A Tale of Twins: Why the U.S. Needs Universal Single-Payer Medical Care (i.e., Medicare for All)

A man, just a few years into his retirement, wakes up one day to notice some peculiar health symptoms. While he has always been in generally good health, something feels abnormal. He has severe lower back pain as well as an odd cough and a bit of difficulty breathing. He can’t seem to find a comfortable position to sleep, and he just does not feel right at all. Deciding that he is not himself and that his symptoms are definitely unusual (even alarming) he heads to the local emergency room. From there he is admitted to the intensive care unit and, after a barrage of tests, finds out that he had a pulmonary embolism. He is stabilized, monitored, and given a course of anti-coagulant (blood thinning) medication. Within a few days, he is on his way, prescription in hand and back to his normal routine.

Man number one lives modestly but comfortably with a pension and comprehensive health insurance. He does not think twice about heading to the hospital when he feels he needs care, and he visits his doctor regularly for routine check-ups. His vigilance about his health as well as his ability to access and afford medical care probably saved his life.

Another man, also a few years into retirement, has been avoiding some medical care. After unexpectedly losing all that he earned through decades of work, he barely survives on a fixed income of social security supplemented by a part-time job. (Note: Regardless of intellect, education, and ability, most employers are loath to hire anyone over 40 or 50 years old – let alone a capable man just over 70 - to a full-time, well-paying, fully-benefitted position.)  This man has also always generally been in good health, but has to consider the co-pays, deductibles, and the cost of services or prescriptions that are not covered by his Medicare Advantage plan (administered through a private insurance company) when deciding whether or not to seek medical care. Every dollar counts. (Indeed, even traditional Medicare, in its current iteration, has numerous out-of-pocket expenses as well, and is insufficient in providing comprehensive medical care to seniors.)

Man number two has been noticing that he hasn’t been feeling quite himself, but he has been under a lot of stress for quite a few years now. He chalks his symptoms up to his persistent seasonal allergies and the general constant stress that comes with financial insecurity, among other common social and economic hardships he faces. He figures that he is probably fine, as he usually is. There is no point in going to the doctor for nothing, then coming home with bills he could not afford to pay. One early morning he wakes up not feeling well, heads to the bathroom, and collapses, dead from undiagnosed atherosclerosis and an emerging pulmonary embolism.

These two men are twin brothers. One is here and one is gone. The first man is my uncle; the second man was my father.

The divergent outcomes of their lives may be blamed on a lack of fundamental human rights and dignity for every citizen in the United States. These include the right to a basic income that affords one the necessities of food, water, shelter, and clothing. Along with these essential elements for human life, all people should have the right to medical care. The increasing penury throughout the nation is a topic for another time, requiring and deserving more depth and explication; however, the lack of universal single-payer health care is very simple to analyze and remedy.

The abhorrent act of denying someone health coverage due to the patient’s pre-existing medical conditions was finally overturned under the Affordable Care Act (aka the ACA or Obamacare), but health insurance companies continue to cause deaths, directly and indirectly, through other means:

• They deny coverage for necessary procedures, rendering them unaffordable to patients in need
• They deny coverage for necessary medications, rendering them unaffordable to patients in need
• They charge premiums and co-pays that are too costly for many Americans to afford
• They cover some costs only after the patients fulfill their deductible, but these deductibles are often too costly for many Americans to afford

As a result, countless Americans die when their insurance will not provide necessary care and medications. Other Americans choose to not go to the doctor or hospital rather than be stuck with a bill that they do not have the ability to pay, and grow sicker or even perish as a result of such an immoral conundrum.

Frankly, anyone who works for a health insurance company has blood on their hands.

As unconscionable as it may seem, health insurance companies are in the business of refusing people coverage for the care they require and/or the care they receive. Health insurance providers are corporations, and their goal is to maximize profits. Keeping themselves from paying for your care and making you pay for as much of it as possible is precisely how they profit. That is how the system works.

It seems unfathomable that anyone in the United States would question the benefit of universal single-payer medical coverage, especially given the insanely chaotic and barely comprehensible labyrinth that comprises our current health system under insurance plans. Unless you have magical, unusual health insurance, you will pay for at least some of your medical visits, procedures, and prescriptions, and you will rarely, if ever, know what anything will cost until you are billed.

Imagine going to a mechanic to fix your car. The mechanic takes your vehicle, makes some repairs, may let you know what those repairs are but does not disclose what she will charge until your receive the bill and are obligated to pay. That is how our health care system works. It is the only product in existence that consumers purchase without being told the price of the service. It is insane.

The health insurance industry wants to do their best to disguise the common sense that is Medicare for All. Their public relations departments seem to have briefed most mainstream media outlets and corruptible politicians with erroneous and misleading talking points. Here are some truths instead:

• Medicare for All (universal single-payer health care as envisioned by politicians like Bernie Sanders) is the most cost-effective way to provide medical care to every American. It saves money by drastically reducing bureaucratic and administrative costs, because there is a single-payer with no middle-men. It creates uniformity, eliminating the disparate and complicated pricing, billing, and payment structures under current health insurance models.

• Medicare for All provides the most freedom of choice of any health care plan because there are no “in-network” providers and no groups you must choose from; you can select any doctor, hospital, emergency room, ambulance service, etc. that you want or need.

• Medicare for All allows you to travel or move around the country and always have health care.

• Medicare for All allows you to lose, leave, or change your job and always have health care.

• Medicare for All means you do not have to have your spouse or your children under your plan because EVERYONE has their own health care coverage – always, everywhere, and anywhere in the nation.

• Medicare for All does not mean that you will lose your precious health insurance from your job. You will lose nothing but the corporate go-between. You will have all the same care, all the same doctors and hospitals that your want - with even more choice and more benefits. No one really cares about health insurance per se; people care about keeping their family doctor and the care they know, and under Medicare for All, they will.

• Medicare for All means that employers no longer have to waste money on health insurance premiums and can pay their employees a higher salary and/or hire more employees.

• Medicare for All means that you will not have to worry about affording to pay medical bills. You just get health care. Period.

I know that last line seems hard to believe, but if you have ever been to most other industrialized nations that have universal health care, you know it is true. When I set foot in New Zealand for my few-month stay there, I breathed a sigh of relief because I knew I would not go broke if I fell ill. Even as a guest in the country, I could see a doctor for routine care and more (which I did) and never have to pay a cent.

Given the rationality, simplicity, cost-effectiveness, and morality of universal single-payer health care, it would seem that those who are outright against universal health coverage are either corrupted by an industry that benefits them personally or are ignorant of what Medicare for All means. There are no other explanations as to why we wouldn’t want to SAVE money and allow every human being in our country access to unlimited medical care. Everyone with empathy, common sense, and even self-preservation should be on board.

Medicare for All has gained great traction in the past ten years since health care reform emerged as a national priority. The Obama administration and the Democrats in Congress catered to the wishes of the health insurance industry with their 2008 plan (the ACA). While some people benefited from some of the small changes enacted, overall our health care system under multiple for-profit insurance companies remains as arbitrary and capricious as ever.

The good news is that after decades of obfuscation and misinformation, Americans have finally caught on to the more efficient, more humane, and only moral health care option: universal, single-payer health care – i.e., Medicare for All.

We are far past due for a universal single-payer health care system. No more of our friends and family members should die prematurely for lack of medical care. No more of us should suffer these needless, preventable, devastating losses of our loved ones. No more daughters should lose their fathers because our country lacks basic human decency and compassion.

Medicare for all - for us all.

* Countless others have quantitatively outlined the rationale, benefits, and affordability of Medicare for All. For one good synopsis, please see On Medicare's 54th Birthday.