We get Universal Healthcare when the system goes bust

With this headline you can’t accuse me of burying the lede. In amongst the impeachment hoopla (not to downplay the significance here, it’s just that aside from a criminal President who needs to be removed from office we do have a plethora of other dire issues in this nation that need addressing) we as a nation are still facing two major issues that threaten our very way of life. Spiraling, out of control healthcare costs with ever decreasing positive outcomes and quality of care, and global warming (Let’s call a spade a spade here, folks. While, yes, we are facing unprecedented climate change, we are specifically and accurately facing a warming world.).

I’m going to focus on healthcare right now. First, because it absolutely needs to be addressed, and second, because there’s only one answer to halt and possibly reverse the damage we’re doing to the climate. Simply, we need to create a Net Negative Carbon World Economy (pulling more CO2 out of the atmosphere than we’re putting in) until we get back to concentrations equivalent to pre-Industrialization. For this, we know what needs to be done and how to do it. It’s just a matter of money and will power. Money, there’s plenty of that. Will power, now, is looking to be a whole other story.

Swiveling back to the topic at hand, regarding the sorry state of healthcare and healthcare costs in the United States, I also see a straight forward solution. Universal healthcare. Single payer. Public Option. Medicare for All. Whatever you want to call it, government paid and run healthcare (sure, include private administration companies, allow private insurance to continue, I’m open, but I don’t want to focus on such details here). The private sector is doing a piss poor job of cost control. It’s doing a piss poor job of responding to the needs of those it pretends to service. It gets even worse for women, people of color, the old, the marginalized, LGTBQ+. Studies time and time again show are all routinely given lessor quality care (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5333a1.htm)

While medical advance after medical advance is made, from novel drug treatments to growing body parts and organs in the lab, insurance costs continue to rise. Co-pays and deductibles are rising at ever more dizzying rates (https://www.politico.com/pdf/PPM110_hiddencosts.pdf). Even with Obamacare the rate of healthcare cost related bankruptcies continues unabated (https://www.cnbc.com/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html). The private sector continues to find ways to increase costs and profits, putting regular, hardworking Americans in a financial bind. Many times, that bind has long term negative health effects as people forego treatment, or ration medication, or just out and out never seek treatment. And, when there’s children involved, what then? When the question is food or medicine for your child, what do you choose? Do you go hungry? Not pay another bill?

At some point, and I see this happening sooner rather than later, the number of people just flat out not paying their medical bills will skyrocket. They’ll stop paying because it’s that or they lose their home, their car (i.e. their ability to get to work). For a rapidly growing part of the population the choice is fast becoming “mortgage/rent or medical bill”. As more and more people are sent to collections, declare bankruptcy, or in the best case scenario hold off paying until the absolute last minute, more and more doctors and hospitals will find themselves with less and less money. Who stops getting paid first? Nurses? Janitors? Other support staff? Suppliers?

So, as less money comes into the medical providers and salaries are lowered or staff are laid off, they too will find themselves in the same bind of not being able to afford their medical care. At some point, doctors become overworked, more and more mistakes happen, medical malpractice suits increase, insurance rates go up, and costs for care increase. Unabated, we will find ourselves in a country where only the wealthiest can afford medical care. The system will collapse upon itself, not gracefully, but swift and violent.

Now, some of you will outright agree with the scenario I’ve outlined. Some of you I’m sure see it as nothing more than a Socialist fever dream. What no one is talking about or seems to realize is that our medical system is already socialized through premiums, government subsidies, co-pays. If you have health insurance through an employer they more than likely cover some of your premium costs. Deductibles and co-pays are just another way to spread the costs around. Premiums are based on a number of factors, one of which is the number of people in a particular plan. Your premium is not specific to you, it’s specific to the group you belong to (age, gender, marriage status, prior health issues, etc.). Your copays and deductibles are also not specific to you, but an average for all purchasers of a particular plan in a particular region.

And, what about Medicare and Medicaid? We all pay into this system with our taxes. What happens when a hospital reduces a bill for a patient who can’t afford the full bill? Or, when a hospital just plain writes the bill off (a scenario I’ve seen first hand with a family member)? You think that those thousands, tens of thousands, or even hundreds of thousands of dollars just disappear into the ether? There is a cost, whether it’s through increased pricing to those who can or do pay, or through decreases in capital and overhead expenditures (think old, outdated equipment not being replaced, not enough nurses or support staff, reduced wages across the board, you get the picture). There is always a cost.

At some point the number of people needing medical care minus the number of people able to pay becomes negative. In other words, there are less people paying for care than there are people receiving treatment. I don’t know about you, but that right there is a recipe for economic disaster.This doesn’t even take into account productivity losses from people missing work do to untreated illness or injury. Of course, the poor will suffer the most, first. Just like they do now. The middle class is right behind. The very base of our economy will fall deeper and deeper into a debt hole and they’ll never find their way out. The people owed the money will find that they are recovering less and less what is owed. What do businesses do when they have shrinking revenue and increasing costs? Why, they cut costs, and the easiest place to cut costs in medical care is by laying off and not hiring people. When that is no longer feasible then they start delaying payments to suppliers, eventually failing to pay at all. And, then, the hospital closes. The clinic shutters. The doctor finds themselves without a practice.

As of 2017 healthcare spending in the United States represents 17.9% of GDP (https://www.modernhealthcare.com/article/20190220/NEWS/190229989/healthcare-spending-will-hit-19-4-of-gdp-in-the-next-decade-cms-projects). What happens to the economy as a whole when that disappears? The only solution here, the only humane, civilized solution that staves off economic collapse is to socialize medicine for everyone. Now, I’d like to point out that this doesn’t negate a role for private insurance. The right solution would allow for both. But, the right solution would be based on a solid foundation that promotes the general welfare by sharing the responsibility of our collective health across the whole of the nation, not through Balkanized insurance plans that are more concerned with profits than with people’s health, happiness, and lives.