An interesting article today in Huffington Post by Steffie Woolhandler and David Himmelstein – both health policy scholars and co-founders of Physicians for a National Program – looks back at the history of Medicare for lessons about single payer today.
They make a few notable points in the piece, which is headlined “Medicare’s History Belies Claim That Medicare-for-All Would Disrupt Care.” First, they note that the implementation of Medicare was actually quite smooth. As they describe, cards were sent to the homes of all the elderly, and those who lived in more remote locations were contacted through various outreach programs; predicted doctors’ strikes never happened, and the health system wasn’t overloaded by the demands of new beneficiaries. Moreover, the process was relatively efficient: by their calculations, the rollout of the Obamacare “marketplaces” cost some seven times as much as the (inflation-adjusted) rollout of Medicare.
Second, they note that Medicare was “disruptive” in a good way: it helped undo the reign of Jim Crow medicine. As they note, the implementation of Medicare forced the segregation of Southern hospitals. At the same time, however, they rightly emphasize that de facto segregation continues today when patients with different insurance plans are treated separately. In contrast, “Medicare-for-All,” they write, “would give all Americans complete and equal coverage, completing the disruption of hospital segregation that Medicare began a half century ago.”
There is a broader point here, about the role of a true universal health care – without tiers and without financial barriers to care – in the fight against racial health inequalities. Despite all the research and discussion around the issue of “health disparities,” this issue gets insufficient attention. I discuss it in a lengthy review/essay about racial health inequality which will be published in the Los Angeles Review of Books sometime in the coming weeks.