U.S. HEALTH CARE TODAY
We are the only developed country in the world that does not guarantee its residents health care.
United States health care is in crisis. In 2023, 25.3 million Americans (7.7%) were uninsured [1], and national health spending was projected to reach nearly $4.8 trillion, or $14,423 per person, accounting for 17.6% of Gross Domestic Product (GDP). [2,3] The Centers for Medicare and Medicaid Services (CMS) expects national health care expenditures to outpace U.S. economic growth over roughly the next decade, increasing to 19.7% of GDP in 2032. [4]
Premiums, co-pays, and prescription drug costs are rising rapidly, leaving many Americans without access to care. Nationally, in 2022, 46% of Americans said they had skipped or delayed care because of the cost, and 42% said they had problems paying medical bills or were paying off medical debt. [5]
In Massachusetts in 2023, despite 98.3% of residents having health insurance, and 90.9% having a primary care provider, 41.2% of residents reported difficulties accessing health care, and 41.3% reported that they or their families had an issue affording health care. This burden is greater for non-Hispanic Black residents (48.7%) and Hispanic residents (58.2%). 28.8% of residents reported that they or a family member had unmet health care needs due to cost. [6]
The way we currently organize health insurance:
- Is expensive: The United States spends more per person than any other country in the world on health care. [7]
- Is unsustainable: Medical care prices and overall health spending typically rise faster than the rest of the economy. [8]
- Leads to poor health outcomes: The U.S. consistently ranks last among its peers on key metrics, including access to care and health outcomes such as life expectancy at birth. [9]
A BETTER WAY
A single payer health care system covers everyone under a publicly financed insurance plan.
While this is also called “(Improved) Medicare for All,” this does not mean simply expanding the current version of traditional Medicare to all age groups (beyond those over age 65). Traditional Medicare is complicated, not comprehensive, and requires additional out-of-pocket spending by patients. Traditional Medicare Part B covers only 80%. It’s expensive (premiums are deducted from Social Security payment, typically about $150/month, plus paying for a private insurance supplement to cover the 20% not covered by Part B, plus paying for Part D drug coverage). And it allows for-profit insurers to extract profits via the “Medicare Advantage” option.
Under Single Payer, medical care would be free at the point of service. All doctors and hospitals would be accessible to any resident without the restrictions currently imposed by insurance companies, employers, and “Medicare Advantage”. Fair, progressive taxation would replace premiums, co-pays, deductibles, etc.
What's more, Single Payer eliminates costly administrative waste from and profit associated with the health care industry. A Massachusetts single payer system has the capacity to reduce overall health care costs by over 30%, and over 98% of Massachusetts households would spend less on health care under the Act than they do now. [10 & https://masscare.org/economic-analysis/]
Single Payer ensures:
- Comprehensive Coverage: Including dental, vision, hearing, and long-term care, all of which are not covered by traditional Medicare.
- Access to Prevention: Giving everyone access to primary care without cost barriers reduces how many people get sick in the first place. [11]
- Early Intervention: Allowing everyone to have a regular source of care, without cost barriers, allows us to treat illness and injury before it becomes serious and expensive to treat. [11]
- Reduced Insurance Overhead: Private insurance companies spend from 10% to 30% of every health care dollar on overhead: public insurance spends less than 5%. [12] Single payer plans don’t need to advertise or compete in a market.
- Reduced Provider Overhead: When hospitals and physicians send all their bills to one payer (the public insurance plan), they don’t need a billing department to juggle different forms for hundreds of insurance companies, and each doctor and each health care practitioner wastes less of their time on paperwork and devotes more time to actual care. [12]
- Bulk Purchasing Power: When there is only one payer for basic medical services and goods, that payer can bargain the best possible prices and make sure that middle-men aren’t overcharging patients. This in particular drives down the cost of prescription drugs. [13]
- Fewer Bankruptcies: Medical debt is a contributing factor in 62% of bankruptcy cases in the United States. [14] Guaranteed health care would eliminate these devastating costs to patients.
Footnotes
[1] National Center for Health Statistics. Health Insurance Coverage: Early Release of Quarterly Estimates From the National Health Interview Survey, January 2022–March 2023. https://www.cdc.gov/nchs/data/nhis/earlyrelease/Quarterly_Estimates_2023_Q11.pdf
[2] Centers for Medicare & Medicaid Services. NHE Fact Sheet. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet
[3] Aboulenein A. U.S. healthcare spending rises to $4.8 trillion in 2023, outpacing GDP. Reuters, 13 June 2024. https://www.reuters.com/business/healthcare-pharmaceuticals/us-healthcare-spending-rises-48-trillion-2023-outpacing-gdp-2024-06-12
[4] CMS Releases 2023-2032 National Health Expenditure Projections, June 12, 2024, https://www.cms.gov/newsroom/press-releases/cms-releases-2023-2032-national-health-expenditure-projections
[5] The Commonwealth Fund. The State of U.S. Health Insurance in 2022. Data Brief, September 2022. www.commonwealthfund.org/sites/default/files/2022-09/Collins_state_of_coverage_biennial_survey_2022_db.pdf
[6] Center for Health Information and Analysis. 2023 Massachusetts Health Insurance Survey. www.chiamass.gov/massachusetts-health-insurance-survey
[7] Wager E, McGough M, Rakshit S, et al. How does health spending in the U.S. compare to other countries? Peterson-KFF Health System Tracker, 23 January 2024. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/
[8] Rakshit S, Wager E, Hughes-Cromwick E, et al. Peterson-KFF Health System Tracker, 2 August 2024. How does medical inflation compare to inflation in the rest of the economy? https://www.healthsystemtracker.org/brief/how-does-medical-inflation-compare-to-inflation-in-the-rest-of-the-economy/
[9] David Blumenthal, Evan D. Gumas, Arnav Shah, Munira Z. Gunja, Reginald D. Williams II, Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System, Commonwealth Fund, 19 September 2024. https://www.commonwealthfund.org/publications/fund-reports/2024/sep/mirror-mirror-2024. See also: Woolhandler S, Himmelstein DU. The relationship between health insurance and mortality: is lack of insurance deadly? Annals of Internal Medicine 2017;167(6):424-431
[10] Friedman GF. Funding universal health care in the Commonwealth of Massachusetts: Replacing an inefficient, inequitable, and destructive health care finance system with a fair system that will promote economic efficiency and better health. University of Massachusetts at Amherst, 21 July 2021. https://drive.google.com/file/d/1WA4dTjA9BE7XDoERYrLfg2RfiSOB5baw/view
[11] U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030: Access to Primary Care. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-primary-care
[12] The Role Of Administrative Waste In Excess US Health Spending. Health Affairs 6 October 2022. https://www.healthaffairs.org/content/briefs/role-administrative-waste-excess-us-health-spending
[13] National Conference of State Legislatures. Bulk Purchasing of Prescription Drugs. https://www.ncsl.org/health/bulk-purchasing-of-prescription-drugs
[14] The Commonwealth Fund. How Medical Debt Makes People Sicker — and What We Can Do About It. 27 October 2023. https://www.commonwealthfund.org/publications/podcast/2023/oct/how-medical-debt-makes-people-sicker-what-we-can-do-about-it