It’s no secret that healthcare is a major priority for many voters in the upcoming 2020 elections. And for the first time in modern American history, major candidates are taking strong and varied stances on how their vision of our future healthcare system should look.
For many Americans, this conversation is as much about saving money as it is about moral values. But for those of us who suffer from life-long, costly pre-existing conditions like diabetes, the future of the American healthcare system has a very real impact on our own personal futures.
Which candidates’ vision of the future of health insurance will likely do the most good for those who literally can’t live without it?
The Medicare for All Option
Many left-leaning Democratic candidates are backing varying concepts of Medicare for all. Both Bernie Sanders and Elizabeth Warren have called for abolishing our current healthcare system and overhauling it with a single-payer system that would provide all Americans with access to government-provided healthcare, regardless of economic class or pre-existing conditions.
On the positive side, this type of system would completely abolish the problem of diabetics being charged more for insurance premiums or being denied coverage altogether. In fact, it would level the healthcare expenditures field completely by providing each and every American with access to the care, medications, and devices they need to treat any ailments, no matter how acute or long-term.
In theory, this type of healthcare system is the perfect answer to a country that has seen a sharp increase in treatable illness and disease over the past few decades. But, just because you don’t have to pay insurance premiums or deductibles, doesn’t mean Medicare for all doesn’t require funding.
And that’s where the problems begin.
Sanders’ Medicare for all plan is projected to cost over 32 trillion dollars over the next 10 years. If we were a country used to paying high tax rates for government-funded programs like people do in Europe and Canada, this target might be doable through tax reform. But the American people aren’t going to be happy if their taxes double or triple over the next decade.
Even if the majority of the population could get behind higher taxes to fund universal healthcare (and no one should until someone actually presents a detailed plan of how this system would work in the USA), the bill is unlikely to ever get past the US Senate. It doesn’t look like the Democrats will gain enough seats in the Senate to reach the “supermajority” needed for policy change and most Republicans have said they will vote down any universal healthcare bill no matter what it looks like.
While the idea of Medicare for all sounds great on paper, it would be a complicated change that’s unlikely to happen even with the support of the American people.
The Medicare for Some Option
Democratic candidates Joe Biden and Pete Buttigieg have expressed plans to expand Medicare or Medicaid to more citizens while allowing those that want to keep their private insurance, to do so.
Similar to ‘Medicare for All’, this option would allow those with pre-existing conditions who can’t afford individual coverage to sign on to government-run health insurance at a reduced cost. Of course, just like Medicare now, much of the program would be tax-funded and these taxes would likely need to increase to cover the number of new members likely to join.
Unlike Medicare for All, by retaining the private option, those who join the public option are likely to have fewer choices for doctors and care than they do now. And for those that want to stay on their private plans, there are some serious downsides as well.
In our current system of private and Medicare options, Medicare routinely underpays doctors and hospitals for the care their members receive. Medical facilities make up for this lapse in payment by overcharging private insurance companies when their members receive care. If Medicare expands and private insurance still exists, private insurance companies will see even higher charges and will be forced to pass these on to their members. Over time, more and more people will jump ship and join the public option, exacerbating the problem.
In the end, a system like this is likely to end up looking more like a Medicare for All system, but only after the private insurance sector crashes and burns. The effect on the economy would be far more devastating than the more regulated transition to universal healthcare proposed by liberal Democrats.
While Medicare for some might seem like a good compromise between those who want private insurance and those who want universal health care, in the end, it’s actually a worse deal for both.
The Conservative Option
At this point in the race, we know very little about what the Republicans are bringing to the table in terms of healthcare reform. We know from attempts to repeal the ACA that they favor a private option but understand that their constituents have had a change of heart regarding guaranteed coverage and unrestricted premiums.
In the past, Republicans have tried to reconcile these ideas by crafting bills allowing insurance companies to create low-cost, low-coverage plans for healthy individuals. Unfortunately, this can lead to two major problems. First, when people on these low-cost plans get sick or injured, they often can’t afford their deductibles. But more importantly, it means insurance companies can’t afford to insure diabetics and others suffering from chronic conditions without raising their premiums to astronomical levels.
The reason the ACA works to cover people with pre-existing conditions without raising premiums is that healthy people are forced to buy in or pay a penalty. This money funds healthcare for people like me and others with incurable and long-term conditions.
Looking Beyond Health Insurance
Given current trends in healthcare expenses in the US, even if the next president upholds the delicate balance forced into place by the ACA, the system will crumble. But so would a universal healthcare system. And so would a fully-privatized system.
There is no doubt that our health insurance system is flawed and in need of a major overhaul to protect the growing number of Americans with pre-existing conditions. But it is only one piece of a very broken healthcare system. This broken system is the reason the US spends more on healthcare than any other country in the world. And it’s the reason that any insurance option is destined to fail.
If you want to vote for the candidate with the best healthcare plan for the diabetic community, don’t focus on health insurance. Instead, vote for the candidate who can present a solid plan for repairing our healthcare system as a whole. Someone who is willing to talk about how to better regulate drug prices, how to ensure better health outcomes for every person no matter their race or economic standing, and how to reward doctors and facilities for the quality of the care they provide, not just the quantity.
I’m still waiting for that candidate to step up. And until they do, every word spoken about healthcare reform is nothing but a broken promise.