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Bernie Sanders and Elizabeth Warren are great Americans, and they have correctly identified most of America's problems but have not identified practical solutions.
Their Medicare for All plan will become 'cannon fodder” for Republicans and will guarantee four more years of Trump. I agree with Sanders and Warren that Big Insurance and Big Pharma are major obstacles to affordable healthcare, but realize that Medicare for All is opposed by two-thirds of the current Congress.
Several reasons can explain Congress's opposition. First, America was built on and prospered from the concept of free enterprise which includes private insurance companies, so anything that 'smells” of socialism or communism, will be about as popular as a king was 250 years ago. Sanders and Warren did not learn from the failed 70-year experiment of the Soviet Union. Second, Americans are distrusting of often wasteful big government programs. A government run healthcare system will merely replace one bad system with another bad system. Finally, the idea of converting the current healthcare system to a government run program will be tied up in Congress for years, while citizens continues to suffer from overpriced healthcare or from no health insurance.
I acknowledged that Sanders and Warren are correct about Big Insurance and Big Pharma. However, this occurred because senators in Washington and the Supreme Court failed to control their excesses. Since the federal government has not managed to control Big Insurance, Big Pharma and Big Money, why should anyone believe they could control a government-run healthcare bureaucracy?
In Germany and other countries, healthcare costs are half that paid by Americans. In the German the system, everyone who is employed is required to purchase healthcare from their choice of more than 100 private insurance companies, the cost which cannot exceed 14.5 percent of their gross income, of which half is paid by their employer.
By limiting the cost to 14.5 percent and requiring employers to participate, government has control of insurance companies and employers. Since the cost is adjusted to the earnings of the employee, it makes healthcare affordable for all. The key ingredient is that the 14.5 percent is based on gross income, so wealthy senators like Sanders and others cannot avoid paying their share by claiming deductions that reduce their taxable income to zero, thus depriving the government of funds needed to any government program.
In Germany, everyone pays according to their ability but all receive the same service, and are free to choose their doctor, their clinic and their hospital. If you earn more than $60,000 Euros, you can opt to buy 'better insurance” and pay more than 14.5 percent. However the only real difference is the speed of service, not the quality. I am not promoting the German system, only using it as an example in which private insurance companies need not be removed from healthcare to assure universal coverage.
John Butler is emeritus professor at the Carver College of Medicine.