America's incredibly successful pilot of universal health care
Last weekend, I finally got my first coronavirus vaccine shot (the Pfizer/BioNTech version), at one of the FEMA sites here in Philly. It was without question the best experience I have ever had with American medicine. The National Guard troops and volunteers had the process down to a science — along with hundreds of others, I just answered a few quick questions, sat down, got my shot, and then scheduled my second appointment while waiting to make sure I had no allergic reaction. The whole thing took about 20 minutes from start to finish.
I didn't have to get out my insurance card, or fork over any co-pays or co-insurance, or fill out a stack of paperwork, or sit in a waiting room for hours. I didn't get a bill at a 10,000 percent markup, or have to argue with my insurance company about whether FEMA is in-network, or spend weeks fighting some enormous surprise bill afterwards. I just got the care I needed and went on my way.
It's not a coincidence that this is very similar to how Medicare-for-all would work: treatment that is free at the point of service, funded by the government. When we have a truly dire need for medical care, the status quo health care system is simply too complicated and broken to get the job done.
Early last year, I argued that America's dysfunctional nightmare of a health care system was a big reason the U.S. had so much trouble fighting the pandemic. Tens of millions of Americans are uninsured or underinsured, which meant that they feared going to get tested or going to the doctor if they got sick. (Sure enough, many got gigantic bills from coronavirus tests.) That was obviously true at the time — other countries like Taiwan that were far more successful at containing the virus relied heavily on their national health care systems to coordinate and fund testing, contact tracing, and hospital care.
But the vaccine rollout is a further tacit admission that Medicare-for-all simply works better. Rather than trying to interface with the Kafkaesque health care bureaucracy, the government basically did an end run around the entire thing. The vaccines are provided free of charge, and the government has stipulated that even private providers who do vaccinations are not allowed to charge individuals for it (though some providers have characteristically broken the law trying to steal money anyway).
Indeed, in some ways the vaccine rollout has gone beyond Medicare-for-all toward Britain's National Health Service, where the providers are also owned by the government. The FEMA sites across the country are run directly by the government, and as noted above, the quality of care is top-notch. I see no reason why the mass vaccine clinics should not be transitioned into permanent facilities, perhaps doing regular immunization drives or basic urgent care.
No doubt many would argue that an emergency vaccination campaign is not a fair argument for Medicare-for-all. It's a once-in-a-century pandemic, and desperate times call for desperate measures.
But while the whole country has a dire need for care today, millions of Americans have a similarly dire need for care all the time that simply goes unmet. For instance, a recent study found that cancer diagnoses spike dramatically at age 65 when people qualify for Medicare — obviously, people are putting off needed checkups and such for fear of being bankrupted by our semi-private system. What's more, the study also found that cancer survival rates increase after 65, no doubt because the cancer has less chance to fester. Another study estimated that lack of insurance causes about 30,400 excess deaths every year.
Similarly, a 2019 Gallup poll found that a third of Americans have put off a treatment for any condition (up from 19 percent in 2001), and a quarter put off treatment for a serious condition (up from 12 percent in 2001). A Kaiser Family Foundation study the same year found half of American adults reported themselves or a family member putting off medical or dental care over cost worries, and of those about one in eight said that delay worsened the condition. Twenty-nine percent of adults reported not taking prescribed medication due to cost.
The great irony of American health care is that it is simultaneously a giant pain in the neck to access, and also costs dramatically more than in any other country. We pay enough in taxes to support a high-quality universal system, then about that much again in private spending, and still huge chunks of the country can't go to the doctor when they need to. Medicare-for-all would take some sweeping restructuring of the medical sector, but the money is already there.
So if you got your coronavirus vaccine and thought, "dang, wouldn't it be nice if all clinics and hospitals were like this," such a future is within our grasp. Just pass Medicare-for-all.