For too many millions of Americans under age 65, health care is a broken, poorly accessible system with a confusing array of insurance plans and prohibitive costs.
The international comparisons are sobering: We're the only wealthy country without a universal health care system. Averaging more than $10,000 per American per year (17.9 percent of GDP), we're spending roughly twice the average of what other high-income countries spend on health care - nations which insure all their citizens.
Compared to other high-income countries, here's what we get for such extraordinary spending: the lowest life expectancy, highest infant and maternal mortality, highest adult obesity rates, the same or less favorable treatment outcomes for most diseases, 30 million-plus Americans uninsured, and the lowest citizen satisfaction rate with the health care system (19 percent).
Coincident with this dismal data, America has the the highest percentage of citizens primarily insured by the private insurance market at 55 percent. The next highest-percentage country is Germany at 10 percent.
The good news for Minnesota: we're competitive with the very best systems in the world for health care quality and accessibility (unlike Mississippi).
The high cost of American health care has been primarily linked to the prices for drugs, procedures, and hospital/physician charges, plus very high administration costs - all averaging twice (or more) what other wealthy countries pay. Much of our health care provider expense results from the complex clerical costs of billing multiple different health insurance plans (approximately $70,000 per physician per year). An average of 20 percent of commercial insurance premiums are consumed by administrative overhead and profit (compared to 1.5 percent for Medicare).
Despite conservative hopes to the contrary, it has become convincingly clear: The competitive free market can neither reasonably control costs nor expand basic affordable health care coverage to all citizens.
The best fix?
Thank U.S. Sen. Bernie Sanders for starting the conversation, but his proposal must be modified: It's with the foregoing poor report card in mind that Sen. Sanders proposed a radical expansion of Medicare, to become a single-payer system covering all citizens. The corollary feature of this bill would severely restrict private insurance, similar to Canada, limiting that coverage to very minor supplementary policies such as elective cosmetic surgery.
In addition to universal coverage, a major attraction of Sanders' proposal is financial. Currently, the predictions for the government's cost to fund Medicare-for-all range from $32 trillion to $40 trillion over the next 10 years. But contrast those dollars with the Center for Medicaid and Medicare Services forecast that the status quo will cost us $50 trillion over the next decade.
So then what's wrong with Sanders' proposed bill? Simply put, its timeline and mandatory exclusion of a significant role for private insurance doom it politically. Some 180 million Americans' health care is primarily via private health insurance, mostly through employer-based plans where employees pay but a fraction of the cost. Many, if not most, of these citizens are satisfied with their insurance coverage.
Alternatively, a number of options has been proposed to preserve a private-insurance option, thereby improving the chances of gaining a majority of citizen and political support. They range from allowing Medicare enrollment at age 50 to a number of proposals making Medicare available (but not mandatory) for all citizens. These proposals allow Medicare enrollment at any age, unrelated to employment, as well as employers able to list Medicare as an employee benefit option in addition to commercial insurance plans.
Because of its massive economy of scale and very low administrative costs, Medicare would be projected to evolve to be the base coverage for everyone - with private plans providing supplemental insurance as happens now with Medicare.
Considerable additional savings are to be had by allowing Medicare to oblige pharmaceutical companies to engage in a competitive bidding process to lower drug costs, which is similar to Medicaid, the VA system, and many other nations.
Medicare as an option for everyone (without excluding private insurance) should be palatable to both liberal and conservative agendas. Achieving universal coverage while eventually dropping overall health care expense from 18 percent of GDP to a projected 13 percent to 14 percent is a win-win prospect we can't afford to ignore.
The only currently missing pieces are the politicians who've done their policy homework and who can credibly and compellingly lead us to where we need to be.
Dr. Geoffrey Witrak is a retired physician from Essentia Health. His research for a University of Minnesota Duluth University for Seniors class on health care costs and coverage contributed to this commentary.