Medicare in the United States

Access to affordable healthcare is a huge issue in America. Whether Americans are dealing with huge amounts of medical debt, are trying to find insurance that will provide adequate coverage, or trying to find insurance that they can afford, millions of Americans deal with issues regarding getting quality healthcare daily. According to the United States Census Bureau, “in 2018, 8.5% of people, or 27.5 million, did not have health insurance at any point during the year” (Berchick). This statistic does not take into account the people who had insurance for part of the year, which would impact the statistic if it were to be considered.

Another estimated “26,260 Americans aged 25 to 64 died in 2006 because they lacked health insurance—more than twice as many as were murdered. In the seven years from 2000 to 2006 an estimated total of 162,700 Americans died because of lack of health insurance” (Tanne). There are many causes of this issue, ranging from the cost of insurance, the lack of employer provided income, and the incredibly low income requirement in order to be qualified for Medicaid. In order to fix this issue, America’s healthcare system needs to be changed so that it is focused on helping the people instead of helping insurance agencies make a profit. Using a single-payer health care plan will help to eliminate people’s lack of insurance and lower the amount of people that die each year due to lack of coverage for their medical procedures.

The cost of insurance is so high because there are not many options currently in the health insurance marketplace. According to a study done by the Kaiser Family Foundation, each state has an average of 4.5 options to choose from when picking an insurance company (Fehr). Some states such as Mississippi, Alabama, Delaware, and Nebraska have two or fewer options and, in some states, numbers continue to decrease. The reason that this is detrimental to people looking to be insured is because most insurance agencies are for profit and the less competition there is, the more they can charge customers. Insurance companies such as Aetna have withdrawn their coverage from 11 out the 15 states they previously covered (Mathews). This lowers the competition for other insurance companies and can increase premiums since many insurance agencies are for-profit. The states mentioned above that had less than two options for insurance coverage saw premium increases ranging from 18% (Alabama) to 48% (Nebraska) from 2017 to 2018 (Holahan). This lack of options makes it even more difficult for Americans to afford insurance and exacerbates America’s healthcare issues.

Another cause of these issues is a lack of employer-provided insurance. Out of the people insured in 2017, 56% were covered for some or all of the calendar year by employer-based insurance. (Berchick). While this is a large portion of the population, it is still only slightly more than half of people who have insurance, leaving 44% to obtain health insurance some other way. This statistic does not take into account what percent of people have insurance that is only partially covered by their employers. However, even with employer-based insurance Americans are paying a lot for insurance. According to a study done by the Kaiser Family Foundation, “the average annual premium contributions by covered workers for 2017 are $1,213 for single coverage and $5,714 for family coverage. Eight percent of covered workers contribute $12,000 or more a year for family coverage” (“2017 Employer Health Benefits Survey - Summary of Findings.”). This study reveals just how much Americans have to pay each year for insurance. On top of that, the government does not require employers to give insurance to part-time employees and many employees that work retail or in the service sector only work part time. The people with some of the lowest wages – retail workers, restaurant staff, etc. – do not qualify for employer-based healthcare, even if they are a part of a large company. Another group of working people that do not qualify for employer-based health insurance are people who work in the gig economy. Popularity of gig jobs has risen noticeably in the last 10 years with the creation of companies such as Uber, Doordash, Fiverr, Instacart, etc. Employers are not required to give these workers insurance because technically they are classified as self-employed.

Yet another cause of America’s health care crisis is that the income requirement for receiving governmental health care assistance is so low. At this moment in 2020, in order to qualify for Medicaid, a person must meet either 100% of the federal poverty level in states that opted out of the Medicaid expansion, or 133% of the federal poverty level under the Medicaid expansion which covers more people. Individual states can choose whether or not to implement the Medicaid Expansion and to date “37 states (including DC) have adopted the Medicaid expansion and 14 states have not adopted the expansion” (“Status of State Medicaid Expansion Decisions: Interactive Map”). States in the south-east have disproportionally not implemented the Medicaid expansion. Under the 2020 federal poverty guidelines, if a family of 4 does not make a combined income of $26,200 or less they cannot qualify for Medicaid (“Poverty Guidelines”). If two people in a family of four worked full-time minimum wage jobs (7.25 an hour in most states), they would not qualify for Medicaid because they made slightly over $26,200 a year. Because the Medicaid requirements are so low, even people who work full time for minimum wage cannot reach them and are forced to either pay the penalty for not being insured or get the cheapest insurance they can find – which in some cases would be more expensive than paying the penalty fee under Obamacare. These causes greatly affect Americans access to affordable health insurance and can cause massive amounts of debt that can permanently cripple people’s quality of life or can even cause death due to lack of treatment.

Another effect is lack of access to affordable health insurance of these issues is massive medical debt.

“In 2012, more than two of five (41%) adults ages 19 to 64, or 75 million people, reported problems paying their medical bills or said they were paying off medical debt over time. Of those who reported difficulties paying medical bills or paying off medical debt, 42 percent (32 million people) said they received a lower credit rating as result of unpaid medical bills.” (Collins)

This can create huge problems for America as a whole. If people have a hard time paying their medical debt due to how large the sum is, many will try to pinch pennies, trying to buy mostly essential items or worse: racking up more debt. The statistic also states that Americans were paying their debt over time. That would prolong the amount of time they were not stimulating the economy as much as is necessary for the health of companies, the stock market, and older Americans who rely on the health of the stock market to fund their retirement. These effects would deeply impact our economy and it would improve not only the American people’s lives who are affected but also the companies who rely on Americans buying their products.

Another effect is that sometimes when the procedure required is expensive enough or the insurance is inadequate, it can cause bankruptcy. In the United States, medical bills are the most cited reason for personal bankruptcies in 2007 (Himmelstein). The number of debtors citing medical issues as the reason for their bankruptcy actually increased 3 years after the implementation of the Affordable Care Act, going from 65.5% to 67.5% (Himmelstein). These bankruptcies can heavily impact Americans lives, and just like with credit card debt or medical debt, they can cripple an entire family’s wellbeing.

Using a single-payer health care plan would help to eliminate American’s lack of insurance, help save lives, and help to improve people’s quality of life. Under a single-payer health care system, medical expenses would be paid for by the government instead of by the American people individually or multiple private insurance companies. Examples of how it has been implemented can be seen in numerous other countries such as Canada, Taiwan, South Korea and even in the United States. An example of a single-payer health care system currently in place in the United States is Medicare. The only difference between Medicare and a universal single-payer health care option is that Medicare only covers Americans starting when they are 65, certain younger people with disabilities, and people with End-Stage Renal Disease. (Cite CMA website here) As of 2013, the single payer health care system in Taiwan insures 99.9% of its population of roughly 23.4 million residents (Cheng). Patients in Taiwan have complete freedom of choice in their health care providers, they may see whichever doctor they choose (Cheng). Health care providers are a combination of both privately owned nonprofit entities and government owned facilities (Cheng). This single payer health insurance system is funded primarily by collecting premiums through payroll taxes (Cheng).

The history of Medicare started in the 1960s. Medicare was signed into law on July 30th, 1965 by Lyndon B. Johnson and initially only covered older Americans (“History”). Today Medicare coverage has expanded to include the disabled and people with end-stage renal disease and offers more benefits such as prescription drug coverage (“History”). Canada implemented a single payer health care option in 1984. The first single payer health care system in Canada began in the province of Saskatchewan (“Government of Canada”). Soon other provinces put in place similar single payer health care systems, until finally in 1984 a nationwide system was put in place (“Government of Canada”). U.S. Representative John Conyers introduced the United States National Health Care Act, which is a single payer health care proposal, in 2003 (“H.R.676 - 108th Congress (2003-2004): Expanded and Improved Medicare for All Act.”). Most recently U.S. Representative Pramila Jayapal introduced the Medicare For All Act of 2019, which is also a single payer health care proposal (“All Info - H.R.1384 - 116th Congress (2019-2020): Medicare for All Act of 2019”).

Many skeptics question how a single-payer health care plan would work and how the United States could possibly afford it. According to a study published in 2020 by Alison Galvani, a professor at the Yale School of Public Health and the Director of the Center for Infectious Disease Modeling and Analysis, the program would save more than enough money than required in order to offset the costs associated with universal health care (Galvani). Medicare for All would save money in part because billing a group of people who have single-payer insurance would mean that rates for treatment would already be set. This means that health-care providers don’t have to consult as many medical billing specialists and would save on administrative costs (Galvani). That does not sound like it would save that much money at first; however, administrative costs make up 12.4% of spending for insurance companies versus the 2.2% of costs for Medicare (Galvani). In total they spend kdfjdkfj per year so 12.4% would be a lot of money saved in the long run. Another reason that this plan would save money is because by providing primary care access to all Americans, we would eliminate unnecessary visits to the emergency room due to lack of primary care.

A pro of using a single-payer option would be that it helps to save lives. An estimated 162,700 people die each year due to lack of insurance (Tanne). If everyone had health insurance, then this number could be decreased significantly. Another pro of this system is that it actually costs less than our current system costs. The cons are that it might be hard to pass. Not everyone supports a single-payer option, although the majority of Americans do. Recent polling indicates slightly over half of Americans are in support of a single payer health care system (“Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage”). Another con is that it could cause lengthy wait times or restricted availability for people receiving treatment. This could cause issues regarding getting an important checkup or getting a surgery done. Wait times could be alleviated by increasing the number of health care providers in the United States.

America has a serious health care problem. Thousands of Americans die each year due to lack of coverage for their medical expenses. Many go into large amounts of medical debt or even go bankrupt because of medical expenses. In order to make a difference in people’s lives big changes need to be made to the way that Americans receive their health care. A single-payer health care plan would help to alleviate these issues that Americans face and in turn effect the country positively. Countries such as Canada have implemented a single-payer plan which serves as a great example of how it can be accomplished. America’s own Medicare plan can also serve as an example through the ways that it covers senior citizens either for free or for a very low monthly cost. If something is not done people will continue to suffer financially and physically. 

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