Medicare & the Moon
In my first conception of this column, I wanted to compare this to the moonshot. On Sept. 12, 1962, at Rice Stadium in Houston, President John F. Kennedy announced, “We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard; because the goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one we intend to win.”10
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The race to put a man on the moon seemed like the perfect analogy for a challenge we took on as a nation, despite the prohibitive cost. But the cost for the Mercury, Gemini and Apollo programs was $25 billion.11 In modern currency, that’s a mere $110 billion—or 300 times less than the cost of Medicare for all estimated by Blahous. We’re not talking about a moonshot. We’re talking about a shot to Jupiter.
It comes back down to table stakes. Are we willing to put $32 trillion on the table? And do we even need $32 trillion? Part of the problem is that we don’t really know how much money may be saved by eliminating administrative waste. Some estimate the cost savings may approach $500 billion annually.
The cost will likely vary wildly by specifics of the plan itself. The devil will be in the details, with some proposals promising full drug coverage with no out-of-pocket costs for doctors’ visits and others being more circumspect about costs.
The benefits of Medicare for all may extend beyond dollars and cents. Imagine a world in which you don’t have to guess what magic words you need to include in your documentation to obtain a biologic for your patient, because you’re only dealing with one insurer. Imagine a world in which pre-existing conditions don’t matter, simply because the government said they don’t matter. We may not end up liking all the rules, but at least there would be rules.
It’s true that Medicare for all may mean reduced salaries for physicians, but we would not be the hardest hit; those who supervise the delivery of healthcare, such as insurance company executives, typically earn much more than those who actually deliver that healthcare. Such administrators will likely be among the biggest losers in a single-payer world, as would the insurance companies themselves, the pharmaceutical industry and pharmacy benefit managers, all of which benefit disproportionately from the disjointed delivery that characterizes U.S. healthcare.
Despite its inherent complexities, Medicare for all has become the political table stake because we have all come to tacitly realize that healthcare access is not solely a monetary question. I doubt that any of us think of healthcare as a privilege that should be restricted to those who can afford it. For example, I don’t think any of us are comfortable with a patient skipping a few meals to see us for his rheumatoid arthritis. And I think all of us squirm at the thought of a child being unable to concentrate in class because she can’t afford an inhaler, or the thought of a patient being housebound because he can’t afford to have his hip replaced.
We may be afraid to create a new entitlement, but in truth, that entitlement already exists. We are already deep in the game, and it’s too late to fold.