Medicare for All: A Cure for Healthcare Injustice

Reflecting on the pestilence of injustice in our healthcare system, Dr. Martin Luther King Jr. remarked in 1966 that “of all the forms in inequality, injustice in healthcare is the most shocking and inhumane.” That remains true today.

The numbers tell a staggering story: Black women are more than three times as likely to die during childbirth than white women. Their babies are two-fold more likely to die before their first birthday. These startling statistics are but the tip of the iceberg of a cascading set of inequities that systematically rob Black Americans of long, healthy lives. They foretell deep differences in rates of obesity, diabetes, heart disease, and stroke, or whether or not someone might visit a doctor or get a colonoscopy. They also result in massive inequalities in overall life expectancy: Black Americans live an average of four fewer years than the national average lifespan. If Black America was its own country, it would have a lower life expectancy than Sri Lanka.

Our health system is sick and we need a comprehensive and powerful treatment to overcome this deadly inequality. I believe that treatment is Medicare for All — comprehensive health reform that would guarantee equal coverage for necessary health services, free of charge at the point of care, for every single American. Medicare for all is critical to rooting out the injustice of inequality that insinuates itself throughout the continuum of healthcare. That injustice starts with differences in access to engaged schools, pure air, clean water, healthy foods, and safe neighborhoods. Injustice sustains in the judgment of healthcare providers and the distrust that so many have of healthcare institutions. And it dictates the ability to get to a doctor’s office, pay for your care, and to trust in that access over time. Medicare-for-all is the only prescription that can work across all of these levels.

Let’s start with access to a doctor. Even after the implementation of the Affordable Care Act (ACA, also known as Obamacare) — a critical first step to tackling inequalities in health — one in five Black Americans still lack access to healthcare. Though the ACA certainly narrowed these critical gaps in coverage, Black Americans are still the most likely to fall through them. When I was health director for the City of Detroit, 85 percent of the residents I cared for were Black and half were insured because of the expansion of Medicaid—made possible by the ACA. That is the case in majority Black cities all over the state, including Flint—home to the tragic water crisis.

However, inequality persists because, under the ACA, not all healthcare is created equal. Too many know the pain of being rejected by a doctor because they don’t take Medicaid patients—and then being forced into long waiting lists just to a see a doctor who does. Many doctors don’t accept Medicaid because it doesn’t pay well and even if they do accept it, Medicaid patients are often stigmatized, at risk for worse treatment, or being dropped for patients whose insurance pays more.

Yet Medicaid expansion only covers so many. Left out are those who can’t access healthcare from an employer, but whose incomes were too high to be eligible for Medicaid and too low to afford insurance on the exchanges. Medicare for All would close these gaps.

Although I am a doctor, I chose to practice public health rather than medicine. Throughout my training, I watched how our multi-tiered health system puts VIPs on the top floor of the hospital, while failing low-income people of color. In fact, when I was a fourth year medical student, I pulled my application for residency after a homeless Black woman —Ms. G— received an incomplete assessment after she had fallen and hit her head. The physician who neglected to do a full assessment said Ms. G would be a “social admit” — meaning that though he hadn’t done a full assessment, he had already labeled her as a patient who didn’t require, or deserve, medical care. Ms. G would be admitted because of her social circumstances.

My senior physician and I got Ms. G admitted. We cared for her for two weeks to stabilize her blood pressure and blood sugar, and get her back on her HIV medications. After caring for her, I realized we need to do more to fix the system, not just to perpetuate its inequities and injustices. Under Medicare for All, Ms. G would have had the same insurance you or I might have — and it would have completely changed the care she received from the outset.

There’s also a structural benefit to Medicare for All. Under the current system, hospitals that rely on Medicaid patients — often those that predominantly serve communities of color in urban centers — aren’t as well reimbursed. Their quality of care suffers. In my hometown of Detroit, the Detroit Medical Center — now owned by a for-profit hospital chain — failed a federal inspection because they hadn’t inspected infections that might have been caused by surgical instruments that weren’t properly washed. Beyond disturbing, such neglectful practices can be fatal.

Medicare for All solves this problem by offering high quality healthcare to everyone. It will open more clinic doors to Black patients, move more doctors into predominantly Black communities, and stabilize hospitals that are already serving them. Although we’ve got a lot more work to do to cure the persistent racism that shades treatment decisions and corrupts clinical outcomes for Black patients, Medicare for All creates the platform on which to do it by ending discrimination in health insurance.

But there must be hope if we are going to achieve health equity. Dr. Nadine Burke Harris, California’s Surgeon General, is a pioneer in understanding how early childhood trauma can set the stage for poor health across the life span. She reminds us: “This is treatable. This is beatable… We are the movement.”

Key to this will be making investments in public health and preventive care, investments in peoples’ lives and the places they live, learn, work, pray, and play that shape health well before we get to a clinic or hospital. Public health and preventive care is about the investments we make in our communities, our environments, and our bodies to keep us healthy before we ever get sick — investments that are less likely to be made in poorer communities of color. For example, Detroiters face three times the asthma hospitalization rates as the rest of the state. Standing up to polluters, investing in public parks, and putting up air quality monitors keeps people healthy and out of the hospital in the first place. Rather than wait until a child has to be hospitalized for an asthma flair, why not invest in keeping it from happening in the first place?

But right now, these investments aren’t made because they don’t make financial sense for the for-profit insurance companies that dominate healthcare. If they invest in long-term health, they don’t usually see the rewards. Instead, because people change health insurance companies so often, ultimately ending up on Medicare after they turn 65, any investment in prevention usually accrues to another company or Medicare.

This is where Medicare for All comes in. Under Medicare for All, the government effectively works as our insurance company from cradle to grave, allowing all of the investments in public health and prevention to accrue back to them over time. That changes the incentives for investing more into public health and prevention, rather than just cure. These investments will be critical to protecting communities of color from environmental ills that disproportionately prey upon them. Reallocating such resources into preventative investments or public health systems demonstrates a commitment to the nation’s overall health. It follows Dr. Nadine Burke Harris’s admonition and answers Dr. King’s call for healthcare justice.

Yet opponents keep pointing to the costs. Terry McAuliffe, former Virginia governor and a potential candidate for President said after being asked about Medicare for All: “It's unrealistic in terms of how we pay for it today.” That’s shortsighted and simplistic; what is really too expensive is healthcare as we pay for it now. Americans spend more on healthcare than any other country in the world, accounting for nearly $1 in every $5 spent in the whole economy. In contrast, countries with universal healthcare systems spend nearly half as much per capita. Instead, our government spent $24 trillion on the folly of the Iraq War, and the American taxpayer pays for nearly half of the entire world’s military expenditures. Furthermore, the US government gives billions to corporations in tax breaks and subsidies every year.

Although it may seem counterintuitive, Medicare for All is actually critical to the long-term sustainability of Medicare as we know it. Along with a few select groups, such as those with disabilities, Medicare mostly covers Americans after they turn 65 when our health generally starts to worsen. As health declines, health costs increase. If Medicare were to extend to everyone, not only could we invest in prevention that reduces costs, but the program would extend to covering younger, healthier people. Rather than dispensing their healthcare dollars into the profits of private, for-profit insurers, these younger, healthier populations would contribute more into the Medicare pot than they take out. That would certainly improve Medicare’s sustainability.

We can afford Medicare for All. But what we truly cannot afford are persistent, gaping inequalities in health, the residue of a pestilence of injustice that has, until now, persisted without antidote. It’s time for Medicare for All.

About the Author

Abdul El-Sayed is a physician, epidemiologist, public health expert, and progressive activist. He ran for Governor of Michigan in 2018 on an unapologetically progressive platform, advocating for universal healthcare, clean water for all, debt-free and tuition-free higher education, a pathway to 100% renewable energy, and to rebuild the barrier between corporations and government. He has authored over 100 peer-reviewed articles, book chapters, and abstracts in public health, with expertise in health disparities and complexity science in public health. His co-edited textbook Systems Science & Population Health, was published by Oxford University Press.