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Medicare for All: A Single Solution to the Health Care Fracas

The Affordable Care Act was upheld by the Supreme Court, but many remain dissatisfied. How we can still make health care work.

Hospital Corridor photo by UM Health System

It will take some time to digest the Supreme Court's decision yesterday, but it appears to have averted some terrible jurisprudence that might have very seriously restricted the government's overall ability to regulate the economy and protect citizens.

In upholding most of the Affordable Care Act, the Supreme Court lets stand legislation that offers some important benefits, but only to a portion of those who are uninsured, and will predictably fail to solve our nation's health care crisis.

However the health reform law ultimately plays out, we know two things for certain: Tens of millions of Americans will remain uncovered as will tens of millions of under-insured who will remain at risk of financial ruin if a major illness strikes; and it will leave the private health insurance and pharmaceutical industries in charge of prices and life-and-death treatment decisions.

There is a single solution to the challenges of providing coverage to the 50 million who are uninsured that would curb out-of-control health care costs and provide a humane standard of care to all who enter the medical system. That solution is an improved Medicare-for-All, single-payer system.

The improved Medicare-for-All approach starts with the premise that health care is a critically needed right that must be afforded to all, irrespective of any individual's ability to pay for care. It solves the problems of 50 million uninsured Americans simply and directly by establishing that everyone is covered by the improved Medicare-for-All system. Everybody in, nobody out.

The improved Medicare-for-All approach would eliminate the greatest waste in the health care system: the needless costs imposed by the private health insurers.

Improved Medicare-for-All would prevent the deaths of the 45,000 Americans who die every year from lack of health insurance. It would eliminate the hundreds of thousands of medical bankruptcies—affecting millions of Americans every year—that occur because people can't pay their medical bills. These deaths and economic tragedies are entirely preventable; a system that permits them to continue is morally repugnant and must be replaced.

The improved Medicare-for-All approach would eliminate the greatest waste in the health care system: the needless costs imposed by private health insurers. These firms impose hundreds of billions of dollars of excess cost on us via excessive profit-taking and executive compensation, marketing expenses, vast bureaucracies devoted to denying care, and imposition of massive paper-pushing obligations on actual health care providers.

It is not for lack of policy justification or moral force that Americans continue to suffer from a malfunctioning health care system. Our failure to have adopted an improved Medicare-for-All system is due in large part to the political power of the health insurance industry.

That political power can be overcome, however, by a grassroots movement that musters enough of its own power. The country cannot continue to survive the continued reign of the private health insurance industry, and it will not.

Our failure to have adopted an improved Medicare-for-All system is due entirely to the political power of the health insurance industry.

Winning a single-payer system will not be easy. In the near term, the single-payer movement will need to devote substantial energy to holding off efforts to further privatize and weaken existing Medicare

The early steps forward in winning expanded and improved Medicare-for-All will likely come from state initiatives, where success will depend on local movements plus assurances that states pursuing improved Medicare-for-All can obtain needed waivers from federal laws and rules.

But there should be no doubt about what must ultimately be achieved. We can no longer tolerate a system that pointlessly kills 45,000 fellow Americans a year. For those who doubt the political potency of this moral imperative, consider that economic facts counsel just as strongly for an improved Medicare-for-All system.

We can be our brother's (and sister's) keeper and be cost-effective at the same time. Indeed, it turns out that being cost effective requires that we take care of each other.


Robert Weissman is president of Public Citizen, a national, nonprofit consumer advocacy organization based in Washington, D.C. Public Citizen has supported a single-payer system since its founding more than four decades ago. For more information on its advocacy for a single-payer system, please visit www.citizen.org.

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