Inside the Long, Impossible Fight for Socialized Medicine in the US
Irene Aguilar knew for a long time that America’s healthcare system was broken. She had worked as a doctor in one of Colorado’s “safety net” hospitals, where the uninsured and seriously ill go for care. Some of her patients were there because they had lost insurance after being laid off, others lost insurance because they divorced a spouse whose job had been providing it. Who qualified for insurance-covered care could seem cruel and nonsensical. The “classic example,” she told me, were diabetics who wound up on dialysis because they couldn’t afford the medications that would let them manage their condition.
“Once you’re on dialysis, you automatically qualify for Medicare. I was furious that I had patients who had worked all their lives and they end up on dialysis and they can’t work anymore and we give them full coverage,” she said. “It seems so fiscally irresponsible that we didn’t help them control diseases and prevent high-cost complications that would lead to premature death—but once they had those complications we paid for them.”
But Aguilar didn’t understand the politics of healthcare fully until 2007, when she was invited to participate in a Colorado state commission studying healthcare reform. The mother of a disabled daughter, Aguilar was assigned to a subgroup focused on the problems facing “vulnerable populations.” Not used to that kind of committee work, she found the sheer amount of talking overwhelming, almost “painful,” she told me. But she’s proud of the conclusions her group reached: Since even the insured can lose health insurance due to unemployment, thrusting them into sudden crisis, everyone in America could accurately be described as “vulnerable.” The current system wasn’t just failing the sick and needy, it was failing, full stop.
The solution was pretty obvious to Aguilar and many of the people working alongside her: A “single-payer” system, also called “Medicare for all,” where the government provides health insurance to everyone and pays hospitals and doctors for services directly. Not only would that have made Colorado’s population at large less vulnerable to the whims of employers and the insurance market, it would have saved the state an estimated $1.4 billion by cutting down on the overhead and waste inherent in a system where for-profit insurance companies serve as middlemen.