A just system of health care insurance: improved Medicare for All

H.R. 676: Expanded and Medicare For All Act

The following is a slightly edited translation of an interview with Edgar A. Lopez, M.D., F.A.C.S., which was conducted in Spanish by journalist Pablo Castelo of Al Día en América in early February. Dr. Lopez is a member of Physicians for a National Health Program and Kentuckians for Single Payer Health Care.

CASTELO: How do you explain to the common citizen what H.R. 676, the so-called single-payer bill, is?

LOPEZ: In English it is known as the “Expanded and Improved Medicare for All Act,” sometimes called the U.S. National Health Care Act. In Spanish the best translation would be “universal health insurance coverage,” financed by the government with payment for medical services going directly to the medical providers. This system would eliminate the intermediaries, or third-party payers, namely, the private health insurance companies.

CASTELO: Many people ask how much this kind of program would cost the average patient.

LOPEZ: Nothing. The patient doesn’t have to pay anything when they present themselves to the doctor or the hospital. Those who are working or employed are already contributing with taxes contributions that go to Social Security and the Medicare fund; along the same lines, a single-payer system would be financed largely by progressive taxation.

CASTELO: What would make us think that this system would actually work in the United States?

LOPEZ: We already have such a system for those who reach age 65; it is called Medicare. Hence the name for H.R. 676 – the Expanded and Improved Medicare for All Act. We also have the Medicaid system that helps those citizens who are in the lowest income levels and have the right to free or nearly free medical attention.

CASTELO: From the point of view of the patient, what are the advantages of eliminating the private health insurance companies as intermediaries?

LOPEZ: The new single-payer system would be a wonderful change because, first, it would eliminate the premiums that we have to pay to the insurers, and second, it would also eliminate co-pays, deductibles and additional out-of-pocket expenses. From the standpoint of physicians, within the current system, doctors are constantly struggling with the health insurance companies over payment issues, diminishing operational effectiveness, adding unnecessary overhead and curtailing proper medical care. For example, when I was in private practice, two of my employees would spend many hours of their working day dealing with the insurance companies.

CASTELO: I understand that statistics show that many people die because of the high cost of medical care under the present system. Is this true?

LOPEZ: According to an Institute of Medicine study in 2002, in the United States, the richest country in the world, approximately 55-60 persons die everyday because of lack of health insurance; that adds to about 20,000 preventable deaths a year. Many people wait until the last moment to go to see a physician or end up at a hospital emergency room. A more recent Harvard study in 2009, using similar methods as the IOM, found the number of deaths linked to lack of health insurance as more than twice that figure – roughly 45,000 deaths each year.

Another study in 2009 showed that over 60 percent of personal bankruptcies in the U.S. can be linked to illness and medical bills. What is rather amazing is that 75 percent of those who went bankrupt under these circumstances had health insurance when they first got sick. What happens is that when you are struck with a catastrophic illness, either you die or you fall into severe debt. Once you can no longer pay your bills, bankruptcy is the result. Hence, just because you have insurance with your employer, that doesn’t mean you are safe.

CASTELO: You and I come from countries where we grew up with the concept that health care is a right, like the right to vote as an expression of democracy. Why, in this country, which calls itself the paradigm of world democracy, is health care not a right?

LOPEZ: I believe this phenomenon is a symptom of a deformed or degenerated type of capitalism that is peculiar to the United States, because there are many industrialized countries in the world where health care is provided to everybody as a right, and yet those countries are not called communist or socialist.

CASTELO: By the way, why is H.R. 676 or the single-payer system frequently characterized as a path to socialism?

LOPEZ: Socialism is a scare word or label that the extreme right in the U.S. uses to attack the single-payer concept. They claim that an improved Medicare for All would be a form of “socialized medicine.” This is a lie. A single-payer system would simply change the way in which health care is financed; it would still continue to be delivered privately. You would go to the doctor of your choice. Hospitals wouldn’t become the property of the government. Through the years, the words communism and socialism have been used to scare people. And it’s ironic: many people who say they are against an improved Medicare for All are in fact supporters of Medicare, and some of them are enrolled in the program.

CASTELO: Any final comments?

LOPEZ: The Expanded and Improved Medicare for All Act, H.R. 676, has just been reintroduced in the Congress by Rep. John Conyers Jr. of Michigan. It embodies some of the key feature of a single-payer program:

1. Universal coverage. Everyone is covered automatically at birth.
2. Coverage for all medically necessary services – comprehensive care.
3. Redirects $400 billion in administrative waste back into patient care.
4. Patients will be allowed free choice of their doctor and hospital.
5. Premiums and out-of-pockets costs are replaced with a progressive structure of income taxation, resulting in almost everyone paying less in taxes than they currently pay for premiums, co-pays and deductibles.


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