Dear Mr. Berko: I strongly object to “Medicare for everyone.” Can you explain to me how it makes economic sense?
— C.L., Jonesboro, Akansas
Dear C.L.: “Medicare for all,” snappy shorthand for a single-payer health care system, may be a huge plank in the Democratic Party’s platform, and it’s not a fantasy for the 156 million Americans (about half the population) who get health insurance through their employers. Canada, France and Denmark have successful single-payer systems. Their taxes are higher, but they’re not charged premiums, co-pays or deductibles. They spend half as much on health care as we do and enjoy better medical outcomes.
In 2018, there were at least 125 health insurers in the United States and they took in almost a trillion dollars in premiums. The largest 25 health care insurers, such as United Health Care, WellPoint, Kaiser Foundation, Aetna and Humana, collected about $646 billion in premiums. And probably all of the 125 health insurers made a profit.
With 125 companies selling health insurance, that’s 125 CEOs, 125 presidents, 125 treasurers, 125 executive vice presidents, 125 vice presidents, 125 assistant vice presidents and each of these officers has a computer and each has a secretary who also has a computer. Each of these 125 companies has a legal staff, sales and marketing director, human resources department, payroll and accounting departments, and each of those departments has computers in every nook and cranny that are attached to a bigger office computer and stored in the cloud.
Now imagine the number of desks and chairs, wastebaskets, copy machines, desk equipment, stationery and coffee cups in constant use by 125 health insurers. A famous Aztec chef once said, “Too many cooks spoil the stew,” and this guy wasn’t kidding. Can you imagine the cost to pay 125 CEOs and all the other officers and directors? Can you imagine the cost to meet the 56,000-person payroll every two weeks at Anthem or the 41,000-person payroll at Centene or the 120,000 person payroll at Community Health, the 230,000 folks at HCA Healthcare and the 260,000 employees at United Health Care?