What is Medicare-for-all?

The level of industry opposition is a measure of its import…

By Jack E. Lohman

Current Political Reality

So valuable and effective (for the public) was the Medicare-for-all (single payer) option that Sen. Baucus and his corrupt colleagues refused to put it on the table. They knew it would pass hands down, and that’s the last thing their insurance funders wanted.

So Congress (and Obama) rolled over to the industry. The industry’s “public posture,” is to oppose any reform to give cover when Baucus and others vote for it … a massive, well-scripted charade to allow $46 million in campaign contributions to work to the max. (Pun intended)

Importantly, anything the insurance companies get is bad for the public. This industry should be eliminated from health care, not expanded as planned.

This is about money. Always has been, always will be. The insurance industry has contributed millions of dollars in the past and will continue sending money in the future…

… that is,  IF  they are left in the loop. Politicians care not about the past contributions, but  they do of the future hundreds of millions of dollars that will most assuredly be given.

That’s why single payer was never put on the table: Medicare cannot contribute cash dollars, private industry can.

This country … our politicians … our esteemed national Board of Directors … must quit trying to satisfy ANYBODY other than the needs of this nation!  Fixing the economy starts with healthcare, and if we don’t fix that correctly, the rest of the fixes will fail.

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What is Medicare-for-all?

It’s what we’ve all been calling a “single-payer system.”  That single payer is the taxpayer, as opposed to the 1500 insurance payers across the nation.

Very simply, with Medicare, you get sick, you get care, and the caregiver gets paid.  It’s just paid for with taxpayer dollars rather than employer premiums. It is part of our national infrastructure.

And if you want cosmetic or other non-essential care not covered by the system, you buy it directly, the old-fashioned free-market way, with cash dollars. Otherwise all essential care is provided. Nobody is without. Nobody dies because they have had to forego doctor appointments.

Sounds simple, why the big fight?

Because there are billions of dollars in insurance industry profits at stake, and they have bought off the politicians to ensure that those profits remain. Over $100 million dollars in campaign contributions pass hands from insurance, pharmaceutical and hospital interests to the politicians calling the shots. They don’t want to lose their profits in the future, but worse, your politicians also don’t want to  lose the contributions next year or in the years that follow.

That your politician is taking money from industry to tweak the laws so money transfers from your wallet to theirs is another issue the voters must soon resolve. With campaign reform we’d not be fighting this today.

But I don’t want to change doctors

You don’t have to. You use the same doctors and hospitals that you use today. They just send their bills to Medicare instead of the private insurer. We use the same payment system that has existed for 50 years. Nothing new is added, except patients. No new government departments, as the new reforms require.

How will this be paid for?

Through our national infrastructure (taxes) rather than the myriad of ways we pay today. There is no simpler or more efficient way.  Part of what makes it cheaper is that it’s a pool of 300 million people rather than a pool of 100 or 1000 (depending on the size of your company), or one, if you pay your own or are uninsured. Another reason is that it eliminates the insurance make-work system.

The taxpayers pay? Isn’t that bad?

The taxpayers already are paying, but in a very roundabout and highly inefficient and more costly way.

At the very least we pay when employers add their health costs to the price of their product and we reimburse them at the cash register. But we also pay when their $40,000 executive packages are written off their taxes, and when uninsured people show up at ERs and the costs are shifted to everybody else, and when bankruptcies and foreclosure costs are passed on to the public, and so forth. We are all — 100% of us — paying horrendously for a very inefficient system, but one that is very profitable to the insurance industry.

But isn’t that “socialized medicine?”

Not really, but it is socialized insurance if you have to give it a name. Yes, pure capitalism is preferred for non-essential consumer products, but essential life-saving services (medical, fire, police) should be made available to all, bypassing the whims of for-profit CEOs and their shareholders.

What’s wrong with the current method of using insurance companies?

A lot. It adds significant and unnecessary inefficiency, virtually all wasted dollars. Insurance company premiums include their medical expenditures, which we all know and respect. But then they must add their administrative costs (billing personnel, which can be cut but not eliminated) and overhead:

* High CEO salaries and bonuses and stock options
* High shareholder profits
* Broker commissions
* Marketing and advertising costs
* Actuarial costs (cherry picking)
* Denial of care costs (nurse gatekeepers)
* Rescission costs (canceling policies retroactively)
* Political costs (lobbying and campaign contributions)

All of which are in the private system, none of which are in Medicare.  Importantly, Medicare-for-all changes only who writes the checks, not how it is provided.

And incidentally, isn’t it nice to know that your politicians are getting a piece of every healthcare dollar, today and in the future?

Does Medicare-for-all increase my costs?

Not the way it is currently designed, but in any case you’d pay for it differently. You’ll be paying through taxes rather than all of the ways outlined above. But some people object because the wealthy will pay more, the middle incomers little if at all, and low-wagers nothing. That’s our progressive tax system which high income folks hate.

So how does it better serve the public?

Actually, for the same amount of dollars we are spending today (16.5% of GDP) we would provide first-class Cheney-care to 100% of our population. Including those in  class=”hiddenSpellError” pre=”in “>BadgerCare, SCHIP, Medicaid, and those who are uninsured and under-insured.

How can it be the same cost (or less) if it does more?

We’d direct the savings on waste (the 31%) on covering the new people added to the system. But be aware that there are also inefficiencies with Medicare that need to be addressed, like malpractice reform, overuse, abuse and fraud. However, these same inefficiencies exist in the private system as well, and usually to a greater degree.

What is Medicare Advantage

Medicare patients have the option to either keep the traditional Medicare or join a “private” version of Medicare, called “Advantage.” But ironically, the private plan costs taxpayers 17% more, so there is no real “advantage.” So much for private being more efficient than public, eh?

But there are sometimes additional services covered, and some advantage patients like that. But my mother dropped her Advantage plan because it didn’t cover some things she needed. You know, that “denial of care” issue. 

You can make your own decisions after reviewing these stories:

— States Look to Rein In Private Medicare Plans 

— Private Medicare Plans’ Cost Questioned 

Medicare Audits Show Problems in Private Plans

What’s the difference between Medicare-for-all and a public option?

Medicare-for-all is funded by the national infrastructure (taxes) rather than by the patient (either directly or through the employer). Or at least that’s what we think now, but the public option is still up in the air. It likely will be weakened by the insurance industry – so that it does not truly compete – by making it applicable only to low income people and not to employers and people who truly want to opt in.

The “public option” is a political posture, not real reform. And it’s interesting that politicians who otherwise like “choice,” don’t want to give this choice when it truly competes with the moneyed industry.

So what’s this “trigger” thing?

It’s giving the insurance industry “one more chance.” Like, if we extend this current mish-mash by three years and you don’t fix it, THEN we’ll get tough and implement a public option (LOL). It’s a political way of letting the public think congress is doing something when they’ve just extended the rip-off another three years.

To what extent will this affect businesses and American jobs?

Certainly extending care to 100% of our population is valuable, but the positive effects on the business climate and economy are rather significant. Health care represents 15% of wages, and eliminating that cost would allow companies to better compete with foreign product and keep jobs in the US rather than outsourcing them.

For example, more Big Three autos are currently made in Canada than in the US because employers there spend $800 per employee per year versus $6500 here. Thus GM is closing plants in the US and opening them in Canada, and that’s just one company out of the thousands outsourcing. Medicare-for-all would be this country’s wisest bailout ever, for 100% of businesses and not just the bankers.

Taiwan adopted Medicare for 100% of their citizens and are running with an unemployment level of 2.5%.

What’s stopping us from fixing the system?

We have a basic problem with political corruption, and here it’s a matter of who can send the most money to the politicians. In this case the insurance industry has clobbered the non-insurance businesses. Unfortunately, the insurers are also part of the business coalitions (chambers of commerce et al), and they seem to have pulled the wool over their heads as well.

But the bigger problem is political corruption. While we re-elected new congressional leadership we did not replace the special interests that corrupt them and the insurance industry is now controlling the new politicians as they did the old. Nothing will change until we get solid campaign finance reform, and that will not only fuel good health reform but also curtail government spending and taxes.

What are some other ways we can make our system more efficient?

Most certainly Medicare-for-all will reduce the burden on emergency rooms if people now have their own physician, but we should open more rapid-clinics in shopping centers and mega-stores, initiate medical malpractice courts, and reinstitute the Certificate of Need program in the states to control over-building and excessive purchases. But as well, we must move lower level medical care – like treating colds and minor stitches – to credentialed nurse practitioners, physician assistants, and pharmacists.

Would Medicare-for-all fairly compensate healthcare providers?

Yes, Medicare sets the level of reimbursement for each test, but it is fair. And if it weren’t fair or my doctor was losing money on me, he wouldn’t be bugging me to come in for my yearly checkup (as he does). In fact he wouldn’t be accepting Medicare at all, because he has that option.

The fees are based on reasonable salaries, technology costs and overhead. They don’t overpay, though with our current system over-billing can occur (in both the public and private systems). But if doctors were losing money, over-billing would not occur! You cannot make up losses with volume; you can only go further into the hole.

But won’t physicians lose money on Medicare-for-all?

No, they’ll no longer have to provide charity care and absorb bankruptcy losses, all of which are currently cost-shifted to private insurance premiums. Their high charges to the privates are to offset charity-care losses, not Medicare losses (because there are none). That doesn’t mean to say that Medicare rates could not stand increasing, which they can. But right now getting the known waste out of the system is the most prudent place to start.

How do physicians feel about a single-payer Medicare-for-all system?

A single-payer system is supported by 59% of our physicians and a greater number of nurses. Only those currently gaming the system oppose fixing it.

Yes, there are some physicians who don’t take Medicare patients now because they’ve grown their practices and don’t have to settle for “fair.” The privates often overpay, sometimes tremendously, but those high-profit days are coming to an end. These physicians will join Medicare when it is the only system available, and they’ll survive quite well.

Will Medicare-for-all bankrupt us?

No, but the current system will.  In their quest to satisfy the pharmaceutical industry, politicians passed in 2003 a Medicare bill that gives the industry $780 billion over the next decade, all while preventing Medicare from negotiating for lower drug prices. The VA system saves 50% on drugs, but Medicare is not allowed to negotiate. These same politicians are now claiming “Medicare is going broke.”

Yes, the most efficient drug distribution system is — get this — drug stores!  And at a fraction of the cost!!!  The doctor would write a prescription, the patient would pay a deductible, and the drug store would bill Medicare the balance. Nothing could be simpler. Nothing could be more cost-efficient. But no “drug plan” is needed, and no insurance industry is needed to fund it.

But what about overall costs?

Multiple studies have been run by non-profit organizations on the efficiency of Medicare-for-all (for example see the “Medicare for All (Single-Payer) Reform Would Be Major Stimulus for Economy with 2.6 Million New Jobs, $317 Billion in Business Revenue, $100 Billion in Wages.”  And I suspect even the Lewin group has looked at it, but being a subsidiary of UnitedHealth would make it difficult to publish the results.

How about health Savings Accounts (HSAs)?

“HSAs coupled with high-deductible health plans increase cost-consciousness among enrollees, but have little effect on overall health care costs.” The Bell Policy Center

A RAND Corp. study demonstrated that when hypertensive patients had to pay part of the bill, they had a 10% higher death rate. Certainly if people die earlier we will reduce our health care costs, but that sounds too much like a Philip Morris study I once read.

Even partial payment by the patient can be counter-productive, like co-pays, which usually cost more than they save. It was shown in a Kaiser Family Foundation study that mothers in low-income families will too often forego their blood pressure medicine to put food on the table, and then they have a stroke or heart attack or, worse, die. This sounds neither compassionate nor conservative.

Yes, for the young and indestructible they can increase personal savings, as they allow people to opt out of contributing to the healthcare system of the nation. But don’t get sick and then seek a real policy, as it likely won’t be available to you.

But I don’t want the government standing between me and the doctor!

That doesn’t happen with Medicare today, or we wouldn’t have 59% physician support. But it does happen when it affects CEO salaries and bonuses and shareholder profits, and the CEOs do indeed intervene and deny care. Even after you’ve paid your premiums. Remember the 17-year-old California girl who died because she was denied a kidney transplant, even after multiple doctor pleadings? That was Cigna, not Medicare.

More importantly, that was Cigna CEOs, not Medicare politicians.

What will happen if we don’t pass Medicare-for-all?

Nobody is looking at where we’ll be in ten years if we don’t fix the system. Corporations like Kohl’s, QuadMed and Motorola have already started to provide their own self-funded on-premises medical services. That means the for-profit CEOs will eventually be calling the shots rather than your doctor. Some will be very good and some very bad.

Some employers have formed co-operative health care systems where for-profit CEOs are again calling the shots over your doctor. If the CEO doesn’t believe in contraceptives or stem cell research, well, tough.

This is not a pretty picture. Doctors will hate it, nurses will hate it, hospitals will hate it, and eventually even the employers and the insurance industry will hate it.

But worse than all of that, employers will still pick up the tab, though it has been reduced but is still there (remember the 15% of wages?).

But, but… Medicare is not “free market!”

Thankfully it’s not. Indeed there are free market types who don’t want the government involved in anything. It is socialized medicine, don’cha know? And the insurance industry loves it, and even funds the Tea Party protests.

But these are the same guys who supported the capitalistic, free market banking and credit industry and are now accepting a government bailout. You know, socialized banking for losses but privatized banking for profits. That is – and read this carefully – shareholders reaping the profits and taxpayers getting stuck with the losses.

What about competition in health care?

Importantly, there is no such thing as a free market in health care. Never has been and never will be. Rarely will patients or parents send their children to the cheapest doctor or hospital. They will always be viewed as cutting corners to keep costs down, and the reverse will occur as patients and parents seek the best in care (the most expensive) and drive costs up rather than down.

Profits have a place in non-essential consumer products, but not in essential life-saving humanitarian services.

Besides, if insurers ever have to cut costs to compete, you can be sure that they won’t reduce executive salaries and profits. They’ll cut payments for tests and services, thus affecting incomes for doctors and nurses.

But look at Canada

Of course we can point to the wait times in the Canadian system, and that looks bad for single-payer systems. And the insurance industry loves to inflate their weaknesses to scare the people in the US, and the industry is fighting fixes in Canada just as they are in the US.

But that’s Canada and not the United States. Canada’s problem is that they spend only 10% of GDP compared to our 16.5%. If they increased their health care spending by just 10%, to 11% of GDP, they’d not have wait times either.

Alternatively they could eliminate 1/6th of their population from the system, as we do here, and they’d not have wait times either.

Most Canadians want more of their taxes spent on health care, but the insurance interests in Canada are lobbying parliament to reduce spending even further to force patients into their more profitable privatized system.

But even still, 86% of Canadians prefer their system to ours!

The US insurance industry has been spewing pure garbage about the Canadian and UK systems. Those systems are clearly not perfect, but they are very acceptable to their people. Here are a number of articles that will support those contentions.

But more important than that…

We are not proposing a Canadian or UK system. We are proposing an American Medicare system that is properly funded to replace all of our inefficient private and public systems. But we’ll let the hot shot conservatives opt out if they want. Pay the extra 31% and go private.

U.S. Medicare isn’t perfect and it surely needs fixes, but it is far easier to fix one system than the current mish-mash of 1500 private plans, and each of those with 5-10 different contracts covering or not covering whatever. 

How about opening insurance competition across state lines?

The idea of opening it up to cross-border competition between these 1500 private insurers is a ploy from an industry that knows full well that if competition were to force their medical payments down the losers would be the healthcare providers and not CEO salaries and shareholder profits, all of which will remain a drain on the system.

That adds massive administrative costs to doctors and hospitals who already have enough trouble satisfying the 450 insurers in Wisconsin, and it opens the system to even more fraud and overuse. The insurance industry should be eliminated, not protected.

Besides, the unnecessary and wasteful billing will not be removed by adding more insurers, it will be increased. The unnecessary costs in the current system are generated by the free-market insurance bureaucracy, which wastes 31% of health care costs. Those are not going away with cross-border sales.

But worse, insurers would move their headquarters to the state with the least consumer protections and all other state regulators would be without legal control, which of course the industry would love.

How will all of this affect quality

For those with pricey policies, it’ll neither go up nor down. And you are paying dearly for that privilege. For those uninsured or under-insured there is only one direction. It will improve. 

America’s higher health care costs have not provided a higher level of care. The single-payer systems in Canada and elsewhere have produced longer life expectancy and lower infant mortality rates than ours, mainly because of the patient’s easier access to proper care. Our costs are twice those of other nations, on a per-capita basis, yet the World Health Organization has us listed as 37th in the world in overall efficiency and effectiveness.

We can do better, and the nation’s economy demands that we do. In this time of need we cannot keep throwing healthcare dollars down the tube.

Well, what’s this “Medical Tourism” all about?

That’s the outsourcing of medical care to other countries. If a procedure costs $100,000 here and $20,000 in India, the patient may be given the option to share in the savings — IF, that is, they are willing to risk foreign travel and picking up diseases on the flight back to the states when their immune system is down. Or dealing with a medical malpractice system 5000 miles away. Or worse, a Mumbai-style takeover of the hospital while you are there. But what the hell, nobody said life was easy.

It is what it is…

No health care system is free. Some are funded directly and some indirectly. Some are funded through premiums, wages, cost shifting, tax subsidies, bankruptcy costs and higher priced products. Others are paid for with taxes, which is the most efficient for all concerned. But the insurance CEOs like things just as they are, so the politicians have acquiesced (for a price).

Top priority: If we could keep the moneyed interests from bribing our politicians, we’d fix health care overnight! But for the moment we can’t, so we must fight the bought-and-paid-for misconceptions.

2 Responses to What is Medicare-for-all?

  1. Johnn Hyland says:

    You mention that health insurance is a life saving necessity. I would think there are a few things that are more of a necessity. Like food, water, shelter. Will we expect to have the government furnish those in the future?

  2. We already are, John. It’s called food stamps. But I’m not in favor of free anything. I believe that anybody on welfare should have to work for it; sweeping city sidewalks, shoveling snow, volunteering time, whatever.

    We, as a society, especially one that allows our corrupt politicians to migrate jobs to the satisfaction of their contributors, ought to pay our our leaders on the basis of how efficiently they run our society. You know, like we expect of CEOs to be paid when they are a failure. 🙂

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