In a recent letter, Rockingham County Commissioner Kevin St. James attacked the idea behind the “Medicare for All” concept that has become one of the important proposals of the 2020 presidential campaign. Mr. St. James appears to be convinced that the current Medicare system is sufficient, and calls a Medicare buy-in option anything but “moderate”.

We would suggest a different view. We believe greater access to healthcare will ultimately save money. With an expanded healthcare program, savings could be realized as more Americans receive coverage for preventative medicine, mental health treatment for the opioid crisis, lower drug costs, coverage for pre-existing conditions and a stop to bankruptcy attributed to healthcare debt.

The particular path to getting there remains an open question. Medicare does seem like a good model; it provides good healthcare coverage, everyone knows how it works, and it has less than 3% overhead costs (compared to 20% or more for private insurers). We would hope Mr. St. James would agree with us, that expanding healthcare coverage would benefit all of us, including residents of Rockingham County.

We are not advocating for free healthcare. In fact, healthcare does cost quite a bit, but other countries (e.g. Germany and France) have been providing 100% of their residents with high quality healthcare for decades at less than ½ of the cost per person compared to the US.

So, how do these countries do it? First of all, they insist that everyone must have healthcare. Healthcare is either provided through employment or by law. They also insist that everyone must be part of the system and pay a fair share of their income for health insurance. In Germany the employee payroll deduction is 7%, and the employer must match this contribution. These countries also regulate the healthcare and pharmaceutical industries like a utility. They view these businesses as essential to the well-being of their residents, as important as water or electricity.

We are not only speaking theoretically. In fact, one of us lived with their family in Germany for approx. 17 years. During that time healthcare insurance was first provided as a minor from the parent, later coverage was provided through student insurance, and then coverage changed as part of employment. Finally, when the family included 2 adults and 2 children the healthcare coverage was included as part of the status of employment by the 2 adults. During the entire period in Germany, we received excellent care and were more than willing to pay 7% of our salaries for peace of mind and good health. When a brief period of unemployment occurred, healthcare coverage continued under unemployment insurance, and if we had retired in Germany, healthcare insurance would have continued under the Germany Social Security system, including long-term care. In most countries, unlike in the US, people do not file for bankruptcy because of overwhelming medical bills.

While some countries such as Britain and Canada have healthcare systems which have significant government involvement, the German and French models use a hybrid mix between free enterprise and government regulation to achieve their healthcare goals. What is very clear here in the US is that our current patchwork of healthcare is not financially stable or sustainable and leaves many residents with inferior or even no healthcare.

The number of people with health insurance did rise sharply in 2013, which coincided with the expansion of eligibility for Medicaid in many states under the Affordable Care Act. However, even with this positive outcome, healthcare costs for the average American remains high at $10,739. per person. Our country can do better than this by recognizing that affordable healthcare for all will save everyone money (e.g. not only in direct healthcare costs, but also by making other healthcare insurance for home and auto unnecessary) and will also produce better health outcomes.

That is why we call on Mr. St. James to join us in the effort to ensure that everyone is protected by affordable and high-quality healthcare.


Rep. Liz McConnell represents Rockingham County District 11 and lives in Brentwood. Rep. Peter Somssich represents Rockingham County District 27 and lives in Portsmouth. Both are Democrats.