records needed for beneficiaries to file their taxes. According to local tax preparers, many, if not most, of the forms that MNsure beneficiaries finally did receive in early April, were not just months late, they were wrong.
A single-payer system, like Medicare, avoids most of these problems because it’s a far simpler system, and it’s one that has operated successfully for more than half a century. The bugs, in other words, have been largely worked out.
Democrats erred badly, beginning with Bill Clinton, by not pushing for Medicare expansion as part of any health care reform. Instead, both the Clinton and Obama administrations advocated entirely new and complicated systems utilizing private insurance. It was bad policy, driven more by campaign contributions from the industry than common sense, but it was even worse politics, because the complexity and unfamiliarity of the proposals made it easy for opponents to demonize them. The Clinton administration, under a process led by Hillary, failed completely in its effort to achieve health care reform. And President Obama was eventually forced to engage in unseemly legislative gymnastics to get even his watered-down proposal passed through Congress.
Politically, it’s pretty tough to demonize Medicare. Americans understand it, and the vast majority can’t wait to hit 65 so they can qualify for it. Yet, if it’s good for a 65 year-old, why isn’t it just as good for a 62 year-old, a 55 year-old, or even a 30 year-old?
By gradually lowering the age at which Americans can buy into Medicare, we could move almost seamlessly to a far more efficient system, and improve the health care coverage for millions of Americans at the same time. Such a plan would undoubtedly be fought by the insurance industry, but that’s where we need politicians who aren’t beholden to big money. We need to understand that there is a direct connection between our corrupting campaign finance system, particularly in the wake of the Supreme Court’s Citizens United decision, and the policies that are put on the table in Washington. Most Americans, after all, support a Medicare-for-all system. It’s insurance industry lobbyists and their vast trough of campaign dough that keeps us from achieving this valuable goal.
Whether Hillary Clinton is serious about the proposal remains to be seen. Sen. Sanders has clearly pushed her to adopt a somewhat bolder agenda, at least for the primary season. In either case, that both Democratic contenders are now talking about Medicare expansion— whether Medicare-for-all, or Medicare-for-more— is a step in the right direction. We can thank Sen. Sanders for keeping the pressure on.