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Two Reasons Medicare-For-All Might be a Foregone Conclusion in the US

For as long as anyone can remember (the early 20th century, to be precise) the American system of healthcare has been something of a work-in-progress. It began with hospitals offering pre-paid care plans to individuals, followed by collectives like the Blue Cross organizations, ending up in the private insurance system we know today. All along, there's been fierce debate over who, exactly, should foot the bill for all of it.

The bill's not small, either, coming in at about $3.5 trillion per year. The latest form of this long-running debate is now playing out in the political arena, with partisans on both sides arguing their vision for how to fix what is undoubtedly an inefficient, somewhat unbalanced system. The Republicans in the House of Representatives have released a plan that would, in effect, move the system back toward individual health coverage purchases. On the Democrat side, most 2020 presidential hopefuls argue that some form of a single-payer system is the only way to go.

All the while, however, some 79 million Americans are busy dealing with some form of medical debt, with many forced to find alternative medical financing to pay for what their insurance won't cover. It's a problem that's begging for a solution, and there's plenty of reasons to believe that the situation is about to get worse – forcing a reckoning for those charged with figuring out what to do with the system.

The first major shift is demographic. It's that the Baby Boomers, the largest US generation on record, are now reaching retirement age. That means that by 2030, there will be about 70 million US adults aged 66 or older, all requiring advanced health services that the current system can't hope to provide at reasonable costs without some major changes.

That particular shift may have more to do with the direction US healthcare policy takes than any other. The reason is obvious: it would mean that a full fifth of America's population would be eligible for (and likely participating in) Medicare. In one fell swoop, the aging of the population would move us closer to a complete single-payer system than any legislative effort has so far managed.

And there's data that suggests the younger people outside of the current Medicare system may no longer fit into the employer-provided healthcare model that some people are fighting so hard to preserve. That's because a growing percentage of the workforce now reports that they freelance – and that number is growing. The trend seems to indicate that by 2027, the portion of the US workforce that freelances will be over 50%, which would fundamentally alter the group insurance buying power that big employers now exert on the insurance market.

It's an issue that's already affecting big parts of the economy. According to the experts at, currency traders and other independent financial professionals are already seeing unsustainable increases in their healthcare costs. That's significant since workers in the financial sector tend to be concentrated at the higher end of the wage spectrum.

At the other end of the spectrum, though, things are even more unstable. Gig economy workers from Uber, Postmates, and others now rely on a patchwork of healthcare startups for their coverage – if they can afford coverage in the first place. And the odds of that aren't good, with research indicating that workers in the gig economy are far less financially stable than their full-time working counterparts.

If you take those two big realities into account, it seems almost inevitable that the US will end up with some form of the single-payer healthcare system within the next decade. First, because Medicare will need to expand to accommodate aging Baby Boomers and making that financially viable may only be possible by allowing an influx of younger, healthier people to buy into the system. And second, because it looks like the market for employer-sponsored healthcare is shrinking before our very eyes, which will drive up costs for those still participating in the private healthcare insurance system.

That leaves only one real question, which is the one nobody – on either side of the debate – seems willing to answer. Will the US find the political will to create a true, universal healthcare system while the setup we have is still functional, or will we wait until the two realities mentioned here take the decision out of our hands? Only time, it seems, will tell – and the clock is ticking louder with each passing day.

This article does not necessarily reflect the opinions of the editors or management of EconoTimes.

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