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Sunday, January 12, 2020

Adding my two cents’ worth on Medicare for All

Managing expectations
By Will Collette

Image result for medicare for allPundits observe with dismay that there are splits with Democratic ranks on how to go about providing health care coverage to most, if not all, Americans.

I’m not dismayed at all – this is a big, complicated issue so you would expect vigorous debate and differing opinions. Besides, Democrats LIKE to argue and not just take their marching orders from Faux News.

We need to seriously work through the details (funding, scope of coverage, etc.) and that automatically leads to differing opinions.

Let’s start with a unifying goal. The idea that health care is a right, not an option, motivated Ted Kennedy to devote nearly his entire Senate career to push the envelope to get more Americans covered. He supported the “single-payer” approach used by nearly every western democracy (except the US, other than its adoption of Medicare in 1966).

The major Democratic contenders agree that we must find a way to ensure health care is a right for all Americans. The candidates are debating how to get there.

In my opinion, Medicare-for-All would probably be the quickest, most effective and perhaps cheapest way to extend basic medical care coverage to all Americans.

However, we need to confront the limitations of that approach. I suspect that many supporters of Medicare-for-all may not know how Medicare actually works. Let's start with two basic facts.

1. Medicare IS NOT free health care.

2. Medicare, as it currently exists, provides only limited basic health coverage.


If you are on Medicare, as I have been for five years and counting, you already paid for it throughout your working life through a payroll tax. 

You continue to pay for it through a Medicare monthly premium. My Medicare monthly premium goes up to $144.60 in 2020.

This is deducted directly from my Social Security check. If you are on Medicare but are not receiving Social Security, you must pay the premium directly.

You also have an annual deductible and co-payments.

Medicare does not cover dental, eye glasses or contacts, hearing aids or long-term care and more. Every year, you receive a manual that describes what is covered and what is not.

You are required to buy prescription coverage (Part D) separately. If you want dental, vision or long-term care coverage, you have to buy that separately too.

Because of these limitations and out of pocket costs, roughly 90% of Medicare patients have some form of supplemental coverage to fill the gaps in Medicare’s very basic coverage. 

Generally, people buy this coverage from private insurers though in some instances, you may have pension or union benefits that supplement Medicare, or Medicare may dovetail with Medicaid. Cathy and I have a union-subsidized Medicare supplement plan that costs us just under $400 a month.

That puts our monthly premiums for Medicare and Medicare supplement at around $700 a month. However, we still are not covered for dental, vision, long-term care, etc. though we could shell out more money to buy that coverage from private insurers. That is, if those insurers would accept a couple of 70+ geezers....

Unless there is a drastic overhaul and major expansion of Medicare benefits, there will still be a major market for private insurance.

Don’t get me wrong: Medicare-for-all would give millions of Americans more than what they have now. It WOULD make health care a basic right and that’s a good thing.

Elizabeth Warren’s plan acknowledges the need to expand Medicare's scope of coverage for the medical needs I described above, especially long-term care. She suggests that if you look at all the money we spend on things not currently covered by Medicare, there might just be enough to make Medicare-for-All good enough that you would not need to buy supplemental coverage.

Her plan's biggest problem is the total cost number is very scary - $20.5 TRILLION over TEN years ($2.05 trillion per year). Unless we’re talking about GOP tax cuts for the rich or military spending, we are generally unaccustomed to talking about numbers that large.

However, as it is, we currently spend $3.6 TRILLION (2018 figure) a year for health care in an unmanaged fashion that still leaves many people without the coverage they need. Not included in that cost figure are the many medically necessary things people do without because they can't pay, such as insulin, hearing aids, wheelchairs, up to date eye glasses and more.

Warren’s plan comes to $2.05 trillion per year. That's a projected savings of $1.5 TRILLION a year for coverage that is significantly better.

She wants to take the money we now spend and put it into a new kind of Medicare program that really does cover what we need.

That would be especially true if Medicare-For-All becomes a viable substitute for Medicaid, the medical coverage for low-income families and individuals. The cost of Medicaid alone is $600 billion (FY2018).

So despite the big scary number, it would improve benefits while eliminating deductibles and co-pays while costing about $1.5 TRILLION LESS each year.

Of course, getting ANY improved health care plan through Congress – even if we do well in sweeping out Republicans in the 2020 elections – will be a daunting challenge.

To win the political struggle ahead, we have to do better than just chant “Medicare-For-All.” We have to be able to show that it CAN work.

Even though I have not yet decided my ultimate choice in the Democratic primary, I appreciate the fact that Warren, alone among the contenders, has put out a plan in detail for how she wants to tackle the issue of health care. Before you decide, I suggest you READ THE PLAN, too.

And for you Bernie fans, he says he has a plan, too, which you can read HERE. It is far less detailed than Warren's.