A debate on whether the U.S. should adopt a single-payer healthcare system took place Tuesday evening, based on the American public divide over Sen. Bernie Sanders’ (D-Vt.) single payer healthcare platform of Medicare-For-All.
The debate, held by the Cornell Political Union, aimed to educate Cornellians on the complex healthcare systems in the country as the midterm election approaches, according to John Sullivan Baker ’20, CPU president.
Mark Webster, CEO of Cortland Regional Medical Center and guest speaker for the debate, began the event by offering his perspective on the challenges the U.S healthcare system faces and the prospect of a single payer system.
Sander’s Medicare-For-All system, as Webster argued, was not equivalent to universal healthcare in that universal healthcare meant “everyone must have coverage regardless of income” while single-payer was a system in which “the government will finance and operate the health care system.”
Any healthcare system inevitably has to choose among quality, access and cost, and only two of the options can be chosen, according to Webster. This creates a need to allocate resources efficiently.
Addressing the large portion of expenditure on care in patients’ final years in Medicare, Webster quipped that, “In Canada, people say death is inevitable. In the U.S., we behave like death is optional.”
Webster also contended that the U.S. should allocate more resources on “social determinants of health,” which include improving full education, job trainings, food and transportation, rather than spending more on medical care.
However, simply changing the policy won’t solve the problem of resource allocation, Webster said, as problems also exist in physicians’ practices because they “are paid more for doing procedures rather than diagnosis work.”
Consequently, population health is slow to improve as more people choose to perform procedures in a specialized field versus primary care.
Webster, from his own experience of running hospitals, suggested that the government is not the “architect” of the solution.
“All hospitals lost money on every Medicaid patient that walks through the door,” Webster recounted, “Medicare reimbursed 90 percent of the cost to care for patients and Medicaid covered about 75 percent. Consequently, commercial insurance pays extra to cover these shortfalls.”
According to Webster, the frustration was that physicians and hospitals could only be price-takers in admitting Medicaid and Medicare patients. Consequently, these patients have limited access as fewer physicians are willing to take patients from these public programs.
A single payer system does exist in the U.S. — the Veterans Affairs (VA) health system, which Webster said was not “a model being considered for expansion.”
The biggest challenge facing Medicare-For-All, according to Webster, is that it requires “substantial tax increases,” which could induce a political fallout.
If the government cannot find a way to finance the system, Webster said it would be like “building a boat in the basement,” meaning that it is nice to admire but void of practical value.
After Webster answered some questions, members of the Cornell Political Union debated whether the country should adopt a single-payer healthcare system. Topics in the debate ranged from exploring healthcare in different countries to the social responsibility of government.
Some argued that government control of healthcare would be detrimental to the economy and prevent America’s renowned pharmaceutical industry from continuing to innovate.
“There are a lot of things wrong with the system now,” said Jack Sillin ’22. “I think the example of VA [Veteran’s Affairs] is a great one because it highlights that we don’t do giant government programs well in America.”
On other side of the debate, many individuals criticized corporate America’s current role in the healthcare industry and referred to the healthcare systems in foreign countries as a proof of concept.
“Obviously, if you have more money, you’d pay the government more and receive better care … I think it’s more reasonable for everyone to be paying a standard rate,” said Evan Bostrom ’20, a proponent for single-payer healthcare.
A final vote tally to end the night counted that 33 to 24 opposed single-payer healthcare reform. However, people continued debating after the vote.
“When you form an opinion first, you will only look for information to reaffirm your point,” Webster concluded, “I encourage you guys to suspend judgement. Rather, be fact-finders and truth-tellers.”