COVID-19 pandemic demands Medicare for All
by Joshua Cho
There’s nothing like a global pandemic to demonstrate that a universal single-payer healthcare system like Medicare for All is not an idealistic fantasy, but an immediate, urgent necessity. When over 16 million Americans have already filed for unemployment benefits within the last three weeks, it’s clear that the American system of making health insurance a privilege only for those who work—or for those poor and old enough to qualify for Medicaid and Medicare—has made the US especially vulnerable to Covid-19.
Despite the false choice often presented to us by politicians and corporate media (our health vs. “the economy”), not only is it possible to address both, a stronger coronavirus response is an absolute prerequisite for avoiding the worst-case economic scenarios (Jacobin, 4/1/20).
While there have been several op-eds (Washington Post, 2/26/20; New York Times, 3/11/20; Bloomberg, 3/13/20) recognizing that Medicare for All is necessary because it’s disastrous to have people delaying or avoiding necessary treatment during a pandemic without a vaccine, many in corporate media are still engaging in class warfare by continuing their crusade against universal healthcare (FAIR.org, 4/29/19, 10/2/19).
Politico contributing editor Bill Scher’s “No, Coronavirus Isn’t Proof We Need Socialism” (3/24/20) parroted the typical canards about technocratic centrists like New York Gov. Andrew Cuomo prioritizing “competence,” and the “nuts and bolts of effective crisis response,” over opportunistic “socialists” like Sen. Bernie Sanders trying to “exploit the crisis in order to advance their ideology.” (It’s worth pointing out that Cuomo’s “competence” delayed taking effective action against the coronavirus until New York State had by far the worst outbreak in the country—FAIR.org, 4/11/20.)
Scher’s doublethink take of arguing against ideology, and any action beyond “temporary stimulus,” because that would be “socialism,” while saying he wants to shelve the debate over universal healthcare for “another day,” indicates insincerity. Especially given that Scher has published hot takes like “The Single-Payer Insanity” (9/12/17) and “Down Goes Socialism” (8/18/18) in more stable times, it suggests Scher does indeed have an ideology—one that prioritizes preservation of the status quo over addressing the severity of the crisis.
Bloomberg columnist Ramesh Ponnuru’s “Italy Shows That Medicare for All Is No Cure for Coronavirus” (3/17/20) confused an array of issues through non sequiturs and category errors. Arguing that “Italy’s high death rate” proves Medicare for All is “not a solution to this problem,” Ponnoru claimed there are adequate solutions that don’t require “going all the way to Medicare for All.” Even if one were to accept the recommended arbitrary “solution” of making “coronavirus testing free for all,” which leaves out treatment for coronavirus—let alone testing and treatment for other diseases —Ponnoru doesn’t explain why Americans should settle for a measure that isn’t as good as Medicare for All.
It doesn’t logically follow that because countries with single-payer healthcare systems can’t literally cure Covid-19, it is therefore not part of a necessary response to a pandemic. Neither is it relevant because, as Ponnoru himself noted, single-payer advocates are not arguing that universal healthcare would cure coronavirus and eliminate deaths, but that it would help prevent infections by allowing people to seek the testing and treatment they need without worrying about the cost. This isn’t difficult to understand. The US’s employer-based healthcare system is exceptionally vulnerable and incapable of addressing a pandemic, because enforcing the economic shutdown required by quarantine causes massive spikes in unemployment, which then lead to further drops in healthcare coverage, and further compound the problem in a vicious circle.
Which is why it is bizarre to hear Ponnoru arguing against Medicare for All because it would not bring as much cost savings as single-payer advocates claim it would, as it would raise “demand for medical services by making it free at the point of service.” Aside from faulty arguments related to “cutting doctors’ pay,” yes, more people seeking testing and treatment for Covid-19 and other ailments is a good thing, and precisely why universal healthcare is necessary to combat a pandemic. Despite corporate media’s resistance to strict quarantines and economic shutdowns, the point is that a universal system like Medicare for All must be paired with strong government action to supply enough medical equipment, aggressively test for the virus, and enforce strict and timely quarantines to minimize the coronavirus’ spread (FAIR.org, 3/17/20, 3/20/20).
The same presumptions in Bloomberg’s opinion pages can be found in the New York Times’ news reporting. While publishing informative reports on Medicare for All (10/31/19, 2/25/20), the Times also publishes problematic reports like “For France, Coronavirus Tests a Vaunted Healthcare System” (3/27/20), which demonstrate the same confusion of issues. When the Times‘ Adam Nossiter writes that whether, compared to the Chinese example, France’s laxer “experiment in confining its citizens” succeeds will “say much about the ultimate adequacy of a well-funded, well-equipped and broadly accessible national treatment plan,” he makes it seem as if the vindication of France’s universal healthcare system depends on it being able to handle the stress on French healthcare providers resulting from looser quarantine efforts. It doesn’t.
Even if the French healthcare system can’t handle the stress from a more lenient attitude toward quarantine, that has no relevance to the point that a universal healthcare system is a necessary, albeit insufficient, component in a nation’s pandemic response. As the Times itself reported earlier (3/21/20) on the “tragedy of Italy,” if Italy’s experience shows anything, it’s that “measures to isolate affected areas and limit the movement of the broader population need to be taken early, put in place with absolute clarity, then strictly enforced.” Not only do Italians themselves reject the notion that their single-payer system is unnecessary, they actually credit it for preventing what would certainly be an even worse disaster than the one they’re currently facing (Jacobin, 3/31/20). As horrifying as their situation is, Italians don’t experience being denied treatment because they’re uninsured.
An overwhelmed single-payer system is not evidence that universal healthcare is therefore unnecessary; it’s evidence that that nation failed to learn from real-world success stories in containing the virus, perhaps because that nation’s media were more interested in scapegoats than in role models (FAIR.org, 3/24/20).
Yet, despite support for Medicare for All surging in recent polling, and exit polls from a majority of primary states demonstrating that Democratic voters prefer a single-payer system to the status quo, media-anointed presidential candidate Joe Biden has been doubling down on his opposition to Medicare for All. Echoing corporate media’s confusion of issues, in the last CNN debate (3/15/20), Biden remarked:
And with all due respect for Medicare for All, you have a single-payer system in Italy. It doesn’t work there. It has nothing to do with Medicare for All. That would not solve the problem at all.
Echoing Biden, one can still find reports and op-eds in the New York Times, in the midst of a pandemic, discouraging efforts to push for necessary overhauls to the fragmented US employer-based healthcare system.
Instead of publishing reports informing citizens on the immediate necessity of universal healthcare and galvanizing a call to action, the Times chose to publish defeatist reports like “Even if Sanders Wins, Medicare for All Almost Certainly Won’t Happen” (3/9/20) and “Why America Will Never Get Medicare for All” (3/14/20). In the latter, instead of explaining the importance of a strong organized labor movement to the rise of European welfare states, the Times‘ Eduardo Porter depicted the US as doomed by demographics, arguing that Americans with their multiethnic society can never get universal healthcare, since “uncompromising racism” is a “forbidding obstacle.”
While racism is certainly a longstanding presence in American life, the voting behavior of racists is also more complex than the Times’ simplistic portrayal, and it is possible to get their votes while still rejecting racism (FAIR.org, 8/29/19). Perhaps the real reason the Times argues that “the chances of a President Sanders pushing Medicare for all through Congress would be slim to none” is because it shares the same hostility toward taking the profit out of healthcare that the healthcare industry does (FAIR.org, 1/24/20).
Resembling Students for Life of America’s Kristan Hawkins’ outlandish take “Medicare for All Scares Me More Than Coronavirus” (RealClearPolitics, 3/28/20), the Times ran an op-ed on “The Dangers of Medicare for All” (3/9/20) by the right-wing Hoover Institution’s Scott Atlas, which made evidence-free histrionic assertions like, “Medicare for All could very well destroy Medicare as we know it and jeopardize medical care for seniors.” The piece deceptively argues that Medicare for All would harm retirees because “more than 70% of them use private insurance in addition to or instead of traditional Medicare”; Medicare would actually expand benefits for everyone, including seniors, which is why it would ban duplicative coverage from private insurers.
It also asserts that healthcare providers would “lose money” because Medicare pays less than private insurers do for healthcare—a claim that resembles a misleading Times report (4/21/19) that told readers hospitals would “lose billions” under Medicare for All. The notion that Medicare for All would bankrupt hospitals because current Medicare rates have lower reimbursement rates than private insurance is unclear at best, and deceitful at worst. While single-payer advocates have pointed out flaws with Sanders’ Medicare for All bill, the Times’ projections assume that hospitals will continue to be paid on a per-patient basis under single-payer to current Medicare reimbursement rates, and ignore how Sanders’ bill, as well as better single-payer proposals from Rep. Pramila Jayapal, also call for replacing per-patient payments with a “global budgeting” system (Health Affairs, 3/3/19, 12/9/19).
Under a global budgeting system, hospitals would be funded through annual lump sums distributed in monthly installments, where hospitals can receive extra funding if unexpected deficits occur to prevent bankruptcies, and would be unable to keep the surpluses currently driving up costs (The Nation, 7/16/18). Under the current system, private insurers are already bankrupting rural hospitals—often the economic heart of a community, and sole healthcare provider for miles—because they’re unprofitable, and Medicare for All, on even a per-patient basis, would actually save hospitals, because Medicare rates would increase revenue for hospitals serving high levels of uninsured and Medicaid patients (Kaiser Health News, 6/27/19; Salon, 7/28/19). It’s also true that lower payments wouldn’t necessarily result in hospital closures, but instead in positive changes to their business model.
The strain in these arguments is due to their unspoken goal: How can we keep everything the same if we change things? This outlook suggests that no one loses out under the status quo—or those who do are negligible.
As FAIR (4/1/20) has noted, corporate media coverage of the coronavirus crisis is quick to report on problems, and slow to provide any analysis or explanations of these problems. Several people have already pointed out, for example, that the US healthcare system is unequipped to handle a sudden surge of new cases, as there aren’t enough ventilators and hospital beds. The coronavirus crisis should be an opportune time to explain how the US’s for-profit healthcare system has led to relentless cost-cutting, reducing “surplus” hospital beds that are now desperately needed, and how resources are unevenly distributed between profitable and unprofitable hospitals. Yet the profit motive incentivizing shortsighted “just in time” and “lean production” healthcare delivery rarely features as an explanation for why the US has less staff and equipment relative to its population than other countries.
As several outlets have noted, the case fatality rates for Covid-19 differ from country to country, and one of the reasons so many Italians are dying is that their system was overwhelmed by government inaction, and faces the nightmare scenario of having to reject patients and triage care. Given that the US death toll has already surpassed Italy’s, it’s crucial for journalists to inform their audiences of larger causes.
A Lancet study (2/15/20) found that universal healthcare would prevent at least 68,000 deaths per year (the death toll of nearly 23 September 11 attacks annually) even without a pandemic. But the case for Medicare for All isn’t merely a moral argument that no one deserves to die because they can’t afford healthcare. It’s also a pragmatic awareness that we are only as secure as the most vulnerable among us; when millions of people are unable to see a doctor or receive treatment because they can’t afford for-profit health insurance, some uninsured describe themselves as a “coronavirus timebomb.”
The US’s employer-based insurance system was already unaffordable before the pandemic, but with private insurers’ business rationale leading them to hike premiums by as much as 40% in its midst, it’s vital that media do everything they can to press the government and inform citizens about a system that can deliver the healthcare we need when we have never needed it more.