The failure of Trumpcare was a victory for healthcare access and affordability. But it’s no secret that our fragmented and for-profit healthcare system is still plagued by deeper issues.
As a working nurse in a busy Emergency Room, I saw these issues up close for 40 years. And while the Affordable Care Act was a step in the right direction, it didn’t go far enough to address the underlying, systemic problems that make healthcare in the U.S. absurdly expensive, unnecessarily complicated, and still inaccessible for millions of people.
The practical solution — the one that saves money while improving coverage, protecting patients, and simplifying the system — is to improve and expand Medicare to cover everyone.
We can fight to protect what we have while also imagining and advocating a system that treats healthcare as a basic right, not an increasingly expensive privilege.
Even after the ACA, many people are only one accident or illness away from financial ruin. Insurers used the complex law to normalize “high deductible” health plans, which force families to pay $5,000 to $10,000 out-of-pocket before insurance even kicks in. After that, many still have to pay 20% or 30% of all their bills (“co-insurance”), possibly totaling tens of thousands of dollars. Average out-of-pocket expenditures for individuals with Multiple Sclerosis can exceed $34,000. For diabetes, out-of-pocket costs can average $26,000. For mental illnesses and unexpected injuries or accidents, average out-of-pocket costs can be more than $23,000. For most families, costs like that are crushing.
In our current system, “high deductible” and “co-insurance” plans are like a tax on the sick.
To make matters worse, employers are increasingly shifting insurance costs onto workers. The amount that workers contributed toward premiums increased 83% between 2005 and 2015, according to the Kaiser Family Foundation. No surprise: Wages did not increase to keep pace.
The ACA made some enormous strides, to be sure.
Before the ACA, insurance companies could limit your coverage and refuse to make payments after you reached a certain cap. NICU nurses could see babies hitting their lifetime caps after being born with complications. ER nurses could see healthy young adults hitting their lifetime caps after one accident. Medical bills were the leading cause of bankruptcy in the U.S.
Thankfully, this ended with the ACA. Medical debts are decreasing and — for the first time ever — fewer Americans are reporting problems paying medical bills.
The “80/20 rule” now requires insurance companies to spend at least 80% of their premium revenue on actual healthcare services. They can’t just pocket the premiums or spend them on administration and marketing while patients are racking up uncovered bills. The ACA also requires all plans to cover certain basic services, like maternity and mental health care, as well as free preventive care, so that we can promote wellness rather than just treating sickness. If employees are paying more for their plans, at least the insurance companies can no longer deny or exclude basic services.
Still, despite this progress, the underlying issues remain: What should be a basic right for everyone — the ability to get healthcare — is treated as a commodity from which insurance companies, hospitals, and drug companies can extract profits.
The best way to finally get at this root cause is to expand our established, successful, popular Medicare program. HR 676, introduced by John Conyers in the House, and a bill to be introduced by Bernie Sanders in the Senate, would provide Medicare for everyone.
Imagine it: High quality healthcare coverage for every single American. No more premiums. No more medical bankruptcies. No more “lose your job, lose your coverage.”
With Donald Trump in the White House and Paul Ryan and Mitch McConnell leading Congress, “Medicare for All” can feel like a far-off pipe dream.
And yet, I’m constantly reminded that we’re closer than we realize: Public programs are already covering nearly 40% of the population. The number ticks slightly higher if you count individuals who are purchasing private plans with government subsidies. According to Physicians for a National Health Program, tax-funded expenditures already account for 65% (and growing) of all U.S. healthcare spending. This is because the government already covers many of the most expensive and high-risk people in the system, including the elderly and persons with disabilities. Bringing younger and healthier people into that pool could dramatically expand coverage without radically increasing costs.
The other reason I’m optimistic?
In my decades of activism on healthcare issues, I’ve never seen the level of energy and involvement that we’ve seen in recent months.
When the ACA came under attack, regular people came out of the woodwork to share their stories and demand that the law be kept in place. These weren’t paid protesters: They were real people whose lives and livelihoods are deeply affected by our healthcare system. Other battles are on the horizon now that the Trumpcare crisis has been temporarily averted, but people are craving a proactive agenda. We refuse to merely play defense when healthcare is still out of reach and far too expensive for millions of people.
“Keep what we have” isn’t good enough.
Medicare for All is not only the best policy solution, but also the guiding principle — healthcare as a basic right for everyone — that we can rally behind as we carry on this fight.