The Register's editorial

Be afraid. Be very afraid.

That is the gist of recent advertisements and rhetoric attacking health reform plans, including so-called “Medicare-for-all," proposed by Democratic presidential candidates.

Iowans are apparently supposed to be afraid of higher taxes and being forced into "government" health insurance coverage. As if people don’t realize the big, bad government already insures about 100 million of us through Medicare and Medicaid.

Democrats are advocating everything from a single-payer system to expanding programs like Medicaid to a "public option" that would give Americans the choice of enrolling in government-operated insurance that competes with private coverage.

They understand everyone in a wealthy, civilized nation should have access to something as basic as health care. Though the details of candidates’ plans vary, the concept is generally the same: Use the power of the government to expand health insurance to everyone.

That is hardly a radical concept.

Numerous countries have long provided health insurance to everyone. They spend much less per person on care, and citizens tend to have longer lives and better health outcomes than Americans.

Yet opposition in this country — largely from insurance companies, drug makers and hospitals — is driven by their fear of profit losses. The status quo has done wonders for their bottom lines.

The country’s largest health insurers are raking in a fortune under the current system. Anthem, which operates many Blue Cross and Blue Shield plans, and Cigna and Humana all reported making at least $1 billion in the second quarter of this year. UnitedHealth Group’s United Healthcare reported $2.6 billion in profits.

Drug companies have the 10th highest average after-tax profit levels of more than 100 industries — a whopping 22.8% of income.

The government, which does not seek to turn a profit or please shareholders, focuses its spending on providing actual health care. If Medicare is so horrible, why do nearly all older Americans sign up for it? Why do almost all doctors accept it?

The government health insurance works well. It has a decades-old infrastructure that health providers and seniors understand. It has lower administrative costs than private plans. And expanding it makes a lot of sense when you consider the basic concept of insurance: Pool people together to pay premiums and use the money to fund services offered to everyone. Everyone contributes and everyone is covered.

Yet the United States has thousands of health insurance pools. Employers cover their own workers; exchanges created by Obamacare cover people in each state, the government covers seniors, the poor and disabled; veterans have their own hospitals and clinics that no one else can access. That fragmented system is confusing, unreliable and forces health providers to employ teams of people to navigate dozens of different insurance plans for patients.

Meanwhile, working Iowans pay an average of about $4,000 per year, or $330 monthly, toward employer-based, private family coverage, according to the 2019 Iowa Employer Benefits Study from David P. Lind Benchmark, based in Clive. They also pay taxes to cover the cost of health insurance for the one-third of Americans who rely on government coverage.

Why not have all Americans — young and old — in one pool? Instead of paying premiums, we could all pay a little more in taxes to fund coverage for everyone.

A compromise is a government “public option” to compete with private plans. Democrats could have delivered this a decade ago, but chickened out.

When former President Obama was elected in 2008, voters gave Democrats control of the House and Senate. For the first time since 1965 (when Medicare and Medicaid were created) the party had the majorities to implement significant reform.

They gave us Obamacare, which rightly expanded Medicaid, protected people with private insurance and guaranteed plans cover the care people need. But politicians lacked the backbone to include a public option in the law. Then many of them got kicked out of office in 2010.

With a public option, Americans would have the freedom to buy government coverage if they wanted it. Iowans wouldn’t have to worry if a private insurer was dropping out of a state-based insurance exchange, because Uncle Sam’s plan would be there.

Over time, more people would likely migrate to a public option, giving the government a larger pool of people to leverage down the cost of health care.

Which is, of course, exactly what this country needs.