The Covid-19 pandemic has exposed several areas of improvement for our healthcare system, with many hospitalized patients confused and concerned about whether or not their health insurance plan covers their treatment. The pandemic has led many to reiterate their belief that our healthcare system is fundamentally broken. Because healthcare is not available to every citizen as a human right in our country, politicians have been quick to speak about how our largely-capitalistic healthcare system fails amid a crisis. I had the honor of speaking with Dr. Donald Berwick about our nation’s healthcare system, and why he firmly believes that healthcare is a human right. In 2005, Dr. Berwick was appointed “Honorary Knight Commander of the British Empire” by Queen Elizabeth II for his work with Britain’s healthcare system. Nominated by President Obama in 2010, Dr. Berwick served as the Administrator of the Centers for Medicare and Medicaid Services (CMS) where he managed an over $800 billion budget and managed health insurance for over 100 million Americans. Most recently, Dr. Berwick worked with Senator Elizabeth Warren in crafting her healthcare plan during her 2020 presidential campaign. Dr. Berwick is one of our nation’s leaders on healthcare, and he made clear that “no healthcare system will truly work in America until we make the promise to guarantee every citizen health coverage.”
The debate on healthcare as a human right is incredibly divisive, yet many may not be aware of what healthcare could look like if we made it available to all Americans. When I asked Dr. Berwick to share why he believes healthcare is a human right, he began by saying that “as a compassionate society, we all realize that there are some things that we need to do together in order to protect each other and ourselves. That’s why we have firefighters, publicly funded roads, and public education for children. It’s better when we have equal access to some things, and that’s partly because each one of us individually cannot produce the service or item ourselves. Take clean air as an example. We need a social contract that says we will together produce clean air. We will make it a right for people so that when we breathe, we can feel safe. The same is true for healthcare. Most of the time, illnesses that we contract are not a result of things we chose. We may have engaged in behaviors that increase the risk of certain illnesses, but we don’t know who is going to fall sick next, and we can’t assume that everyone will have the ability to fund their own care.” Dr. Berwick’s point on the financial capability of most Americans is true, with over half of Americans having less than $1,000 in savings. The economic hardship experienced by millions of American families explains why medical expenses are tied to over 65% of all personal bankruptcies: most families simply don’t have a comfortable financial safety net if a family member falls ill.
I asked Dr. Berwick about his thoughts on those who say that we all have a personal responsibility to manage our own situations, to which Dr. Berwick replied by saying “Even if you only care about your own economic situation, you would still want healthcare available to everyone as a right because other people’s illnesses affect you. We can see that very clearly right now during this pandemic, but it’s also true for circumstances outside of this emergency. When people’s health deteriorates, total costs for society go up. And if we make healthcare a right, we can offer people an opportunity to stay healthy and have their diseases treated earlier so that problems such as heart attacks don’t arise later. Then, total costs for society would go down.”
In every developed country, healthcare is a human right… except the United States. When I asked Dr. Berwick about how our current capitalistic system would compare to a single-payer system, in which the government finances all care, he said that “The system we have now is a crazy quilt of different financing systems—numerous private insurance companies, government insurers, and even some state programs—the complexity of billing, payments, and record-keeping drives administrative costs way up.” Administrative costs in the U.S. are indeed absurd, with over $300 billion in administrative waste spent each year. That’s right–$300 billion. And don’t be fooled about where this money comes from… Dr. Berwick says that “every single nickel we spend on healthcare is coming out of the pockets of workers— there is no other source. The money is coming out of workers’ wages-as companies put money towards healthcare premiums instead of their employees’ wages… it’s coming out of the taxes they pay… and it’s coming out of their out-of-pocket expenses, which are steadily rising.” He followed this up with saying, “So, whenever we say we spend $300 billion on administrative costs, remember that every nickel is coming from workers. Instead, if we take a single-payer approach, you can take all the money we spend on healthcare—through employer contributions, tax contributions, out-of-pocket expenses—and create a healthcare system that costs far less than the one we have today. It’s simpler, more responsible, less wasteful, more proactive… and that lowers costs.”
A traditional Medicare-for-all plan would essentially dissolve very powerful private insurance companies. In one of my previous articles, I spoke with the former CEO of Blue Cross Blue Shield of North Carolina, Dr. Patrick Conway, who spoke on the idea of having a “Medicare-Advantage-For-All” plan. Medicare Advantage is a public-private partnership in which Medicare pays for a healthcare plan, which is administered through private insurance companies. It is considered by some to be the “middle ground” between upholding private insurance and embracing a single-payer healthcare plan. When I asked Dr. Berwick about whether he believes a Medicare-Advantage-For-All program would work well, he said that from what we have seen of the program so far, “it’s a mixed bag.” He continued by saying, “It’s still private insurance, and remember, those private companies are taking profits—the government is not taking a profit—and that’s added costs. So to me, Medicare Advantage does not seem like the most favorable way to tackle the challenge of getting everyone covered.”
Dr. Berwick began working in Washington D.C. just 4 months after the Affordable Care Act (Obamacare) passed in March of 2010, so I took this opportunity to ask him about an interesting discrepancy within the Republican Party in which many Republican voters who obtain health coverage through Obamacare also chant alongside President Trump’s promise to “Repeal and Replace” Obamacare. Dr. Berwick responded by saying that “President Trump has not come up with any effective alternative to the Affordable Care Act. During Trump’s tenure thus far, millions of Americans have already lost their health insurance… If voters think that taking the Affordable Care Act away is a good thing, then they have to explain how over 20 million Americans are going to get the care they need. What happens to prevention benefits? Obamacare expanded prevention benefits to everyone—not just Medicare and Medicaid beneficiaries—so do you want to say goodbye to that? I think that as people became more familiar with the Affordable Care Act, they started to see the benefits. The bill is not perfect, but it is a big step forward for our country”
It’s important to note that about half of us already receive healthcare through government-financed or government-provided care, such as Medicaid (70 million), Medicare (44 million), Tricare (10 million), Veterans Health Administration (9 million), and the Indian Health Service (2 million). As Dr. Berwick says, “The government is already involved in your care in ways that you like. Do you really want Medicare to disappear? Don’t you want to offer our military veterans a promise of receiving healthcare? Be skeptical about this idea that the government is inept or can’t help you.” Despite its drawbacks, a government-funded healthcare system would likely be cheaper and more compassionate. For our extraordinary expenditure on healthcare, we must ask ourselves how much value we are really receiving in return. As the debate continues, however, Dr. Berwick reminded me that “we are one country… and we must make important decisions on how willing we are to be united as one country” on vital issues such as providing healthcare to all Americans.