The convoluted mess that America’s healthcare system has evolved into is largely due to the myriad of rules and requirements imposed by insurance. To effectively collect payment from insurers requires a deep knowledge of that massive book most patients file without more than a cursory glance at “FOR EVERY COMPANY” in the market. Those books are full of dirty tricks and hoops that providers and patients must jump through to complete payment for services already provided because those companies make massive profits from “NOT PAYING” the bills.
Medicare, while not completely free of such chicanery, is much easier to administer and would provide a single book of rules across the nation. It isn’t reasonable to expect Medicare to pay for the extreme cost of administering a payment system made overly complex by other entities or to pay for losses to providers those entities impose when they don’t pay. If providers could be reasonably sure of being paid Medicare reimbursements would be sufficient to allow them a reasonable profit.
The mistake we are making in this debate actually has little to do with the money. It is undeniable that Medicare4All will save money for patients and that has been proven by one of the most conservative think tanks in politics. What we need to talk about is the available resources of our health care system and the potential demand resulting from people being free from the worry of being bankrupted by one of those tricks used by insurance to avoid payment, or simply not having insurance.
Are there sufficient primary care physicians and nurses to diagnose, refer, or treat the expected patient load? Are they currently distributed properly or are they concentrated in more prosperous areas where more patients are insured? Are there enough patient beds and equipment in the right areas if demand shifts to areas now already underserved? If the plan fails it won’t be from lack of payment. When the monopoly issuer of the money is the single payer the money is in infinite supply to meet any demand that there are available resources for.
It will be America’s fixation on deficits and debt that will determine the success or failure of Medicare4All. A basic misunderstanding of how our government funds itself and the economy has been the root source of most of its problems as people relate rules applicable to their kitchen table budgeting to the processes of the monopoly issuer of the nation’s currency. Politicians, never being known for passing up a chance to pander to popular opinion, even when it is wrong, have added to the negative effect of this for so long that the financial system has evolved their public image to it, while mostly ignoring it in reality.
Americans are unique in the world for their, often violent, negative reaction to their government providing any benefit to them. This stems from the misperception they almost universally have of who pays for those benefits. As long as they believe their tax dollars are paying for their government they will be reluctant to approve of any large scale programs, even those that offer universal and significant savings to them and society. This has made America unique in its rush to privatize any and all functions of the government and has enabled the general worship of the market as the best distributor of resources.
It isn’t difficult to predict the path of such utter nonsense in such a wealthy country. Ultimately it will always produce a binary society of haves and have nots and the anger fueled misery that goes with that. Nowhere is this more evident than in our completely dysfunctional healthcare system. It has given us diabetics, many with insurance, relying on GoFundMe for their insulin and well over half of the caseload of bankruptcy courts. Our system, in spite of costing multiples of that of other less affluent nations, is far down the list of best outcomes and many providers must dedicate more resources to billing than to actual delivery of services.
None of this failure is the fault of the government payment programs and only the most rabid worshipers of the market could deny our problem as employer-based insurance/healthcare threatens the very structure of our economy and undermines the empathy needed to hold a society together. If the current advocates of single-payer healthcare are making a mistake it is their capitulation to demands of “how will you pay for it” when the best policy may be to not pay for it with any revenue source.
In the short term at least, the economy is going to have to provide for a large number of insurance industry workers made unemployed by the government’s efficiency. I know some pretty sharp economists saying that the economy may need the added boost of a tax “CUT” on top of eliminating all premiums, copays, etc to avoid single-payer being deflationary. This may be the issue that demonstrates our mistake in how we view financing government programs, or it may cause a serious recession if we remain stuck on stupid and insist on “payfors” for a government that neither needs nor uses revenue from any source.
