First of all, we still have uninsured and underinsured people, millions. And it’s one of the reasons why we can’t be satisfied with where we are. The [Affordable Care Act] made a great difference. It made a big difference for members of my own family. But it hasn’t gotten us all the way there, and it’s vulnerable to being undermined. As a matter of fact, right now, it’s under attack by the current administration.
That’s why I believe we do need to move in the direction of a Medicare-for-all system. Now, I think anyone in politics who lets the words “Medicare-for-all” escape their lips also has a responsibility to explain how we could actually get there, because as you know, from working on this day in and day out, it’s not something you can just flip a switch and do.
In my view, the best way to do that is through what you might call a Medicare-for-all-who-want-it setup. In other words, you take some flavor of Medicare, you make it available on the exchange as a kind of public option, and you invite people to buy into it. So if people like me are right that that’s ultimately going to be more efficient over time and more cost-effective, then you will see that very naturally become a glide path.
But your question mentioned something else, right, which is even within Medicare, there are a lot of issues, delays, concerns about whether the rate setting and reimbursement is done in the right way, and so there's also some technical work we've got to do under the hood.
You know, we as a country pay out of our health-care dollar less on patient care and more on bureaucracy than almost any other country in the developed world. And so it’s very clear that we’ve got to do some unglamorous technical work. Actually, some of the benefits of automation could come in this sense. You think about how many hands have to touch a prior authorization sometimes. And the right answer to that should be zero, but we’re not there yet. So we’ve got to do that, that kind of unfashionable technical work within [the Centers for Medicare and Medicaid Services] to make the system more efficient.
We've also just got to broaden access to it until everyone has health care. I just refuse to accept that when citizens of just about every developed nation in the world enjoy this, that we should settle for less.
And it's become very personal for me, too, because we lost my father a few weeks ago. And it was to cancer. It was a brutally difficult time for our family. I make decisions for a living, and I was not prepared for some of the decisions that we faced in consultation with the medical team.
But what I’ll say is, the decisions that we made only had to be about what was medically right for Dad and what was right for our family. We didn’t have to think about whether our family would be financially ruined, because of Medicare. And I want that to be available, that kind of security, that kind of freedom, frankly, to be available to every American.