U.S. Senator Bernie Sanders brings his national tour against the Senate health care bill to Morgantown Sunday. At some point, the Vermont independent and former presidential candidate will likely say, “If you cut Medicaid by over $800 billion, there is no question but that thousands of Americans will die.”

It’s a money line that helps galvanize the opposition.  It puts the incredibly complicated system of healthcare delivery in this country into a simple life or death choice, a moral decision where one can only reasonably choose to preserve life.

Sanders, and others who make similar arguments, do have facts to back them up. For example, the 2009 study by the American Journal of Public Health concluded that “Lack of health insurance is associated with as many as 44,789 deaths per year in the United States.”  The study found that people without insurance still get care at places like community health clinics, but it’s not as good as the protections provided by private insurance.

But, as I said, healthcare is more complicated than that. Few among us would disagree with the statement that all Americans should have access to quality health care.  The question then becomes how to pay for it.

Consider our predicament in West Virginia. We’re a poor state and only half of the working age population actually has a job where employer insurance might be available.   Should everyone else be on Medicaid?  Is coverage under Medicaid as good as private insurance? Should people who are working and a little better off pay for their own insurance as well as everyone else’s coverage?

The insurance exchanges were created under Obamacare to give coverage options to those who don’t have employer insurance and don’t qualify for Medicaid, but they’re not working the way they were intended.  Young healthy people are opting out, and without them, the premiums and out-of-pocket costs are skyrocketing.  In some instances, people have insurance, but cannot afford to use it.

The exchanges would work a lot better if everyone who does not have coverage through another means had to participate. That would broaden the pool, spread the risk and lower the costs.  But remember the outcry when people thought Obamacare was forcing people to buy “government health insurance.”

Obamacare’s coverage of those with pre-existing conditions at an affordable rate is popular, and the only way to keep those costs down and avoid bankrupting really sick people is to have others help pay for it.  Here’s where the argument again is both moral and economic.  You have cancer and I don’t.  I’m willing to be in the pool that helps you pay for your healthcare if others will do the same if/when I get cancer.

A listener told me recently that argument made me a socialist.  I disagree.  Call me a capitalist who believes its smart to hedge his bets.

Inevitably, any debate about healthcare eventually gets to a single-payer system.  But remember that one-size fits all doesn’t actually fit all, at least not the same.

Medicare is a single-payer system, yet those who can afford it buy supplemental insurance to fill in the gaps.  And in the U.S., which already has a private/employer based insurance model, insurance companies are not going to disappear under a single-payer system; the survivors will pivot to provide boutique coverage and care for those who can afford it.

We would still have a two-tiered system, and one would undoubtedly be better than the other.  Studies would be done and politicians would glom on to the findings which, predictably, would say the inferior delivery system is associated with thousands of deaths per year.

 

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