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Improving on Medicare for All
I was recently asked a question to which my response was that I support a single-payer system, but would vote for lowering the age of eligibility to Medicare to 50-year-olds and older as an important step in the right direction. I am flexible about how we get to quality healthcare for all as a right, and not a privilege, but firmly committed to that outcome. A recent study that I want to share, serves as a powerful reminder of just how much better healthcare is provided where healthcare is a right than it is in America, even under Medicare. The founders of our country were capable of learning from the experience of others and we have to regain that ability.  

Older Americans are sicker and more likely to skip treatment than senior patients in 10 other developed countries, according to an international survey by the Commonwealth Fund. And that is the tip of the iceberg of the superiority of healthcare in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.

Robin Osborn, one of the authors of the study, notes: “In other surveys, the U.S. looks relatively poor on many measures, just because of access, but everyone age 65 has Medicare. Medicare is such a beloved program…yet in quite stark relief, we see some of (its) real shortfalls.”

The ModernMedicine network, reporting on the story , offers telling details: “Americans, nearly a quarter at 23 percent, reported financial worries, saying that in the past year, they had not visited a doctor when they were sick, had skipped a recommended test or treatment, had not filled a prescription or had skipped medication doses because of the cost. This compares to five percent or less in France, Norway, Sweden and the United Kingdom. Additionally, 22 percent of American respondents in the survey reported spending $2,000 or more on medical care in the past year. Except for Switzerland, which reported 31 percent, less than 10 percent of older adults in the other countries spent that much. Problems get even more exacerbated for the high-need older adults – those with three or more medical issues – in that 31 percent of them skip care because of costs.”

In an earlier newsletter on the subject — available here — I stressed the need for workforce improvement efforts to dramatically increase the number of primary care doctors in the United States and compensation structure improvements to pay doctors sufficiently to encourage a return to making housecalls, particularly for high-need older adults for whom repeated emergency room visits are a source of great expense, strain, and danger. 
Ultimately, we, as a people, have to recognize that the only path to seriously lowering healthcare costs over the long run is providing better quality care, and that our present system—even at its best—fails to provide quality care for vast numbers of patients.  

We must start with the moral recognition that, especially in the wealthiest country in the history of the world, no one should be crushed into bankruptcy by a chance illness or driven into debt by excessive deductibles and copays, or denied the care they need by insurance company bureaucrats who are ignorant of the art and science of medicine, or by an inadequate governmental compensation system. That moral recognition—that we are all in this together—and can do better if we act together through government for the common good, is a necessary first step. But it is only a first step and we have a long journey ahead.