What if everyone had Medicare?

By Henry Abrons

The Census Bureau released its annual report on income, poverty and health insurance coverage in the United States earlier this month, and it’s no surprise to learn that we’re in bad shape. The number of people living in poverty was 43.6 million (14.3 percent), up sharply from 2008, and real per capita income declined 1 percent.

Looking at health insurance, the situation is truly dire. There was a dramatic spike in the uninsured – 4.3 million more, to a record 50.7 million – in spite of the expansion of government health insurance rolls by nearly 6 million.

Those opposing government health insurance should ponder the fact that private health insurance coverage dropped to the lowest level since comparable data were first collected in 1987. On the other hand, those who look to the new health reform law – the Patient Protection and Affordable Care Act (PPACA) – for a solution should be deeply disturbed.

PPACA was not designed to provide universal coverage. In fact, if the new law works as planned, in 2019 there will still be 23 million uninsured. Yet the consequence of being uninsured can be lethal: Research published last year shows about 45,000 deaths annually can be linked to lack of coverage. That number is probably more than 50,000 today.

As Don McCanne, senior health policy fellow at Physicians for a National Health Program, has observed, PPACA is an underinsurance program. Employers, seeing little relief, will expand the present trend of shifting more insurance and health care costs onto employees.

Individuals buying plans in the new insurance exchanges (which won’t start until 2014) will discover that subsidies are inadequate to avoid financial hardship. Inevitably, they will end up with underinsurance, spotty coverage and high deductibles.

And workers who are unemployed or without employment-based insurance will move into Medicaid (Medi-Cal in California), where providers are reimbursed at such low rates that many will not accept patients.

When Congress passed the new law last spring, it based its decision on a faulty assumption – namely, that the rest of the population will have sustainable private health insurance. But between 2008 and 2009, the number of people covered by private health insurance decreased from 201.0 million to 194.5 million, and the number covered by employment-based health insurance declined from 176.3 million to 169.7 million.

If this trend continues, as it’s bound to do under current economic conditions, the ranks of the uninsured will expand and the new law will fall far short of the mark – either the cost will exceed projections, or coverage will be need to be reduced.

The Census Bureau report underscores the urgency of going beyond the Obama administration and swiftly implementing a more fundamental reform – a single-payer national health insurance program – improved Medicare for all.

Improved Medicare-for-all, by replacing our dysfunctional patchwork of private health insurers with a single, streamlined system of financing, would save about $400 billion annually in unnecessary paperwork and bureaucracy. That’s enough to cover all of those now uninsured and to provide every person in the United States with quality, comprehensive coverage.

A single-payer plan would also furnish us with effective cost-control tools, like the ability to negotiate fees and purchase medications in bulk. It would permit patients to go to the doctor and hospital of their choice.

Short of a full national plan, some states, like ours, are eyeing a state-based single-payer model. The new health law allows states to experiment with different models of reform, but not until 2017. Congress should move that date forward. There is no time to waste.

(Henry Abrons, M.D., is a member of Physicians for a National Health Program-California – www.pnhpcalifornia.org.)


  1. Jenny Hazard on October 5, 2010 at 7:50 pm

    I wish more people could grasp this concept, and the fact that the only thing anyone stands to lose is obscene profits for big pharmaceuticals and insurance companies. I live in Wisconsin and I think our Badgercare is similr to Cal-care. For the most part the coverage is pretty good with the exeption dental, vision and certain types of mental health care; again the reimbursement rates are a joke.
    I am currently being treated for Hepatitis C, and I am grateful to have the coverage. If I didn’t have a child under 18 I would be on a witing list for the new Badgercare core program and if I wanted interim covrage I’d have to pay 150.00 a month. That may not seem like a lot to most people, but I’m barely scraping by on SSDI. I’m with this cause to the bitter end. It’s shocking to me that people are so uninformed, or misinformed that they won’t support this system.
    Jenny H

  2. Sidney Brooks on October 12, 2010 at 11:47 am

    How many times does this need to be said? Medicare for all is not the answer, single payer is. My Medicare through AARP costs $180 a month. How many Americans can afford it?

  3. Kent Zavacky on October 12, 2010 at 1:04 pm

    As I have written in one of many editorials, previous to the rise of 4.3 million more to the ranks of the uninsured (this does not count underinsured of course); the previous number of 47 million or so without any care is pretty much equal to the population of the 50 largest cities in the USA (city popultion only, not Metropolitan statistical area). You can easily find the figure from US Census Bureau data. So now 4.3 million more!, well this is more or less the population of Nevada and Idaho combined, or if you so choose the combined state populations of Vermont, New Hampshire, Main,and Rhode Island. As written above by jenny hazard how uninformed (or misinformed) the American public is beyond belief. Believe me , most US citizens who I have contact with (I would say 90%+) have zero knowledge on issues affecting their very lives.

  4. Shoshannah Benmosche on October 13, 2010 at 2:39 pm

    Over the summer I have been observing all this from beyond the propaganda curtain at the borders of the USA. I am amazed at the preference my fellow countrymen demonstrate for preserving their ignorance to exercising a bit of skepticism in evaluating the sources of their information for its agendas, or even identifying their sources. There seems to be a disconnect between ones personal experience and ones self identification for representation of their own personal or class interests. Is it that our education prepares us to be cogs not cognitive of our own interests and totally unable to universalize or identify that “what is good for all is also good for me and what is not good for all cannot be good for me?”

    I spent my working life primarily in Europe and Canada and have greatly benefited from access to universal health plans on both continents. The disinformation in the US about the accessibility, universality and effectiveness of health care in other western industrialized countries is astounding. This is also true of my personal experience of the run up to the Afghanistan and Iraq wars. So much unbelievable garbage went unquestioned.