In the last Democratic candidate debate, Biden claimed that single-payer healthcare didn’t help Italy fight the coronavirus. Health system expert Dr. James Kahn explains why he was wrong.
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This is a rush transcript and may contain errors. It will be updated.
Greg Wilpert: It’s the Real News Network. I’m Greg Wilpert in Arlington, Virginia. As the coronavirus continues to spread exponentially across the world and the United States, the question increasingly comes up whether the US healthcare system is equipped to deal with the crisis. This is an issue that took on a particularly significant role in the recent democratic presidential debate between Joe Biden and Bernie Sanders. Sanders argued that Medicare for all or single payer health care system, as it’s also known, would be a tremendous help in dealing with the pandemic. Biden, though, responded as follows.
Joe Biden: With all due respect to Medicare for all, you have a single payer system in Italy. It doesn’t work there. It has nothing to do with Medicare for all. That would not solve the problem at all. We can take care of that right now by making sure that no one has to pay for treatment, period, because of the crisis, no one has to pay for whatever drugs are needed, period, because of the crisis, no one has to pay for hospitalization because of the crisis, period. That is a national emergency, and that’s how it’s handled. It is not working in Italy right now, and they have a single payer system.
Greg Wilpert: During the debates, Sanders did not respond to Biden’s claim that Italy’s single payer system did not help stem the spread of the coronavirus. So just how useful would a single payer system be for coping with a pandemic such as the coronavirus? Joining me now to explore this question is Dr. Jim Kahn. He’s professor emeritus of health policy epidemiology and global health at the University of California San Francisco. Also, he is an expert on health system design. Thanks for joining us today, Dr. Kahn.
Jim Kahn: Happy to be here.
Greg Wilpert: So in what ways would Medicare for all help in a situation such as the coronavirus pandemic?
Jim Kahn: Well, a proper response to a looming pandemic involves several steps. Italy did not do sufficient testing, and that led to the epidemic being worse there. Also, their population is quite a bit older than other places, and that affected the severity of disease, but another critical piece of the response is to have a healthcare system that does not have any financial barriers to seeking care. Single payer Medicare for all would make sure everyone has insurance without any substantial cost sharing, and maybe none at all.
That would mean that when people get sick, they go to the doctor, and as appropriate, they get tested and may then self isolate to prevent infecting others. In addition, single payer offers really good data on what’s going on in the health system. Right now, today, our data systems are chaotic. Every provider has a different electronic health record, and the billing systems vary from one insurer to the next, and so you can’t collect data on clinical encounters and study it and learn from it. Under single payer, you’d basically have big data for health encounters, and that would be useful to guide the epidemic response. In fact, in Taiwan, which has a single payer system, they combine that with extensive testing and with use of the clinical data from these encounters for billing in order to have just about the best epidemic control or pandemic control that we’ve seen for coronavirus.
Greg Wilpert: Just quickly, in terms of, you mentioned cost sharing, now generally, it said that the United States has health insurance coverage for between 80 and 90% of the population. So in what way would this issue of cost sharing impact how the academic is being dealt with?
Jim Kahn: Well, first of all, there is the 10% or more who don’t have insurance at any point in time. So those people, of course, have huge financial barriers, but more importantly, of the people who are insured, about a third are underinsured, which means they have very high deductible, sometimes many thousands of dollars plus substantial copays and cost sharing, and there’s ample evidence that shows that people who are under-insured in that way are much less likely to go to the doctor and report frequent episodes of delaying or foregoing care because of financial barriers. So even a system that increased the percent of the population that’s insured but left people under-insured would not solve this problem.
Greg Wilpert: I just want to return to the question about Italy, that in Italy, Biden said that it didn’t work. Now you mentioned, of course, the problem with the lack of testing in Italy. So just briefly, in what ways might that not have happened or not have been an issue that it had single payer?
Jim Kahn: So I think there are three legs to the stool if you’re trying to have a strong pandemic response. One leg is having strong public health infrastructure, another leg is recognizing independent and taking action quickly, and the third leg is everyone having really good insurance so that they can see their doctor. So Italy failed in the relatively lax response to the second leg, that is they didn’t respond quickly enough, they didn’t implement widespread testing. Taiwan did, South Korea did a lot of testing and also did much better at controlling the pandemic.
Greg Wilpert: One of the main arguments that Biden has also against Medicare for all is that it’s not clear how it would be funded and that even if it is properly funded, it would raise taxes on the middle class and would generally be too expensive for the United States. Recently, Biden even said that he would veto a Medicare for all bill should it pass Congress while he is president. Now, we have a clip here from an interview that he conducted with MSNBC, with Lawrence O’Donnell.
Lawrence O’Donn…: Let’s assume, and I’ve asked other candidates this kind of question, veto question. Let’s flash forward, you’re president, Bernie Sanders is still active in the senate, he manages to get Medicare for all through the senate in some compromise version, the Elizabeth Warren version or other version, Nancy Pelosi gets a version of it through the house representatives. It comes to your desk. Do you veto it?
Joe Biden: I would veto anything that delays providing a security and the certainty of healthcare being available now. If they got that through by some miracle and there was an epiphany that occurred, and some miracle occurred that said, “Okay, it’s passed,” then you’ve got to look at the cost. I want to know, how did they find $35 trillion? What is that doing? Is it going to significantly raise taxes on the middle-class, which it will. What’s going to happen?
Greg Wilpert: What’s your response to Biden’s argument that Medicare for all would be too expensive?
Jim Kahn: Well, my response is our current system is too expensive. It’s wasteful. We spend about $600 billion per year in unnecessary paperwork because of the complexity of our insurance system. If we took that $600 billion a year and put it into care, then we could provide people the care they need without costing more. In fact, if you add up the savings from simpler paperwork plus negotiating more reasonable drug prices and other ways to decrease costs, the best estimates are that we would save on the order of eight to 10% or more. Let me be clear, what I’m saying is we would cover everyone with first dollar coverage, and at the same time, save about 10% of our healthcare costs. In my field, that’s called a dominant solution. It’s cheaper and it’s better. Why wouldn’t we want to do it?
Greg Wilpert: What about the issue or the question about whether individuals would end up having to pay too much? One of the points that Biden makes is also that it would raise the tax burden on the middle class. What’s your response to that argument?
Jim Kahn: Well, the role of taxes under single payer is to replace the premiums and out of pocket costs that families currently have to pay, and since Medicare for all would save money, perhaps 10%, you actually have some wiggle room there to put in taxes that are progressive, focused on people who earn a lot more money or who are extremely wealthy, while protecting the middle class and certainly protecting the lower middle class. So in general, people who are currently earning low and moderate amounts of money would save, because they would pay less for the premiums, and their taxes, if they go up at all, would go up a lot less.
Another important consideration is that wages have been stagnant for decades. Why is that? That’s because employers have had to pay a lot more for health insurance, and that comes out of wages. Without that obligation, we would see wages start to increase, and that would be a very important reversal of this bad trend of static wages.
Greg Wilpert: We’re going to leave it there for now. I was speaking to Dr. Jim Kahn, professor emiritus of health policy epidemiology and global health at the University of California San Francisco. Thanks again, Jim, for having joined us today.
Jim Kahn: My pleasure.
Greg Wilpert: Thank you for joining the Real News Network.
Gregory Wilpert is Managing Editor at TRNN. He is a German-American sociologist who earned a Ph.D. in sociology from Brandeis University in 1994. Between 2000 and 2008 he lived in Venezuela, where he first taught sociology at the Central University of Venezuela and then worked as a freelance journalist, writing on Venezuelan politics for a wide range of publications and also founded Venezuelanalysis.com, an English-langugage website about Venezuela. In 2007 he published the book, Changing Venezuela by Taking Power: The History and Policies of the Chavez Government (Verso Books). In 2014 he moved to Quito, Ecuador, to help launch teleSUR English. In early 2016 he began working for The Real News Network as host, researcher, and producer. Since September 2018 he has been working as Managing Editor at The Real News. Gregory's wife worked as a Venezuelan diplomat since 2008 and from January 2015 until October 2018 she was Venezuela's Ambassador to Ecuador.