Single-payer Healthcare: Dollars, Sense and Your Right

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A single-payer NHP would cover every American for all medically necessary services, including mental health, rehabilitation and dental care, without copayments or deductibles. Covered services would be determined by boards of experts and patient advocates; ineffective services would be excluded from coverage.” -- Physicians for a National Health Program

Many southern Illinoisans stood up to our state and federal government these past years, asking for better and more affordable healthcare. We have done this over many state and federal election cycles, and in our union halls.

With its lack of universal healthcare, the United States stands apart from the world’s other developed nations. Many of these other developed nations initiated their universal healthcare from four decades to over a century ago. In 2015, our current health expenditure per year was nearly $3.1 trillion, or 17% of our gross domestic product. While health expenditures were about 17% GDP much of the past decade, this became 18% GDP in 2020 (compared to 9 to 12% of GPD in other developed nations). For this expense, we still had infant and child mortality worse than some developing nations like Haiti, Rwanda, and Cambodia according to the World Health Organization’s Global Health Expenditure Database. In dollars, the 2017 U.S. current healthcare expenditures averaged $10,246 per capita; France, $4,380; Germany, $5,033; Canada, $4,755; and United Kingdom, $3,859. The figures were not much different in 2010 before the Patient Protection and Affordable Care Act (ACA) further piecemealed health insurance coverage with other Medicare, Medicaid, Veterans Affairs benefits, and employer sponsored health insurance.

Even with ACA in 2018, 9% of the United States population, and 7% or 877,700 Illinoisans were uninsured (about three times more than presently enrolled in the ACA in Illinois). State data indicate that even higher rates of uninsured are located across the 115th District, and these areas overlap with higher Medicaid areas. While the ACA was enacted as a compromise with the GOP to allow competition between multiple insurance companies (instead of a single-payer program), many regions only have one or two companies from which to choose various ACA Marketplace policies. ACA policy rates (plus deductibles and co-pays) are high for the 50-to-64-year-old age bracket before an income adjusted subsidy lowers out-of-pocket cost. In short, the current system isn’t working.

ACA is not a universal healthcare program in the real sense compared to the proposed single-payer healthcare system that has been on state and federal legislation dockets for more than a decade. The insurance industry is still a major issue concerning access to and cost of healthcare, wherein its very presence is shored up by federalist interpretations of our Constitution and preceding documents, or now recent corporate personhood orientations. Yet the Supreme Court did order that the ACA was Constitutional, on a couple of occasions. Universal healthcare is a stronger argument within our Illinois Constitution, as it was established “in order to provide for the health, safety and welfare of the people” wherein we have “certain inherent and inalienable rights among which are life.” State’s rights aside, our federal Constitution speaks of its very being in order to “promote the general Welfare,” and of Congress having the “Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States,” predicated on the earlier Declaration which proclaimed “certain unalienable Rights, that among these are Life.

These clauses have been interpreted such that our government provides a variety of services for the common good of our nation, including public education (some benighted politicians actually claimed that public education was unconstitutional, into the mid-20th century). The Fair Tax initiative would further enable single-payer healthcare (or any improvement in healthcare and education) as a state’s right, although one could discuss whether this should be a state or federal healthcare plan. It is good to remember that our Constitution insures that the states may grant more rights, but never fewer, to its people than those protected by the US Constitution. Universal single-payer healthcare, or “Medicare for All” as some call it, is another common good that would strengthen our state’s and nation’s workforce, socioeconomic wellbeing, and stability. Despite some in global corporate networks manipulating our government and resources for their self-interest (at the expense of ordinary people and the common good), health and healthcare should be a right, not a privilege enjoyed by those who can afford it. The insurance companies want their profits and they are blocking the push for a better system.

Illinois House 115th District residents stand to gain from better ways to achieve health, including access to and coverage of healthcare. In the U.S., 47.4% of companies offered their employees health insurance coverage in 2019, and in Illinois, slightly more at 50.4%, although we fell below the national average other years. COVID changes this in 2020. Small businesses are often financially less able to provide health insurance. Thus, expecting people to secure access to health insurance through an employer is unrealistic, especially when those employed only part-time are often not eligible for company benefits. Often, companies and businesses have scheduling systems designed to keep part-time employees from qualifying for benefits. They under-employ people so that they can save the cost of providing benefits. Although labor unions have historically been important in negotiating healthcare coverage for workers, many labor unions presently support a single-payer healthcare system, including a number of unions in Illinois.

The Illinois House 115th District counties, and much of rural southern Illinois, are designated by the Health Resources & Services Administration (HRSA) as health professional shortage areas for primary care, mental health and dental health providers, or medically underserved areas. While local health companies have attempted to increase health services and access, sometimes using HRSA capital improvement grants to add more clinics, Illinois’ budget deficit, and consequent delay in Medicaid or state employee health insurance reimbursement, has periodically prompted furloughs and downsizing of such services in the last dozen years. A dedicated healthcare budget line, that is not subject to being “borrowed from” without repayment or serious delay in repayment (our predicament), would help to stabilize healthcare finance and delivery.

HRSA’s existing capital improvement grants, along with its National Health Service Corps forgiving medical school loans for physicians who work in our medically underserved areas, can remain as important features of supplying better healthcare access in a universal healthcare system. Healthcare provider education and capital improvements can be reorganized into the proposed National Health Program structure.

In addition to access, we must lower healthcare cost –not just to the people, but the overall cost of providing the care. A single-payer healthcare system could minimize overhead billing cost that is running wild with our current insurance system, estimated by some non-partisan studies at $500 billion in cost-savings annually. Pharmaceutical prices must also be reined in. We shouldn’t be paying for so much of their management and marketing costs that include advertising and physician lunches and vacations and other “incentives” to prescribe (which have made the opioid crisis worse –see below). Suing Big Pharma strikes only at the symptoms of this problem, not at the cause. The cause is corporate greed and a system that facilitates that greed.

We must also mitigate healthcare cost by not surrounding people with an unhealthy environment in which to live, work, and recreate. The Illinois House 115th District’s people cope with a variety of health problems for which they need medical attention and preventive measures. Our local health departments have attempted to coordinate with local healthcare services and schools to encourage individuals to choose healthier lifestyles (at least, that is what they do when they are not underfunded), but we can do better at both this level, and with the broader community and environmental levels. We have a high incidence of cancer along our I-57 corridor and in Perry County. The EPA has also mapped environmental justice issues for fine particulate matter and ozone air pollution, lead, hazardous waste, Superfund sites, and COPD or cancer risk for parts of our 115th District which need to be rectified for residents to have fewer related health conditions and cost. I have been active in support of these concerns.

In terms of healthier environments, we must not neglect the problems we have with the availability of decent and affordable food. Food desserts and limited access to healthier food for some of our residents are other factors in our healthcare costs, which is inexcusable in our large agricultural state of Illinois. Food is a health issue and an important element in a universal, single-payer healthcare which is more suited to an emphasis on preventive medicine and general health. The insurance system mainly responds after we become sick. Its incentives for healthy living are minimal, and the concern for the general health of the workforce and the society are absent.

Opioids have become a problem in the Illinois 115th District and must be dealt with as a medical and socioeconomic problem instead of simply continuing high incarceration rates and bringing suits against the corporations. The opioid mitigation problem has been further complicated by the COVID pandemic, as well as the possible retraction of the ACA which enables more Medicaid-based care. More Illinoisans OD and die from these addictions than from homicides or fatal vehicle accidents, while many more aren’t coping under their addiction, and are thus unable to contribute to the economy and join the workforce at full strength. With a universal healthcare system, better access to treatment, less pharmaceutical marketing, getting doctors to use the Prescription Monitoring Program in their electronic health record systems (computer database tools available for some years to reduce narcotic over-use), better education, and improvements to our local economy, many of the current problems could be mitigated. Granted, we also have seen increased opioids enter Illinois from non-prescription sources too, including heroin and fentanyl, although the programs just indicated could help reduce use. Use of these drugs should be de-criminalized and the resources now spent on arresting, adjudicating, and incarcerating these addicts should be devoted instead to rehabilitation and the return to health. These desperate people have a healthcare issue, they are not criminals. They should be entering detox, not prison.

The recent COVID-19 pandemic has highlighted much dysfunction and many disparities in our economic and healthcare system. People with health insurance, possibly with high deductibles and co-pays and small in-network sets of providers, sometimes cannot access adequate healthcare to get tested and treated for COVID-19. Over 12 million Americans are suddenly without employer paid health insurance after becoming unemployed because of COVID-19, are in a bind. Some with symptoms of COVID have been denied testing because they didn’t exhibit extreme symptoms, so they had to go without treatment and advice while suffering and possibly infecting others, or they didn’t get treated promptly for another problematic health condition that had similar symptoms. A disproportionate number of minorities have contracted and passed from COVID in Illinois. The lingering long-term cardiovascular and neurological damages by COVID-19 infection, could possibly be deemed a pre-existing condition, which could deny future healthcare, if pending ACA decisions in the U.S. Supreme Court occur that are not in the ordinary American patients’ favor. According to the Economic Policy Institute, if ACA is repealed, 1,150,000 more Illinoisans will lose health insurance, 47,060 more jobs in Illinois would be lost, and $4.2 billion in federal health care dollars will be lost in Illinois. Nevertheless, others do gain access to extensive COVID-19 healthcare, including at the tax payer funded public Walter Reed National Military Medical Center, which highlights the inequity in our system which must be rectified. Given the pending SCOTUS ACA decision later this year, we’ll soon see if states’ rights become even more important with regard to mitigating the impact of COVID-19, as well as more general healthcare access, although it has been argued this national pandemic warrants a federal plan.

Northern Illinois Representative Mary Flowers has repeatedly introduced single-payer healthcare bills in Springfield. The Illinois Medicare for All Health Care Act, HB 2436 (formerly HB 311, HB 942, and HB 108), would create a statewide universal health insurance plan to provide comprehensive health benefits to all Illinoisans equally. However, this legislation has been tabled over the years, either to see what might occur at the federal level with ACA, and federal Medicare for All, and because of pending Illinois Fair Tax related legislation.

There are bills before Congress right now, Bernie Sander’s Medicare For All Act (S1129) in the Senate, and Rep. Pramila Jayapal’s similar Medicare for All Act in the House (HR1384, which also includes long-term care). Former versions of this single-payer legislation include H.R. 676, the Expanded & Improved Medicare For All Act, sponsored by Keith Ellison, which was first sponsored by former Rep. John Conyers all the way back in 2003. These bills have been promoted by the Physicians for a National Health Program, National Nurses United, and many other labor and civic organizations. Single-payer healthcare covers primary care, acute care, long-term care (Jaypal’s HR1384 version), mental health counseling, substance abuse treatment, dental and vision, medications, labs and medical equipment that are indicated as medically necessary. Comprehensive women’s healthcare is included. No deductibles, copayments, coinsurance, or other cost-sharing are imposed with respect to covered benefits. Benefits are available through any licensed health care clinician anywhere in the United States. Although the Physicians for a National Health Program do suggest a few improvements such as ensuring long-term care coverage, no prescription co-pays, and not-for-profit healthcare facilities.

There are also other major healthcare proposals on the table, each envisioning a different future for the American health care, yet not quite a single-payer system. Use this Commonwealth Fund chart, below, to compare single-payer with Medicare buy-in in the ACA system, Medicaid buy-in, and other renditions of public options which are still aligned with our insurance system.

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Bernie’s plan in the Senate is estimated by the conservative-libertarian Koch brother funded Mercatus policy center at George Mason University to cost $32.6 trillion over 10 years, realizing a savings of $2 trillion compared with recent healthcare expenditures. A recent study in The Lancet, summarized in a reposted Washington Post article, indicates that Medicare for All would cost $3 trillion per year instead of our present $3.5 trillion we currently pay for healthcare. A University of Massachusetts Amherst study estimates a $2.93 trillion cost to cover everyone. Somewhat similar numbers are estimated in other studies. Co-pays, deductibles and out-of-network service that we have in current private health insurance would be eliminated. The Mercatus study tries to scare people that Medicare for All would increase cost from our current public sponsorship of 6.6% GPD to an additional 10.7% GDP in 2022, or 12.7% GDP in 2031. They ignore that total healthcare costs paid from all public plus private sources was already 17% GDP in 2015, and 18% GDP in 2020. So, we are paying for this cost already, and ineffectively. Some analysts regard the Mercatus study numbers as inflated, and note that 30 million more people would gain coverage and eliminate added out-of-pocket healthcare expenses. Our 2016 US healthcare cost was $3.4 trillion per year (think $3.4 trillion x 10 = $34 trillion), increased a little more from the 2015 WHO data indicated above at $3.1 trillion per year. The sum seems large to an ordinary southern Illinoisan, but it covers our entire U.S. population of over 330 million people. In addition, we must make healthcare available to all who reside within our borders. The productivity of the undocumented workforce is difficult to measure, but it is large and a crucial contribution to our national economy. Also, many non-citizens who reside legally within our borders must be included, just as they are in other developed countries. These residents and visitors contribute greatly to our economy.

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Some will still insist that the cost is too great, but for comparison, if we keep our current for-profit healthcare model, healthcare costs are estimated to increase to $5.5 trillion per year by 2025. In 2018, the government paid $1.04 trillion for Medicare, Medicaid, health insurance subsidies, and CHIP, and in 2020, this sum has become $1.258 trillion. The remaining $2+ trillion is already being paid by most all of you out of pocket or as an insurance plan by your employer. Someone is paying the difference, and that falls hardest on small businesses and individuals. Currently, and in the future, if we stay with the same for-profit healthcare system, we pay out of pocket or through our employers’ increased costs (which must be passed on to consumers), whereas the lesser sum for Medicare for All would be collected through our income tax. The second is more efficient. Savings could come by reducing billing costs, redundant services, marketing, and negotiated rates in a single-payer National Health Program. A healthier environment and lifestyles could bring further healthcare cost reduction.

A Decades Old Discussion: December, 1991 Congressional Budget Office

“If the nation adopted…[a] single-payer system that paid providers at Medicare’s rates, the population that is currently uninsured could be covered without dramatically increasing national spending on health. In fact, all US residents might be covered by health insurance for roughly the current level of spending or even somewhat less, because of savings in administrative costs and lower payment rates for services used by the privately insured. The prospects for con-trolling health care expenditure in future years would also be improved.” (“Universal Health Insurance Coverage Using Medicare’s Payment Rates”) http://www.cbo.gov/ftpdocs/76xx/doc7652/91-CBO-039.pdf

I support the single-payer healthcare bills in Congress, and I will support similar single-payer healthcare bills in the Illinois State House that attempt to mitigate Congress’s recent attempts to take away ACA coverage or obstruct COVID-19 mitigation. The GOP’s recent attempt to not cover pre-existing conditions, to charge exorbitant fees for the 50-64-year-old age cohort, to remove the medical expense tax deduction, to take away comprehensive women’s health care, and to replace comprehensive coverage with partial and short-term coverage policies that hardly pay for your healthcare when you need it most, all of this just hurts many southern Illinoisans. Insurance companies have big profits and you pay for it every time you get sick. Those who can’t pay for it suffer needlessly and many die.

Also to support health, and lower healthcare costs, I will support Illinois State House bills that reduce health risks and contribute to maintaining our health. The present federal administration is dismantling many processes that were meant to support clean water, air, and land, safe food, and safe workplaces. Many of these safety mechanisms should be put back in place, or we will continue to have high healthcare costs dealing with the cancer, diabetes, heart disease, asthma, COPD, and many other ailments that are more likely to occur with unsafe, polluted surroundings in which to live and work. Plus, wouldn’t you prefer to keep our southern Illinois outdoors cleaner, safer and more beautiful for healthier outdoor recreation like hiking, swimming and fishing with your kids, family and friends?


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  • Randy Auxier