In this blog, former RN and longtime HCFA-WA supporter Cris Currie addresses a common concern. Once upon a time, from the 1930s through most of the 1960s, the phrase “good enough for government work” was meant as a compliment for a job really well done. Its meaning is much different today, and far too many potential supporters of Medicare for All have no confidence in government work and do not want the government to be involved in their healthcare. How should single-payer activists respond to this concern?
While it is tempting to assume that the relative efficiency of private business would produce the most effectively run healthcare system, this is not the case in actual practice. Medicare is currently split between traditional Medicare (government run) and Medicare Advantage plans (privately run).
Traditional Medicare covers all those from whom a profit can’t be made including the permanently disabled and those on renal dialysis. It also covers the 68% of seniors who do not have Advantage plans and who are generally the sickest such that private companies avoid insuring them. The Centers for Medicare and Medicaid Services (CMS) accomplishes this amazing feat by spending only 2-3% of its budget on administration and with much lower premiums and far fewer complaints than the private sector.
Since 1972, private insurers have promised that they can run Medicare plans more economically, but that has never happened. In fact, CMS has spent billions of dollars more to finance Advantage plans than it would have spent without them, mainly because of their exorbitant private administrative costs and need for substantial profits. Both Medicare and Social Security (which also runs like clockwork on a lean budget) have had a profound effect on the poverty rate, while private insurers continue to drive businesses and individuals into bankruptcy. Quite simply, the reorganization of the current CMS into the single-payer will undoubtedly be much more effective than our current hodgepodge bureaucracy of expensive private companies financing healthcare today.
It is also important for critics to understand that our government was never designed to be efficient or to be run like a business. Its three branches were established as checks and balances to prevent tyranny and give all “men” in our very diverse society a voice in self-government. According to UCLA law professor Jon D. Michaels in his new book called Constitutional Coup: Privatization’s Threat to the American Republic, the same system carries over into the executive branch where a rather bewildering array of agencies is charged with creating procedures to adjudicate and enforce the laws made by Congress. Each agency is led by a director appointed by the president and subject to his priorities, but actually run by tenured civil servants who provide the continuity, the expertise, and typically the strength to resist any partisan directives that might upend the will of Congress.
The third check on power is a watchful public that is always ready to “constrain, prod, or redirect agency officials” (p. 62). When it comes to expanding Medicare to everyone, having a transparent system subject to these checks and balances is critical for success, because policies for the common good have the best chance of being achieved once these three entities reach their slow, inefficient consensus. Privatization of government services removes these protections and dilutes the goals to mere efficiency, profit making and shareholder satisfaction. Government is essential for balancing public and private interests. Fortunately, as American citizens, we have both the right and the ability to keep pushing our government to perform at its maximum effectiveness for the common good.