At last count, there are eight formally announced Democrats running for the Presidency and a number of others with exploratory committees. Many of these people have designs on a health care system that replaces the current one; the most common labeled, “Medicare for All” (MFA). This concept was originally introduced by Democratic Socialist, Senator Bernie Sanders, years ago and was summarily dismissed then. But that was then and now the bandwagon needs another horse to pull it. I say let’s have a real discussion about the merits of MFA but in the context of its lofty goals versus the morass of details that would cloud the actual understanding necessary for voters to make up their minds.
Let’s start with where I think most, if not all, would agree. No person in the USA should be denied urgent health care. I believe that if another human saw someone suffering poor health, they would be fine with addressing the situation. There may be exceptions, like when the situation was self-induced or the result of not properly addressing a prior illness or injury. But on the whole, no one wants to see a person suffer unduly. It’s important to establish this as a goal for, without it, we have no way of ever agreeing on what it is we are trying to solve. Assuming we want everyone to have access to health care, let’s examine the questions of how to deliver it taking into account our current systems.
Today, by law, anyone presenting themselves to a licensed hospital must be treated. Public and private hospitals alike are prohibited by law from denying a patient care in an emergency. The Emergency Medical and Treatment Labor Act (EMTLA) passed by Congress in 1986 explicitly forbids the denial of care to indigent or uninsured patients based on a lack of ability to pay. So today, we have in place a means to treat everyone in the US. That it is not the most efficient can easily be argued.
Also today, over 50% (~155m) of all persons in the US get private health insurance through their employer. Medicaid covers another 76 million and Medicare, 55 million persons. Add Obamacare’s 11 million and, out of a population of 330 million, 90% of the population has health insurance of some form. (https://www.cnbc.com/2016/07/13/number-of-people-with-health-insurance-via-jobs-remained-steady-with-obamacare.html) Again, how well the current insurance schemes work is a big part of the debate.
Most opponents of MFA use the argument that “it’s too expensive”. Proponents argue, we already spend the money through the current system so it is just another way of delivering it. Will more people access health care when there is no question about payment? Will it lead to healthier lifestyles and preventative medicine that will eventually lead to lower costs? Other issues include rationing of care and when is care no longer provided at end-of-life. There are long term examples of government provided healthcare in other countries with fact based outcomes that can be used to test both these questions. The most difficult question to answer is the effect a government controlled health care system has on personal freedom. How do citizens reconcile the American value of independence and self-reliance with the state controlling your very health?
Candidates who talk in platitudes about MFA or other state sponsored health care, need to be held to account on their proposals. It is incumbent upon the media and the American people to pin down the answers to these and any other critical questions before we overturn our current system. Before we make our choice on a government provided health care system, the concept must be fully debated and understood by voters. Our very freedom to choose is at the heart of the debate.
Current Day Publius 