Medicare for All? The Viability of a Nationalized Health System in America: Part II

This article is part two of a four part series in which we will delve deeper into the controversy surrounding the concept of “Medicare for All.” In particular, we will examine the proposals issued by 2020 presidential candidates Bernie Sanders and Elizabeth Warren and assess the extent to which a universal healthcare system in the United States would parallel the existing programs in other foreign nations, addressing its feasibility, efficiency, and popularity in the context of the current socioeconomic state.

Sanders and the Drug Dilemma

Vermont Senator Bernie Sanders has garnered considerable support among Democrats across the nation for his progressive stance on major policy issues, and his proposal for universal coverage has been a defining feature of both his 2016 and 2020 presidential campaigns.

Since his debut on the presidential election stage in 2015, Bernie Sanders has touted his single-payer healthcare plan as a solution to the pre-eminent issue of Medicare in the United States. Throughout his campaign in the 2020 race, the senator has directed criticism at the conglomerate of pharmaceutical corporations for the rapid surge in drug prices, which have significantly hurt lower-class patients who are unable to afford vital treatments for their medical conditions. According to Sanders, the government has been more occupied with “wasting hundreds of billions of dollars a year on profiteering, huge executive compensation packages, and outrageous administrative costs” than with challenging the iron grip that drug companies have on the market. Current Medicare policy limits the capacity of officials to pressure pharmacies into lowering their exorbitant costs, and in combination with the big-tech-like structure of the industry, in which competition from firms with cheaper generic drugs is crushed by the domineering patent-backed oligopoly, this hindrance all but eliminates the level of accountability demanded by the public from these providers. 

To remedy this major healthcare problem, Sanders has advocated for the passage of three bills that attempt to delimit the powers of Big Pharma. Within this legislative package are opportunities for the government to a) open the table for price negotiations with drug companies, b) rein in prescription drug costs to an acceptable international standard, and c) expand the market to accommodate firms from Canada and other nations. The immediate effect of such policies would be a nearly 50% slash in costs for brand-name drugs such as Humira (for arthritis) and Xarelto (for blood clots), bringing the staggering expenses of Medicare Part D plans down to earth for many patients. The expected long-term outcome would be the promotion of healthy competition in the industry, forcing pharmacies to prioritize people over profits and invest in the research and development of effective, accessible treatments.

“The expected long-term outcome would be the promotion of healthy competition in the industry, forcing pharmacies to prioritize people over profits and invest in the research and development of effective, accessible treatments.”

Given that the average American faces a lower life expectancy than his/her foreign counterparts despite substantially higher prices, a number of which are driven by redundancies and somewhat peripheral expenditures within the system, the plan is especially appealing to middle- and lower-class families who struggle to meet the ever-rising costs associated with health insurance. Support for this Medicare-for-All-associated triad has garnered support across the political spectrum, with more than 90% of Democrats, Republicans, and Independents alike supporting the government conducting negotiations to determine appropriate drug prices. Given the highly-polarized split over “Medicare for All,” the bipartisan agreement on this point is quite remarkable, yet at the same time, this by itself is certainly no guarantee that the bills will reach the president’s desk for approval.

Unsurprisingly, the pharmaceutical industry has fired back against Sanders’ proposals on a united front: the Partnership for America’s Health Care Future, which represents the interests of more than 100 associations from drugmakers to private hospitals, spent more than $143 million in lobbying campaigns in 2018 alone. While the obvious rationale behind these efforts would appear to be the fear of major revenue losses, members of the field have pointed out that such laws would cause drug development to lapse. It is no coincidence that America is paving the road when it comes to innovation in the world of health; biomedical research in the U.S. constituted nearly 45% of all global investments in 2012, while spending from Canada and Europe, which both operate under a universal healthcare system, dwarfed in comparison.

“...the mere fact that doctors’ salaries and hospital funding could diminish under Medicare for All could discourage bright minds from entering the medical field and subsequently lead to a reduction in intellectual capital, which could potentially prove to be worse for the future of healthcare”

If Sanders’ Medicare-for-All system were to take effect, critics argue, its restrictive framework would discourage discovery that could lead to the creation of life-saving treatments and life-enhancing biotechnologies. Additionally, the mere fact that doctors’ salaries and hospital funding could diminish under Medicare for All could discourage bright minds from entering the medical field and subsequently lead to a reduction in intellectual capital, which could potentially prove to be worse for the future of healthcare; the shortage of specialists in the United Kingdom, which will be discussed in a later article, is a partial indicator of how such an outcome could play out in the United States. This approach to Sanders’ plan suggests that the tradeoff between the single-payer option and scientific progress might prove too costly to be worth it for the average American.

At this stage, the American public has already reached a consensus on the need for reform in the pharmaceutical industry; it is the extent of government intervention required to precipitate that change which has now divided members within the Democratic party. Whether or not the purist “Medicare for All” for which Sanders advocates is a requirement to meet this end is unclear, given that other candidates such as South Bend Mayor Pete Buttigieg have released plans to tackle Big Pharma in a similar manner without mandating universal coverage or by working within the existing structure the Affordable Care Act (informally dubbed “Obamacare”). Regardless of the objective analyses, the final judge of which plan moves forward to the national election stage will be the voters heading to the ballots for the upcoming primaries. Fortunately for Sanders, the Bern is aflame in Iowa, New Hampshire, and most recently Nevada; provided his momentum continues into Super Tuesday, we may see his vision of a nationalized healthcare system rekindled.

Source for thumbnail image: Wikimedia Commons

Source for article image: The Progressive