Medicare Population Essay: Literature Review

The Medicare for All bill would primarily aid the uninsured American population. Medical bills and health insurance are extremely expensive in the U.S. As a result of these high costs, people miss out on care. Health policy analyst Thomas Waldrop writes, “Uninsured people are much more likely to postpone seeking care or skip needed care due to cost.” Avoiding care is a dangerous practice, but some people who don’t have insurance are forced to avoid care. The majority of these people do not have insurance because they can’t afford it and do not qualify for Medicaid. The result of not having insurance is being forced to pay expensive medical bills out of pocket, or choosing to avoid care altogether. Lots of Americans simply cannot afford healthcare. Christopher Ingraham, a writer and statistical researcher for the Washington Post, highlights the issues associated with our current healthcare system: “Fully one-quarter of [Americans] have put off needed care because of cost. More than 8 million Americans have started a crowdfunding campaign to pay for medical care.” Abstaining from care is an extremely dangerous practice and has led to preventable deaths. Furthermore, a large number of Americans have to rely on donations from strangers to pay for their medical expenses, showing how desperate these Americans are for care.

In addition to there being a high amount of residents who are unable to receive care, there is also a lack of equality when it comes to health insurance. As of 2020 data, 16.7 percent of Hispanic people don't have insurance, compared to 5.2 percent of white people (U.S. Department 7). This inequality is very detrimental to minority communities, as it causes members in these communities to have a lower average life expectancy. The Centers for Disease Control, the United States federal health agency, found that African Americans’ average life expectancy is 75.5 years, compared to 78.9 years for white Americans. While not having access to health insurance is not the only factor causing this disparity, it is a contributing factor. Inequitable access to healthcare for minorities leads to lower life spans, which is a large problem that needs to be addressed.

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Senator Bernie Sanders is striving to create more equality and better access to affordable healthcare. To achieve these goals, Sanders proposed the bill ‘Medicare for All’ in April 2019. To uninsured Americans, this bill will provide them with many benefits. First of all, they would be given access to healthcare. According to CNN writers, “In Sanders’ proposal, everyone who is a U.S. resident, including undocumented immigrants, gets coverage” (Wolf et al.). As a result of everyone gaining access to healthcare, more people will be able to get healthcare whenever they need it, not just when they can afford it. Furthermore, the bill claims to cause no discrimination and provide care to everyone. “No person shall, based on race, color, national origin, age, disability, or sex, including sex stereotyping, gender identity, sexual orientation, and pregnancy and related medical conditions (including termination of pregnancy), be excluded from participation in [this act]” (United States, Congress, Senate, 104). The bill promises to provide healthcare to all people, which in turn may help address the inequalities in our current healthcare system. To further the idea that everybody will receive care, the Medicare for All bill would be similar to private insurance companies as they will not charge more or deny coverage to people with pre-existing conditions. The bill also says that they will not discriminate against people based on demographics. All Americans will be enrolled, which will likely lead to more evenly distributed healthcare among all Americans.

Furthermore, all residents will be given access to any facility they choose and for cheap prices. As Mr. Sanders says, “You go to any doctor that you want, you will go to any hospital that you want...you're not paying any more premiums, you're not paying any more copayments, you're not paying any more deductibles” (qtd in Herzlinger). Mr. Sanders promises to give everyone access to any facility they choose, meaning everyone will get the same quality of care. People also will not have to pay many of the fees associated with a traditional, private insurance plan. This will likely encourage more people to visit the doctor, as they will not have to pay as much in fees every time they go to a medical facility. As a result of this increase in doctor visits, Americans will presumably be healthier. Lower payments to doctors and access to any facility are not all of the benefits that Medicare for All would provide. Medicare for All would also cover a substantial amount of services, even more than private insurers. According to Margot Sanger-Katz, a New York Times writer, this act will cover most things that private insurances cover and more services, like hearing aids, eyeglasses, and long-term care for people with disabilities. Uninsured Americans will get many benefits under Medicare for All, including comprehensive healthcare coverage and even services that are typically not included by private insurers. They not only will receive insurance, but the insurance provided will be comprehensive. Overall, currently, uninsured Americans will receive access to substantial health insurance coverage, as well as access to all facilities, meaning this bill would be extremely beneficial to them.

While Medicare for All will provide insurance to many uninsured Americans, the effects the bill will have on the currently insured population as well as insurance companies will be harmful. Currently, many private health insurance companies offer health insurance to Americans. However, these companies may lose a lot of money if not go bankrupt if the Medicare for All bill is enacted. This is because “Sanders would make it illegal to sell private health insurance that covers the benefits offered by Medicare for All” (Wolf et al.). Mr. Sanders will severely limit what the insurance companies can cover, as coverages that duplicate the ones listed in the Medicare for All bill are prohibited. This will mean that these companies can only cover the few things that the Medicare for All plan won’t cover. Furthermore, author Karen Pollitz, a former researcher for Georgetown and employee at the United States Department of Health and Human Services, writes that “because Medicare-for-all covered benefits would be comprehensive, the market for insurance to cover supplemental benefits likely would largely be limited to nursing home care” (Pollitz et al.). Pollitz and other researchers predict that private insurance companies would only be able to cover nursing home care, as almost all other coverages would be monopolized by the U.S. government. Private health insurance companies will have a very small list of services that they are allowed to cover, like nursing home care or cosmetic surgeries. All of these coverages that private insurers are allowed to cover are not necessary, as necessary services will be covered by Medicare for All. As a result of this bill, these private insurers would lose the ability to cover a lot of services.

Due to a decrease in available coverages dictated by the Medicare for All Bill, private health insurance companies will likely lose money. These companies make money when people buy their insurance. If Medicare for All is enacted these companies will be limited to the coverages they can provide, and presumably will make less money. New York Times writers Reed Abelson and Margot Sanger-Katz write that “The effective takeover of the health insurance industry in the United States would mean a huge hit to the companies’ stocks, although the companies, which have additional lines of business, would most likely survive.” These insurance companies will inevitably make less money, which will cause the shareholders to lose money. In addition to the shareholders being financially harmed by this bill, there are also concerns about what will happen to the employees who work for these companies, as well as the economy in general: “The private health insurance business employs at least half a million people, covers about 250 million Americans, and generates roughly a trillion dollars in revenues. Its companies’ stocks are a staple of the mutual funds that make up millions of Americans’ retirement savings” (Abelson and Sanger-Katz). Over 500,000 people are working in the health insurance industry, and it is assumed that many of them would have to be fired if the Medicare for All bill is enacted. This bill will require much fewer employees as the government will have no competition and fewer administrative needs. Therefore, this bill will eliminate many jobs and likely create only a few in return, causing a devastating effect on health insurance employees. In addition to the number of people who will lose their jobs, many people who hold mutual funds that contain health insurance stocks may lose money. A lot of these insurance stocks are in people's retirement funds, and a decrease in the stock value may cause people to lose some of their retirement money. People who are invested in the health insurance industry and working in the industry will likely lose money if Medicare for All is enacted.

Already insured Americans also are going to be expected to have to pay more money to contribute to making universal healthcare in the United States a reality. This is because the government will incur lots of expenses to insure the millions of uninsured people, as well as many other expenses associated with transferring millions of Americans from private insurance plans to government-run insurance. To enact Medicare for All, many people will have to pay more money in taxes. Pacific Research researcher, a conservative-leaning think tank, and Wall Street Journal writer Sally Pipes explains the cost for people above the poverty line: “He’s floated a new 4 percent income tax on all households earning over $29,000 a year, a new 7.5 percent payroll tax,” (“No, Bernie, ‘Medicare-for-all’ Won’t Save Money”). Americans who make over $29,000 a year, most of whom can afford health insurance, would have to pay significantly more in taxes. Other projections also predict how the Medicare for All bill will impact Americans who currently are insured. The Committee for a Responsible Federal Budget, a non-profit organization that addresses government spending, ran a study estimating how much taxes will go up for certain income brackets. They estimate that people making over $207,351 will have their federal taxes raised from 35% or 37% to 70%. This is a massive tax increase that is placed on wealthier Americans, they are going to have a vast majority of their paycheck taken by the federal government. These people will have their federal taxes doubled or almost doubled as a result of this bill.

In addition to the people in the top two brackets for income tax, all Americans above the poverty line will have to pay significantly more money in taxes. Marie Fishpaw and Jamie Bryan Hall of the Heritage Foundation, a conservative-leaning think tank, conducted a study to try to determine the cost for Americans to implement Medicare for All. They determined that U.S. residents would have to pay 21.2 cents more in taxes per every dollar they earn than they do currently. This huge tax increase is very difficult to justify, as many Americans currently spend less than that on healthcare. According to the Bureau of labor statistics, a U.S. government agency that monitors the economy and Americans’ spending, Americans spent on average 8.1% of their income for all healthcare expenses (Chalise). This bill will lead the average American to have to pay on average 13.1 percent more of their income to receive healthcare through the government instead of through their private provider. Many other studies found the same conclusion: Medicare for All will be extremely expensive and result in increased taxes, specifically on already insured citizens. Medicare for All would not only cause an increase in taxes but would also greatly hurt health insurance companies’ revenue, as well as severely hurt its shareholders, employees, and recipients of their services.

In addition to the profound effect that Medicare for All will have on already insured Americans, there will also be a large negative impact on the medical care community. If the U.S. switches to a universalized system such as Medicare for All, Americans can expect tremendous increases in wait times for all medical appointments. Other countries such as Canada and Britain, which follow similar models as the Medicare for All plan, both have significant wait time increases. In Britain in 2018, according to the United States Republican Policy Committee, “One in five emergency room patients waited longer than four hours to see a doctor, and 50,000 procedures deemed non-urgent by the government’s National Health Service were simply canceled.” Britain's long-existing system of providing healthcare to all residents still experiences long wait times. They not only keep emergency room patients waiting which is extremely dangerous, but they also cancel appointments. These wait times and cancellations are directly linked to universalized healthcare because in universalized healthcare systems more people use the medical resources available due to them being free.

These increased wait times are also seen in other universalized healthcare countries, like Canada. In Canada, the wait times are extremely long. The Commonwealth Fund, a company dedicated to healthcare research and studies, found that 56% of Canadians were forced to wait over 4 weeks for an appointment (qtd in Herzlinger). Canada has a very similar healthcare model compared to Sanders’ Medicare for All plan, and if we switch to Medicare for All we can expect much longer wait times for specialists. Author T.R. Reid chronicled his experiences in 2007 trying to get treatment for his shoulder in Canada and highlighted the long wait times. While in Canada, he was told he would have to wait at least 10-12 months for an appointment, and another 6-8 months for surgery (137). Reid was in pain but was not able to get an appointment or receive treatment quickly, as the waiting list was too long. Enactment of the Medicare for All bill could cause patients in pain, like T.R. Reid, to have to wait for care.

In many universal healthcare systems, medical care is free or heavily discounted. As a result, people tend to overuse these services and get appointments or tests done that aren't necessary. Adam Gaffney, a researcher and instructor at Harvard Medical School, and David Himmelstein, a lecturer at Harvard Medical School, predicted the increase in medical care usage. They estimate that under Medicare for All, ambulance usage will increase by 7-10%, and hospital usage will increase by up to 3%. This increase in the usage of medical facilities and resources will not only be costly but will also contribute to longer wait times. As more people use these services unnecessarily, the wait times will increase and so will the costs on taxpayers who are funding these services.

Not only will there likely be an increase in wait times for medical services, but doctors may also be paid less. Under a universalized healthcare system, doctors and other medical workers tend to have a decrease in salaries. Medicare for All is expected to significantly reduce wages for medicare workers. Sally Pipes researched and studied the Medicare for All bill, and determined that doctors are likely going to be paid 75% or less of what they were originally being paid by private insurance companies ('Medicare for All Could Mean Doctors for None'). This is a very large reduction in salary, and will inevitably cause medical workers to be upset. When comparing doctor salaries in the U.S. to other countries with universalized healthcare systems, doctors are compensated significantly less than in the U.S. A study by the Commonwealth Fund reported that “American general practitioners earned a little more than $218,000 on average in 2016, compared with $146,000 in Canada and $134,000 in the U.K.” (qtd in Pipes). In countries that follow a similar plan to Medicare for All, in which health insurance is primarily run by the government, there is a significant decrease in doctor salaries. If the United States enacts the Medicare for All plan, there will likely be a significant decrease in doctor salaries, which will consequently lead to fewer doctors in the future.

A decrease in salaries may also discourage potential doctors from becoming doctors and eventually cause a doctor shortage. Under Medicare for All, the amount of people who will become doctors is likely to decrease, which could cause a shortage of doctors. This theory of Medicare for All decreasing the number of doctors available is supported by FTI consulting: