Updated: Oct 19, 2021
The United States currently has over five million cases of COVID-19 with over 170,000 recorded deaths. The pandemic response has undoubtedly failed to flatten the curve, and a multitude of factors can be attributed to this failure. One in particular is the lack of sufficient healthcare for all Americans. The implementation of a Medicare for All (M4A) healthcare system pre-COVID, however, would’ve ensured a swifter and more effective pandemic response.
What is Medicare for All?
While different proposals have been put forward by Democratic candidates such as Elizabeth Warren and Bernie Sanders, at its most basic interpretation, Medicare For All is a proposal that, if passed, would eliminate private insurance and transition to a single-payer healthcare system. Through this system, the government would pay for every citizen’s health care coverage through tax revenue. Most proposals include an expansion of the current medicare system so that it would cover vision, dental, and prescription drugs, and possibly reproductive services such as abortion. Supporters of Medicare for All often cite cutting excess administrative costs as a principal reason for endorsing the bill; these expenditures consist of billing and payment processing costs, anti-fraud programs, and claim submissions. These costs could be cut by more than 600 billion dollars annually by adopting a single payer health financing system, according to a study in the Annals of Internal Medicine.
A Medicare for All system would radically change many segments of the healthcare industry. Currently, private insurance enrollees are required to pay a varying fixed amount of money for different services, based on different coverage levels that their chosen plan entails. However, alongside guaranteeing universal access, with M4A, cost sharing and co-payments would be almost entirely eliminated, with certain exceptions, such as if treatment encourages the use of generic drugs (copies of brand-name drugs with equal pharmacological characteristics such as recommended dosage and side effects).
Although this idea might seem costly, a cost benefit analysis considering unique conditions in the status quo leading to high prevalence of chronic diseases, shows that such a system would show net positive gains in the long term. Americans are currently refusing to pursue prophylactic or preventative care due to high out of pocket fees, which can be linked to the over $3.7 trillion lost in explicit costs and lost economic productivity annually due to chronic diseases. Eliminating the possibility of families going into medical bankruptcy would give them more incentive to pursue preventative care, and thus less money would be lost in the future due to chronic illnesses being treated earlier on. Higher taxes are a key reason why many individuals aren’t in favor of a single-payer healthcare system; however, health insurance already costs the average family of four over $12,000 a year from premiums, copays and deductibles. These average annual fees would be replaced by an equitable tax based on income and most people will wind up paying far less in new taxes than they are currently paying for all of their healthcare costs.
The Major Barrier to Implementing Medicare For All
Individualism has been linked with economic growth and innovation for a long time, however, it can also amplify economic downturns, as well as exacerbate collective action problems at times when they are most prominent such as pandemics. A research study spearheaded by three University of Virginia researchers found that even after controlling for variables like political ideology, social capital or population density, higher local levels of individualism reduced compliance with state lockdown orders by 41% and reduced pandemic-related fundraising by 48%.
The major barrier to enacting a M4A system has been our obsession with the ideal of individualism, and making decisions based on our self interest, ideals that aren’t entirely applicable to health-care. This is why the Affordable Care Act was also viewed negatively until recently. The American public saw the expansion of coverage as an imposition on individual freedom, rather than a necessary reform for the common good. This viewpoint undermines the essence of health insurance, which is intrinsically communal due to the concept of risk sharing; at some time or another the healthy subsidize the sick. Concrete individualistic mentalities and hyper-focusing on personal responsibility in healthcare ignores the role of social structures in exposing certain groups to more health risk factors. In addition, these mentalities also fail to address how social inequalities that disproportionately affect different races can be embodied in poor health outcomes.
The pandemic hasn’t impacted everyone equally. Hispanic and African-American residents of the United States have been three times as likely to become infected as their white counterparts, along with a mortality rate that is twice as large. Racial minorities are also disproportionately in essential work settings, with more possibility of exposure to COVID-19 due to factors such as close contact with the public or other workers, and lack of paid sick leave.
Support has been growing recently in favor of a single-payer health-care system, with 77% of Democrats and 61% of independents favoring a Medicare for All system. However, the DNC Platform committee voted 36-125 rejecting the Medicare for All amendment introduced by single-payer advocate Michael Lighty on July 27th. This has led over 360 DNC delegates to vow to vote against the Democratic platform because of its lack of endorsement of Medicare for All.
The vote also drew scrutiny from various other figures such as Jeff Cohen, founder of rootsaction.org, who stated the following: “History teaches a clear lesson: The fact that our nation is the only advanced industrial country without universal healthcare cannot be blamed on Republican obstruction alone. It was also caused by Democratic leaders who’ve spent decades catering to corporate interests (while collecting their campaign donations)—and refusing to fight for universal coverage.”
A M4A System Would Have Flattened the Curve More Efficiently
It is unrealistic to imagine an effective pandemic response in the status quo of privatized healthcare, where people are unwilling to pursue treatment for COVID-19. One out of every seven (14%) U.S. adults report that they would avoid seeking treatment if they noticed COVID-19 symptoms due to fear of high costs or potential medical bankruptcy, and nine percent of U.S. adults would do the same even if they explicitly believed they had contracted the illness. A Medicare for All system, which would almost certainly reduce out of pocket fees, would consequently reduce the amount of people unwilling to pursue treatment for both COVID-19 and chronic illnesses.
Social distancing orders on their own are not sufficient due to varying abilities of different groups to follow them to a tee. For example, Mayor De Blasio of New York Citys’ recommendation of avoiding close contact by not entering spaces such as crowded subway cars seemed tone-deaf as well as an example of the bourgeoisie’s disconnect from the working class, considering that low-income workers disproportionately rely on public transit and often do not have the option of working remotely.
COVID-19 exposed the flaws in our employer-based healthcare system. The U.S. unemployment crisis hit its peak in April 2020, with a figure of 14.7% unemployment, the highest since the Great Recession. Because of job losses between February and May of this year, 5.4 million laid-off workers became uninsured. The individuals being hit hardest by job and health-care insurance losses are Hispanics and African-Americans. These groups are also more likely to live near food deserts and have higher rates of diabetes and heart disease, which makes it obviously why they’re more vulnerable to COVID-19.
Medicare for All would have a profound impact on structural violence in the U.S., since due to systems of institutionalized racism minority groups are disproportionately under the poverty line. A private healthcare system exacerbates these inequities by limiting social mobility through phenomenons such as Job Lock; a system that pins health insurance to employment makes health care a commodity rather than a right, and reproduces the racial inequalities of the labor market.
One major issue with the U.S. response has been the failure to implement mass testing, as well as the inability to use available statistics effectively for measures such as contact tracing. In February while other countries that had mobilized businesses were performing tens of thousands of tests daily, less than a 100 occurred per day in the U.S.
Medicare for All would be advantageous compared to the current privatized healthcare system because of its ability to implement a standard billing and payment system, which would accelerate COVID-19 case reporting. Within a centralized system, patterns in billing data can signal outbreak hotspots to public health surveillance officials. Even with the cases that are currently able to be reported, in the status quo crucial information such as underlying health conditions is not recorded about those cases.
A report from the US Centers for Disease Control and Prevention published on March 31, 2020, could only identify underlying health conditions for 7162 of 122,653 laboratory-confirmed cases (5.8%) of COVID-19. Not only are the statistics regarding the pandemic underreported, they’re also unreliable, considering the fact that this report relied on data submitted through questionnaires, a prime example of a voluntary response bias.
Early on in the public health crisis in Taiwan for example, the outbreak was able to be contained largely in part due to the centralized electronic medical record system. The Taiwan CDC used the NHI smart card system to trace real-time travel and arrival history from the National Immigration Agency. Big data analytics using Taiwan’s extensive database and new technology such as online reporting of travel history and symptoms to classify travelers’ infectious risks helped mitigate the spread of COVID-19 and protect the interests of its citizens. In summary, countries with single-payer systems can conduct mass testing quicker, track the spread of the virus, and intervene appropriately. Unlike the U.S., they aren’t forced to negotiate with numerous private insurers, coordinate multiple public insurance programs, or figure out how to handle testing and treatment for the uninsured.
Through Teen Lenses: What are your opinions on Medicare For All? How do you think it could have affected the pandemic response if it was implemented pre-COVID-19?
“I think that healthcare is a human right, and it should be intrinsically guaranteed to everyone. Medicare for All in my opinion would have eased people’s anxiety over being bankrupted by hospital bills if they contracted the virus, especially now that many people are unemployed. Supply chains would also be stronger and hospitals would have to worry less about running out of materials.” Alicia June, 15, Rising Sophomore at Hayfield High School, Alexandria, VA
“I think Medicare for All is vital and provides a lot more benefits compared to private insurance that outweigh the cons. It’s time for us to prioritize the health and the livelihood of the citizens before anything, as we’ve seen so many lives lost due to COVID. If it was enacted before the pandemic, I think it would have had a positive influence in many ways. First, medicare for all would ensure that all people who contracted COVID could receive treatment without risk of bankruptcy, therefore less lives would be lost. The spread of the virus would have also been contained because of more supply of PPE.” Odessa Zhang, 15, Rising Sophomore at McLean High School, McLean, VA
“I think Medicare for All would affect testing and treatment significantly. It’s already been shown that the government does a horribly inefficient job of running healthcare through the VA. I have no faith in the government being able to test every american and treat those with COVID-19 if we can barely take care of our veterans. Once people get tested, it’ll probably take a while for them to get treated. M4A in other countries has had significantly longer wait times, and even if you prioritize every COVID-19 case, you’d still have people left behind waiting for longer periods of time than if you had some private insurers in the economy. Due to the current conditions people face, some governmental form of healthcare should be offered as an option, but forcing everyone into public healthcare is too far.” William Gutierrez, 15, Rising Sophomore, Thomas Jefferson High School, Alexandria, VA