Hey Friend,

Quick note: I’m going on vacation with my family. Been a long time since we’ve been able to take some nice, quiet time together so I’ll be logging off and unplugging. I wanted to give you a heads up that next week, there won’t be a new newsletter in your feed. I’ll see you soon!

“There are lots of ways to get to universal coverage,” is the line you’ll hear ad nauseam from liberal opponents to Medicare for All.

There are, as I hope the last three posts have demonstrated, many more problems in American healthcare than simply “getting to universal coverage.” Indeed, the ideal of universal coverage itself is a private health insurance talking point: if you absolutely have to give everyone healthcare, do it by offering them one of our (shitty) products.

But extending private health insurance to more people doesn’t solve so many of the core problems in healthcare — that the profit motive in private health insurance is itself part of the problem, that it’s led to the most expensive healthcare in the world, that it’s enabled massive healthcare consolidation that destroys health access for low-income people, and that it’s created a tiered healthcare system which undervalues Black and brown people.

So while there may be lots of ways to get to universal coverage, there’s really only one way to get to equitable, universal coverage: dig out the private health insurance profit motive, reduce healthcare costs, address healthcare consolidation, and fix the fundamental inequity at the heart of our tiered system. That’s Medicare for All.

Medicare for All offers everyone the same coverage, instantly solving the inequity problem. It offers every single healthcare provider the same rate for the same procedure, addressing the bargaining problem at the heart of the consolidation problem. And the government is your insurer; it solves the fundamental disincentives inside private health insurance. Let’s cut deeper.

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Universal coverage and health equity go together.

It’s literally Medicare for ALL. No matter who you are, employed or unemployed, rich or poor, older than 26 or older than 65, married or unmarried — you’re covered. And you're covered by the same exact health insurance as everyone else, which means that the reimbursements are exactly the same. And because your insurer is the federal government, they’re not trying to nickel and dime you by denying you the healthcare you already paid for.

One pushback we often hear is that Medicare, itself, has issues — and that these limitations would be ported over to Medicare for All. This betrays a clear lack of imagination. Medicare’s gaps are a function of politicians trying to strip out the system to reduce its costs (and create an implicit incentive to push more people onto private Medicare (dis)Advantage Plans). But the Medicare in Medicare for All would include vision, hearing, dental, and prescription coverage, without copays or deductibles.

How can we offer such a generous package without sending the costs sky high? Because we’re eliminating the overhead costs in the current health insurance system that pay CEO’s salaries, advertising budgets, and profits.

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Government monopsonies mean lower prices — and less consolidation.

We all know what a monopoly is: it’s when there’s a single seller of a good. That monopoly can then dictate the prices because they’re the only one selling. A monopsony is the same, but on the other side of the transaction: the only buyer of a good. Under Medicare for All, the government becomes a monopsony for healthcare — it's the only buyer, buying on our behalf. So it can dictate the reimbursement rates for healthcare.

If you remember back to my previous post about hospital monopoly, it’s these reimbursement rates that hospitals manipulate to put each other out of business and consolidate, which drives prices up. But if the government is a monopsony on our behalf, it can charge every hospital the exact same rate, cutting out the games the biggest hospitals play to command better reimbursement rates because of their size, and putting hospitals and physician practices on an even playing field.

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And so much more!

There are other problems Medicare for All would solve. Prescription drugs are far too expensive? Well, Medicare for All’s monopsony power would allow the federal government a simple way to negotiate with Big Pharma and pass the savings on to us.

Healthcare is too complex? Well, right now so much of the complexity in healthcare exists because of how hard it is for healthcare providers, like doctors and hospitals, and health insurers to cross talk. Both sides have to employ an army of billers to navigate all of the specific rules and regulations insurers impose to reimburse care. Medicare for All replaces the nearly 500 private insurers with one public insurer. Away goes all of that overhead that exists simply to figure out how to pay for healthcare.

Too little public health investment? Well, in our current system, there is no incentive for any one insurance company to invest in keeping you healthy because they know that you’re probably going to be on another insurance plan — let alone Medicare — by the time the investment pans out. Medicare for All means that the same government that is paying for your healthcare tomorrow could instead pay to prevent you from getting sick in the first place today.

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A solution for all.

Medicare for All isn’t just about “universal coverage.” It’s about a universal solution to almost all the problems we face in our multi-faceted, profit-driven, complex healthcare system. Rather than individual technocratic fixes for each problem that are hard to understand, Medicare for All offers a simple solution to many problems that is easy to understand.

That’s exactly why the corporations who profiteer in our current system want to keep us from having it. And that makes the politics anything but simple. For more, check out Medicare for All: A Citizen’s Guide.

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The Incision

Medicare for All… of our healthcare problems.