A patient of mine (who was also a friend) reached out recently to say the cost of one of his essential medications had increased to a $300 monthly out-of-pocket expense. As an independent musician, he did not get his health care through an employer. The COVID pandemic eliminated his gigs. His money reserves dwindled, and he stopped this essential medication — something he did not share with me. Not long after, I heard that he suffered a stroke and died. No doctor should have to know the feeling of losing a patient — especially a friend — because they cannot afford routine, standard-of-care medications, the price of which is governed by the whims of an insurance company. It doesn’t have to be this way. The goal of all-inclusive health care is again a possibility. But it has been this close before. In 2013, just prior to the rollout of the Affordable Care Act (ACA), there were 42 million Americans uninsured. This dropped to a low of 27.4 million in 2016. Over the next four years, the prior administration chipped away at provisions of the ACA, and the uninsured rate increased to 31.5 million by 2020. In a recently launched open enrollment period that lasts until August 15, President Joe Biden announced that to date 1 million Americans have already signed up for health care coverage. This is part of Biden’s ambitious health care plan. In his recent speech to Congress, Biden said, “Let’s give Medicare the power to save hundreds of billions of dollars by negotiating lower drug prescription prices. And by the way, it won’t just — it won’t just help people on Medicare. It’ll lower prescription drug costs for everyone. And the money we save, which is billions of dollars, can go to strengthening the Affordable Care Act and expand Medicare benefits without costing taxpayers an additional penny. It is within our power to do it.” Yes, the ACA wasn’t perfect. It raised costs for some more so than others, and overall costs increased over time. It didn’t insure everyone. Now, whichever health care plan we adopt — Medicare for All (which has recently been proposed to Congress), Biden’s beefed-up ACA or one of the myriad other proposals — complete inclusion should be a priority. Critics claim this would be too expensive. But they don’t see the many hidden costs that can be avoided with all-inclusive health care coverage. The fact is that there is already a form of universal coverage, but it is the most expensive and least effective way to deliver care: sporadically through emergency rooms, where care costs, on average, 12 times more than it does in a physician’s office. This accounts for an excess cost of $32 billion annually. This is because of a law passed during the Ronald Reagan administration that requires emergency departments of hospitals that accept Medicare payments to provide care for anyone seeking treatment regardless of ability to pay. While well-intentioned, it had the unintended consequence of driving uninsured patients to the emergency department for routine and non-emergent care. Our refusal to cover everyone is, paradoxically, one of the reasons that America’s health care costs 30 percent more than the next highest-spending country. It is about twice as much as the average amount spent by countries that provide universal coverage. There are some costs that are harder to quantify. About two-thirds of all bankruptcies were tied to medical issues. This affects roughly 530,000 families each year. About one-third of all crowdsourcing donations go to funding health care, a uniquely American phenomenon. This highlights how our current health care system is failing and is in need of repair. A recent study by the Lancet found that a “Medicare for all” model would save approximately 68,000 lives and $631 billion per year. This plan is the most studied, but it may not be the best; other proposals should also be scrutinized. Looking to other countries that provide universal coverage to see what works and what would fit well for the U.S. is an option. Countries like France, Australia, and England provide universal coverage and rank their health care systems very highly, and are culturally and socioeconomically similar to the U.S. Whatever health care direction the country moves toward, it is essential to prioritize universal coverage. Otherwise, Americans will eventually end up paying for inefficient, expensive services in the form of higher premiums and taxes, while millions of Americans will remain uninsured, without access to health care or life-saving medications. Many, like my friend and patient, will die. That is too high a cost to pay. Source
