Everybody In, Nobody Out

COVID-19 provides the most compelling rationale in our lifetime for winning Medicare for All. With M4A we could address the systemic racism and other healthcare inequalities revealed by the pandemic by

  • replacing employment-based private insurance with a publicly financed and administered system of guaranteed healthcare for all, including undocumented workers;
  • expanding treatment of existing chronic conditions and the toxic stress disproportionately affecting Black and Latino communities;
  • expanding preventive care, instituting culturally competent care, and redirecting resources toward robust public health;
  • establishing a new social solidarity that guarantees housing, jobs and food security to address the social determinants of health.

Critics say that such a program is too expensive and that we must move incrementally. But we must take financing out of the hands of private insurers. Hospitals face losses of $350 billion due to the pandemic, yet insurance companies report undiminished profits.

If we establish single-payer financing that controls costs in part by providing “global budgets” to hospitals and clinics, these facilities will have the operating resources they need to re-open and stay open in rural areas and inner cities even when not profitable or “paying customers” do not show up, as when elective procedures are cancelled during a pandemic.

Under single-payer financing, the hundreds of billions siphoned from healthcare services in the form of administrative waste, profits, and high executive salaries (typically $22 million per year for insurance CEOs) would be redirected to primary care, prevention, public health, and essential supplies. Shortages of Personal Protective Equipment are not an accident; they exist by design. To maintain cash flow, supplies are limited and produced by an outsourced supply chain “just-in-time.” Nobody has stockpiled them for exactly the purpose for which they were needed and still are needed, because it’s not profitable to plan ahead. During a pandemic, especially for healthcare workers, that’s a fatal flaw.

Under the present fragmented system or the “public option,” patients change plans, and plans restrict access to providers through limited networks, thus disrupting continuity of care. The “everybody in, nobody out” approach of Medicare for All creates incentives for preventive care. Drugs developed with public funding would be available at no or low cost to the public.

Because Medicare for All would provide a single standard of quality healthcare free at the point of service without financial barriers in the form of co-pays and deductibles, patients will get the care they need, not just the care they can afford. This in turn provides resources for patient education, as well as the ability to educate more culturally competent providers. Well-funded public health programs can address other barriers, such as access to reproductive health services, including publicly funded abortions. With guaranteed healthcare, those with the least ability to get care now will benefit the most.

Other benefits provided by Medicare for All, but not by incremental piece-meal reforms, include the following:

  • complete choice of doctors, hospitals and other providers;
  • long-term care with a preference for home-based care;
  • the medical portion of workers compensation;
  • dental coverage;
  • in-patient psychiatric care, substance abuse rehabilitation and out-patient therapy, covered equally to physical health conditions
  • peace of mind.

Because employers will save an estimated one-third to one-half of what they currently spend on healthcare, those savings can be redirected to wages and pensions, as mandated by programs accompanying the national Medicare for All legislation.

Those workers whose jobs are eliminated when we transition to Medicare For All will receive income maintenance, a bridge to pensions, job training for new clinical positions or placement in comparable administration positions, funded by 1-2% of revenues for five years.

Overall funding for the program comes from progressive taxes, including payroll and income taxes that are substantially lower for 95% of people in the United States and replace the premiums, deductibles and copayments we currently pay.

If all of this sounds too good to be true, that’s because our expectations have been lowered by the false claims of political infeasibility. In fact, since the pandemic began, support for Medicare for All has increased by nine points to 55% of registered voters, per a March 27-29 survey. Guaranteed healthcare for all undermines the politics of resentment that currently poisons the debate—as some people get subsidies for coverage while others struggle to get the care they need.

Imagine if every politician, union, and advocate who expresses support for improved Medicare for All actually worked to enact it. Ours is a movement to save lives. Join us at medicareforall.dsausa.org, where we organize a pressure campaign to win national Medicare 4 All, nothing less!