Improve and Strengthen Medicare by Expanding It to All
[The following text is the testimony that Dr. Margaret
Flowers presented to the National Commission on Fiscal
Responsibility and Reform at its June 30 hearing in
Physicians for a National Health Program.]
I am Dr. Margaret Flowers and I am here today on behalf
of Physicians for a National Health Program, the
leading physician research, education and advocacy
organization in support of a truly universal single-
payer health system in the
specifically about the contribution of health care
costs to our national deficit and the evidence-based
remedy to control these costs.
When compared to health care in other advanced nations,
of money spent per capita per year. Despite our high
either uncovered or underinsured and thus vulnerable to
Medical debt is a leading cause of bankruptcy and
foreclosure in our nation despite the fact that most
families declaring medical bankruptcy had insurance
when they began incurring such debt.
Our health outcomes are relatively poor, placing us
37th in the world, and we rank the highest in
preventable deaths, over 100,000 preventable deaths per
year, when compared to other advanced nations. It is
clear that we are getting poor value in return for our
health care dollar.
Health care costs, which are rising 2.5 percent faster
than our GDP, are a leading driver of our financial
deficit. In fact, if our health care costs were
comparable to those in other advanced nations, which
provide nearly universal health care with better
outcomes, we would currently experience a budget surplus.
The recent health legislation, misleadingly titled the
Patient Protection and Affordable Care Act (PPACA),
lacks proven cost controls and is predicted to cause
been no reform at all (Centers for Medicare and
Medicaid Services, April 2010) despite continuing to
leave tens of millions out.
Given the impact of health care costs, members of this
commission may attempt to decrease the deficit by
cutting our public health insurance programs, Medicaid
and Medicare; however, doing this would be a mistake
because it would increase poverty, worsen health
outcomes and increase costs.
Since its enactment nearly 45 years ago, Medicare has
substantially lowered poverty among the elderly.
Studies show that health disparities in the
decreasing when our population reaches the age of 65.
And the cost of health care per beneficiary is rising
more slowly for those on Medicare than for those with
private health insurance.
Medicaid and Medicare have not caused our rising health
care costs but are victims of our fragmented and failed
market-based model of health care financing. Shifting
the cost of health care from the taxpayer to the
patient will not magically make these health care costs
disappear or become sustainable.
The solution to our economic crisis is to jettison the
costly failed market model of health care and adopt a
publicly financed and independently delivered national
improved Medicare for All. This is commonly known as
"single payer." A national improved Medicare for All
system has myriad benefits:
* Administrative savings of approximately $400 billion
per year, which is enough to provide comprehensive high
quality health care to all who are uninsured and
* Ability to negotiate for pharmaceutical prices as a
monopsony which would lower costs by about 40 percent
and bring our prices in line with those of other
* Inherent cost controls of global budgeting for health
facilities, negotiated fees, bulk purchasing and
rational, rather than profit-driven, allocation of
capital expenditures and health resources.
* Ability to identify outliers and develop quality
* Eliminate the burden of rising employee health care
costs on businesses.
* Enhance the competitiveness of
* Liberate our population to pursue advanced education
or entrepreneurial enterprises.
* Allow older workers to retire which would increase
job opportunities for our younger workers.
* Stimulate the economy because families would have
more money for discretionary spending.
* Improve the health, and therefore the productivity,
of our workforce.
* Eliminate bankruptcy and foreclosure due to medical
* Eliminate the spend-down required for those who need
long-term care funded by Medicaid.
* Provide true health security to our population so
that nobody has to choose between necessary medical
care and other necessities such as housing, food,
education and clothing.
Given these multiple economic benefits - and I have not
begun to describe the ways in which national improved
Medicare for All would improve patient choice and
quality of health care - it is no surprise that the
single payer approach is supported by the majority of
those in the
physicians. This was evident once again last Saturday
in the town meetings sponsored by
participants across the nation demanded single payer as
an option to solving the health care crisis and 71
percent voted not to cut Medicaid and Medicare.
Private health insurance is rapidly becoming a thing of
the past. There is a steady trend in fewer people being
enrolled in employee-sponsored health plans. This is
expected to increase under PPACA as businesses have an
incentive to drop insurance benefits and pay the lower
There is a steady trend in people choosing high
deductible plans which leave them financially
vulnerable in their time of need. As people enter the
individual market, those with health conditions will
find it difficult to afford adequate insurance.
The trends for those who are uninsured and underinsured
will continue upward. Under PPACA, billions of public
dollars will be used to subsidize rising private
insurance premiums for policies that cover fewer and
fewer services. The result is a flow of patient and
public dollars into the coffers of private insurance
corporations with declining return in terms of health
care. This trend is not sustainable.
The alternative scenario of a national improved
Medicare for All will save lives and save money.
National improved Medicare for All will place our
nation on the path of becoming one of the best health
systems in the world - something of which we can all be
This commission has the ability to recommend creating a
financially sustainable universal health system. I urge
the members of this commission to recommend addressing
the deficit through adopting this most popular
approach: national improved Medicare for All. Don't cut
Medicare. Protect it, improve it and expand it to cover everyone.