While I support the concept of UHC, I don't think the numbers for Medicare for all are at all realistic, especially not without copays and premiums.
After I saw this OP, I did some extensive reading about the UHC systems in other countries. What I learned is just about every one of them is having difficulty maintaining them, due at least partly to the high cost of all the new technology that has been created in health care in recent years, along with the fact that most Westernized countries have low birth rates and aging populations. Older adults tend to have a lot more health problems compared to younger adults and children. The other countries that have UHC have higher tax rates and less spending on defense than we do. And, while I'm on board for lowering our defense spending, I don't see that as a reasonable expectation considering how the military industrial complex has so much influence on our politicians. And, even if it was cut back substantially, it would not be enough to cover Medicare for all. One more thing. The idea that people with coverage will stop running to the ER hasn't worked out that way. It's a problem in most countries. I guess there are a lot of people who will avoid seeing a doctor until they are desperate enough to rush to the ER. This type of care is far more expensive and apparently, no good solution has been found yet to change that behavior.
Another thing that I learned is that most of the countries that have UHC aso have copays, and often don't cover basic primary care, while they do cover what we might consider catastrophic care, or any care that involves serious illness. Some countries have a fairly substantial VAT to help pay for their UHC. The VAT has a tendency to be a burden on poor people.
Some of the other problems that I see with establishing Medicare for all, especially without premiums and copays, is that obesity has added a lot to the cost of our care. I'm not judging obese people. I consider it a disease of modernity, but obesity is a high risk factor for a variety of serious diseases, some of which can be very expensive to treat. As a former professional nurse, I have learned that Americans, generally speaking, often have unreasonable expectations as to what medical care can do for them. They often expect the most expensive treatments, regardless of how effective those treatments might be. And, there are a lot of physicians who have the idea that they must do everything for the patient, even if the patient is a 90 year old suffering from end stage dementia. I've seen this many times, and it's usually not due to greed, as the providers that I've seen doing this often order tests and procedures that they don't personally benefit from, so that's another part of our medical culture that would have to change.
But, speaking of greed, our current system is pretty much a profit driven one. This wasn't always the case, but starting in the mid to late 80s, I saw almost every aspect of health care become based on profit. How do we change that culture? Medicare doesn't pay nearly as much as most private insurance policies do, so some providers have stopped taking Medicare recipients. I just had a mammogram. Medicare pays 88 dollars for it, but the usual charge is over 300 dollars. That does seem very high but there is a lot of overhead to consider when one has a test or procedure. So, how is all of that overhead maintained if the rate paid is always on the low end?
I'm not saying it couldn't be done, but pretending that we can somehow magically change from what we have now without adding a lot to the deficit and with out paying copays and premiums, sounds as absurd as the Christian claim that Jesus is coming again. Perhaps we could have a system like many of the European countries do, based on non profit insurance policies, with some limitations in coverage, while subsidizing those at the bottom of the economic pie, it would eventually become a reality.
Finally, how on earth do you think there will ever be enough support for Medicare for all? Obama had a very difficult time getting enough support from the Democrats for the ACA. Do you honestly think that Congress would be willing to pass free care for all? I hate to say this but I strongly believe that the politicians, including some of my favorites, are being either very dishonest or very unrealistic, when they say they support Medicare for all. So, where do we go from here? The one thing that I plan on doing is voting for Stacey Abrams this fall. She wants to expand Medicaid, which I feel is a good start at helping low income folks have access to care. Most of the women that I worked with prior to my retirement, would be eligible for Medicaid if it is expanded. Overwhelming change is usually done gradually. If the obstructionist Republicans had worked over the years to tweak the ACA, instead of doing everything in their power to defeat it or overturn it, we'd probably have a fairly decent type of coverage for most people by now. Sorry for the long post, but there's a lot to consider when talking about changing our system.
