To the letter writers embracing the idea of Medicare for All: Don't be under the illusion that Medicare for All would look like health care delivery today ("Not so fast to trash universal care," Oct. 29).
The single-payer program is, properly administered, the most economical and very well could have the best overall outcomes for a population. However, delivery of that health care would not resemble today's experience, especially with elimination of deductibles and copays. Although private insurance is very expensive, it provides the dollars that allow us the almost luxurious experience we encounter in hospitals and clinics these days. Hospitals and clinics would not exist as they are now solely on a Medicare reimbursement schedule. To survive, many conveniences and amenities would go by the wayside, and most rural hospitals would not survive. Strict formulary restrictions would apply, much like the current Veterans Affairs program. Treatment choices would be based more on a "one size fits all" philosophy. Eliminating copays and deductibles would cause unlimited demand for services, with resultant long waits and artificial bureaucratic barriers.
I actually think that the single-payer system would best serve us, if done in a thoughtful way. I think it would need a private option and copays. It would probably not be as nice for people who can afford the better current plans, and it would increase our taxes a lot, but would keep down or eliminate premiums, release employers from having to provide coverage, and be a fairer system for all. We also need to keep in mind that lifestyle is more important than health care systems in regards to health and longevity.
Current conversations about Medicare for All need to include the details and understanding of what that means.
David Brockway, Hopkins
The writer is a retired physician.
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Rahm Emanuel and other critics of Medicare for All frequently cite anticipated "disastrously unpopular tax increase on the middle class" ("Let's admit that Medicare for All is just a pipe dream," Opinion Exchange, Oct. 29). This is not necessarily true. Or, at least, the concern is grossly overstated. Medicare for All naysayers fail or refuse to take into account the amount of taxpayer dollars currently funding health care. A study published in the peer-reviewed American Journal of Public Health analyzed health care spending data and determined that approximately two-thirds of all health spending in the U.S. is directly or indirectly paid for with tax dollars. Nearly every federal, state and local tax we already pay is used in large part to fund health care expenses for a wide variety of individuals and groups. This includes elected officials and other public servants such as Emanuel.
However, tax dollars that pay for health care are split up between a convoluted patchwork of constituencies, agencies, programs, etc. This administrative inefficiency is a huge contributor to the excessive cost of health care in the United States. Further, our tax dollars are frequently handed over to private insurance middlemen who receive multimillion-dollar annual compensation packages creating an inordinately expensive additional, but unnecessary, layer of bureaucratic waste.
In calculating the cost of Medicare for All, it is time for Emanuel and other critics to account for the gain that a universal, single risk pool of all Americans would experience from efficiently redirecting taxes we already pay.
Glen Peterson, Mankato, Minn.
PREGNANCY DISCRIMINATION
It's real, and it happened to many of us
Being retired for 20 years, I was surprised to read that pregnancy discrimination is still with us ("There's a 'motherhood penalty' in the workplace," editorial, Oct. 29).
At my first employment 70 years ago with a large insurance company, a rule was in place for women (the women were workers, men were department heads and bosses). When you married, for every year you had been employed there, you were allowed to work one month into your marriage. That was canceled several years later because of a shortage of employees. They revised the "marriage" rule to the "pregnancy" rule — one month more of work per year there.
Pregnancy discrimination was still in place 20 years later with Sen. Elizabeth Warren's firing from teaching. Some conservatives say that didn't happen.
We know it did. We must work hard and keep listening to eradicate sexism in all forms.
Carol Dawidowicz, Brooklyn Center
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