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Could you possibly invent a more expensive and less effective healthcare system than what we have in the US?

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Robert Reich
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Healthcare is so expensive that many Americans put off seeing a doctor until their health has seriously deteriorated. Even with the Affordable Care Act, some 30 million Americans have no health insurance coverage at all.

Not only do too many dollars go to super-specialists and too few to preventive generalists, but the administrative costs involved in private for-profit insurance are humongous. About a third of what the typical American pays for health insurance goes to the people who oversee billing and collections. And then of course there are marketing and advertising expenses, and the profits that go to shareholders or private-equity managers.

Finally, if the pandemic taught us anything, it's that we need to decouple health insurance from employment. Losing a job shouldn't mean the loss of a family's lifeline to healthcare.

The Affordable Care Act was a good start at reform, but today I'm urging Congress*to replace private for-profit health insurance with Medicare for all. This would lead to far lower total costs - including premiums, co-payments, deductibles, and taxes - and it would cover all Americans. People could keep their same doctor or other health-care provider, and could buy private insurance to supplement it - just as some people now buy private insurance to supplement Medicare and Social Security. But as Medicare and Social Security have demonstrated, we shouldn't need to pay private for-profit insurers boatloads of money to get the insurance we need.

I have no illusions this will happen soon. But the road we're now on is unsustainable - economically, politically, and socially. Eventually, we're going to have some version of Medicare for All (and hats off to members of Congress who are leading the way, such as Representatives Pramila Jayapal, Debbie Dingel, and Ro Khanna). The question is how much unnecessary cost and hardship must we bear before we do?

* The hearing was well-attended by members, and the conversation was thoughtful and intelligent. A few Republicans got into their age-old "socialism" rant, but I quietly pointed out that Social Security and Medicare - both hugely popular with the public - were also criticized by Republicans as being "socialist" when first proposed.

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Robert Reich, former U.S. Secretary of Labor and Professor of Public Policy at the University of California at Berkeley, has a new film, "Inequality for All," to be released September 27. He blogs at www.robertreich.org.

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