James E. Dalen

AZ I See It

Bernie Sanders is introducing a bill that would ensure that all Americans have access to health care. It is called “Medicare for all.”

Is this a wild socialist scheme?

Nearly every industrialized nation (except the U.S.) provides universal access to health care. They spend less on health care than the U.S., and nearly all have better health care outcomes because they provide ongoing primary and preventive care to all their citizens.

There are two ways to ensure care

There are two ways that a nation may ensure health care for all its citizens. It may directly provide the health care by employing all physicians and health-care workers, and owning all hospitals and clinics. The cost of health care is paid by taxes.

This is the English system established as the National Health Service in 1948. This is socialized medicine. There may be rationing or significant waiting times for certain tests or procedures. Many Scandinavian countries also have this system. Socialized medicine works well for them, but it would never be accepted in the U.S.

SANDERS:Why it's time for Medicare for all

The second way to provide universal care is mandatory national health insurance paid by a payroll tax shared by the employee and the employer. Health care is provided by the private sector: private physicians and private hospitals and clinics. The government does not provide the care.

This system has worked well in Germany, France and many other European countries for decades. There is no rationing of care and no long waits for care. Health-care costs are lower and the quality of care is equal to or exceeds the U.S’s.

Nations with universal health care have a single payer for health care: either the government itself or a national health insurance plan.

Sanders' plan offers a single payer

In the U.S. we have multiple payers. Most Americans have employment based insurance. Employers contract with various insurance companies to pay the medical bills of their employees. Physicians and hospitals send their bills to hundreds of different insurance companies, each company has its own forms and fee schedules. It is a very complex and very expensive system.

The other major payors are Medicare and Medicaid. Again, they have different fees and different billing procedures.

Sanders proposes that all U.S. health-care bills would have a single payer: Medicare. Medicare would set fees and pay health providers in much the same way it currently pays for care to Medicare patients. Billing would be much simpler: a single billing form and a single fee schedule. The administrative costs of Medicare are about 2 percent, compared to about 17 percent for U.S. private insurance. Medicare as a single payer would decrease U.S. health-care costs by billions of dollars.

Many Americans will object to the Sanders plan because they believe that the government should not be involved in health care. Yet our government is already heavily involved in health care. More than half of U.S. health care – Medicare, Medicaid, military and VA care – is provided by or administered by federal or state governments.

Government is already involved in care

Many Americans oppose mandatory health insurance, yet we have had it for more than 50 years. Medicare is mandatory health insurance administered by the federal government.

Health care to Medicare patients is provided by private physicians and private hospitals and clinics; not the government as in England or Scandinavia. Patients have free choice of hospitals and physicians. All surveys have shown that quality of care is excellent and that seniors are pleased with their care. There is no rationing of care and no long waiting times for care.

MY TURN:Single-payer is almost guaranteed to fail

Polls since 1945 have shown that most Americans favor national health insurance. A poll in 2007 showed that most U.S. physicians also favor national health insurance.

If we are looking for a way to provide comprehensive health care to all our citizens at less cost, it is in plain sight: Medicare for all.

James E. Dalen, MD, MPH, ScD (hon) is dean emeritus at the University of Arizona Medical School and executive director of Weil Foundation in Tucson, which serves to advance integrated medicine. Email him at jdalenmd@gmail.com.