As the Republican-controlled federal government attempted to destroy the Affordable Care Act (ACA) this summer, Oregon’s government moved in the opposite direction. 

Instead of stripping hundreds of thousands of Oregonians of their health insurance, bipartisan legislation raised $600 million in revenues needed to trigger $5 billion in federal funds to shore up Medicaid and ensure that one million people continue to receive health coverage.  In addition, the state’s expanded coverage for reproductive services, including abortion, places it in the forefront of providing high-quality care for its citizens.  These actions, along with ACA subsidies for hundreds of thousands of privately insured Oregonians, represent important steps toward providing universal access to health care in our state.

But they are not enough.  Five percent of Oregonians still fail to qualify for coverage even under the ACA and, as even the ACA’s supporters concede, the system is riddled with problems.   Premiums continue to rise rapidly in some places, some rural areas lack a choice of providers, and many people remain underinsured.  In addition, out of pocket costs for many plans remain high, many small businesses have difficulty covering their employees, and costs for drugs and medical services continue to increase well beyond the inflation rate.

Many of these problems could be fixed if Republicans in Congress were willing to work with Democrats to address them, but even if they improved the ACA it would still leave the United States with the most expensive, wasteful, and inefficient health care system in the world.  According to the Organization for Economic Cooperation and Development, between 2011 and 2016 average annual health costs in the U. S. amounted to $8,900 per person.   In countries with comparable living standards, however, such as France, Germany, the United Kingdom, and Canada average outlays in that same period amounted to $4,400.  The result: the U.S. has $1.4 trillion in excess costs per year, costs that do nothing to improve health outcomes, but do ensure fat profits for private insurers, drug companies, and some health providers.

No other developed country tolerates such waste and almost all avoid it through some type of public provision of universal health insurance (Canada) or services (Britain).  In the U. S., however, despite the fact that government outlays for Medicare, Medicaid, Veterans’ Administration, public employees’ private plans, and tax subsidies for private insurance amount to 64% of all health spending, the system is dominated by the interests of private insurers, service providers, and drug companies, rather than the health needs of people.

The solution is simple: extend Medicare to all.  Due to the complexities of the current system, this is difficult for states to implement, but it would be relatively simple if done nationally.  If one combined all government outlays (Medicare, Medicaid, etc.) into one public insurance program and covered remaining costs with tax revenue, the U.S. could introduce single payer insurance for all.  With private insurers unnecessary, and profits, redundant bureaucracies, and advertising eliminated, costs would be sharply reduced.  Premiums, co-pays, and deductibles would be gone, the vast majority of U.S. households would save money, and all patients, rich and poor, could choose their own doctors.

Medicare for all is a realistic solution to one of our most serious problems. Achieving it is a matter of political will.  The current impasse in Washington will end, bringing new possibilities for change.  We hope that Oregonians will not “settle” for the ACA, but will organize and fight for a system that will bring high quality healthcare to all Americans.