Time to Reboot “Medicare-For-All”

By | April 6, 2021

By MIKE MAGEE

In the fog of the Covid pandemic, many are wondering what ever happened to prior vocal support for universal coverage and Medicare-for-All. Expect those issues to regain prominence in the coming months. A bit of recent history helps explain why.

The January 6th insurrection, followed by the past weeks two mass shootings, have served to remind our citizens that we must address a range of issues while continuing to confront the pandemic threat.

Modern civilized societies rely on a double-armed approach to maintain order, peace and security. The first arm is laws. But laws are of little value without even and unbiased enforcement.

The second guardrail of civility is culture. MIT professor Edgar Schein described it this way: “Culture has three layers: the artifacts of a culture — our symbols and signs; its espoused values — the things we say we believe; and, most important, its underlying assumptions — the way things really are.”

In the Senate chamber this week, and in Republican controlled state houses across the nation, Americans witnessed a colossal collision of reality and ideals in the form of new Jim Crow laws to suppress minority voting rights, and refusal to address gun violence.  In the wake of a constant stream of racial animus and mass shootings, this lethal epidemic demands a response as well.

Were these the only flashing alerts signaling danger ahead, that would be enough to cause sleepless nights. But unenforced or unevenly enforced laws, and value dissonance in America, do not occur in isolation, but are supported by an even more erosive underpinning – greed-induced economic inequality.

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A 2019 pre-pandemic report in the Wall Street Journal laid out the numbers. While the vast majority of growth in assets in the prior three decades went to the top 10% in the US, debt increased by $ 9 trillion with ¾ of the debt issued to the bottom 90% of American families. For the top 1% during this period, median net worth grew 178% to over $ 11 million. For the rest of us, earnings had been flat while housing prices increased 290%, four-year college tuition soared 311%, and average per-capita health care expenditures rose 51%.

May 14, 2021 WSJ report from the Federal Reserve reinforced the uneven impact of the pandemic: “Almost 40% of households earning less than $ 40,000 a year experienced at least one job loss in March, versus 19% of households earning between $ 40,000 and $ 100,000 and 13% of those earning more than $ 100,000, the Fed said. And while 85% of those with no work disruption said they could pay the current month’s bills in full, just 64% of those who had lost a job or had their hours cut said they could cover their expenses for the month.”

The quickest, most direct pathway to address income inequality, safety and security is now through universal health coverage. Not only would this offer the opportunity to distribute wealth more equitably, but it would also offer the country the opportunity to acknowledge mistakes of the past, and work anew at aligning our actual behaviors with our stated values of compassion, understanding and partnership.

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Where is the American public when it comes to a fundamental reboot of our inequitable and wasteful system focused on cure over care and profit over just about everything else?

The quick answer is, “They’ve moved left at a pretty fast clip.”  That’s the underlying message in a pre-pandemic poll from the Kaiser Family Foundation. The report stated that “Medicare-for-all starts with net favorability rating of +14 percentage points (56% who favor it, minus 42% who oppose it). This jumps to +45 percentage points when people hear the argument that this type of plan would guarantee health insurance as a right for all Americans.”

The uneven pandemic response, as well as a continued epidemic of hate-induced gun violence, have only served to reinforce the need for an equitable national health care system with a capacity to address ordinary and extraordinary public health demands. Expanding Medicare eligibility is the fastest pathway toward accomplishment that important goal.

Mike Magee, MD is a Medical Historian and Health Economist and author of “Code Blue: Inside the Medical Industrial Complex.“

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