I Supported Medicare for All — until I Didn’t
I retired exactly one year ago today. I’m approaching my 75th birthday. I’ve been a Medicare beneficiary for almost a decade. My wife, who qualified for disability coverage prior to retirement age, has been a Medicare beneficiary for much longer. So when “Medicare for all” emerged as a viable policy in our political discourse, I was supportive, enthusiastically so. But to me, that meant Medicare as my wife and I participate — as satisfied enrollees in a Medicare Advantage Plan. More than a third of all Medicare recipients are covered by such plans and we’re delighted with the service.
I was an enthusiastic supporter of Bernie Sanders in the 2016 Democratic Primaries. I’ve supported Elizabeth Warren’s campaigns with modest donations and visible endorsements. I believe both of them are addressing many of the key issues that need fundamental change in the immediate future — Bernie named them in his closing remarks at last night’s debate reminding us that an election alone will not be sufficient to overturn the forces that have a lock on Congress and the laws it passes — Wall Street and the largest corporations including “Big Pharma” and the large insurance companies and health care providers, the military-industrial complex, and the fossil fuel industry. But both Sanders and Warren raised their hands when asked to indicate whether they favored eliminating private insurance companies as part of their “Medicare for All” plans. To me, Medicare includes Medicare Advantage, and I would be very disappointed to lose that option.
Under Medicare Advantage, my Medicare premiums are deducted from my Social Security benefit each month and go to my Medicare Advantage provider. There are no additional premiums. For that I get all the benefits of Medicare and more. My provider aggressively practices preventative medicine and regularly inquires to be sure that my wife and I have been screened, checked and vaccinated as needed to catch potentially serious diseases early and to prevent as many as possible. We have no copay for visits to our delightful primary care physician and only modest copays for referrals to specialists. The provider even underwrites my membership fee in a fitness club. There’s more I could say, but you get the picture. I would lose benefits if my Advantage provider were closed under the Sanders-Warren Medicare for all plan. My wife and I would not be happy.
In her debate remarks, Senator Warren cited a figure she claimed represented the annual profits garnered by the health care insurance providers. She argued that those funds should have gone to patient care. But under a provision of the Affordable Care Act, 85% of all premiums collected by Medicare Advantage providers must go to patient care, leaving only 15% for all other administrative costs, executive salaries, and profits. That doesn’t strike me as excessive. And the oft-cited claim that regular Medicare operates with only a 2% overhead has been discredited.
What’s more, if a corporate entity can provide excellent care and additional benefits and manage a profit, it’s because it has made arrangements and negotiated fees that have reduced costs. Nothing wrong with that in my view.
I strongly favor making step-by step progress toward universal health care coverage as favored by candidates such as Amy Klobuchar and others. First, undo the damage to the Affordable Care Act that has crippled its effectiveness. Fight to win majorities in state legislatures that have refused to expand Medicaid or establish a state insurance marketplace. Add a public option to provide an affordable alternative to private plans. While overturning Trump’s wasteful tax cuts, restore the individual mandate, the only way to guarantee a large enough insurance pool to bring down costs. Evaluate the systemic changes and areas of need and make additional refinements as necessary. Remember, few of the much-admired national health care systems found in other advanced societies are single-payer systems. Most are mixed systems that involve both government and private insurance. All provide better care for far less overall cost. That’s what we should aim for — universal coverage and better care at lower cost.
Don’t forget the Affordable Care Roll-Out Disaster
It cost President Obama nearly all his political capital to push Obamacare through Congress. By the time he succeeded, he had been forced to abandon the Public Option and Republican state legislatures across the country did everything they could to hamstring its success. Republicans in Congress joined in the assault, holding regular votes in a futile effort to overturn the legislation. The Obamacare launch was overseen by perhaps the most qualified individual that could have been assigned to the mission, Kathleen Sebelius. Despite her efforts, the initial launch was a bumbling disaster beset with computer programming errors and Republican administrative roadblocks at the state level. Still, despite these impediments and the complexity of the plan, after two shake-down years, there were signs that Obamacare was succeeding in reducing health care costs in some areas and its popularity with the public began to grow.
https://www.statnews.com/2019/03/22/affordable-care-act-controls-costs/
Consider now the difficulty that Sanders, Warren or another Medicare for all advocate would face in launching their plan, even over a four-year roll-out. Think about the difficulty of campaigning on a plan that would terminate the employment of some 500,000 people who work in the health insurance field and some 900,000 in related areas.
Think about the combined attacks of the entire health-care industry, the entire Republican financial war chest and its capacity to spread hostile propaganda via social media and the airwaves. The Republican goal once Obamacare was passed became ensuring that Obama would be a one-term President. They failed at that but remained utterly obdurate to any bi-partisan effort through the rest of his Presidency. No other major legislation passed. Sanders and Warren both have many admirable legislative goals. None will go anywhere if the launch of Medicare for all stumbles out of the blocks as did the Affordable Care Act.
And isn’t it strange that no one I’ve heard has directly tied a proposed national single-payer plan to the woe-beset Veterans Administration health care system? Don’t get me wrong. Many veterans are very happy with the care they receive and many of the problems in the system can be attributed to hypocrites in Congress who pontificate self-righteously at hearings demanding improvement while the problems they’re addressing are due to chronic under funding and staff shortages. But before we jump on board the single-payer train, we’d best consider that there can be serious problems with such systems, including wait times for elective surgeries as one finds in Great Britain.
A step-by-step approach to universal health-care coverage such as proposed by Senators Amy Klobuchar, Michael Bennett and other’s strikes me as the way to go. It won’t tie up as much political capitol at a time when other vital matters need to be addressed. It is less likely to get tripped up out of the gate by a bungled roll-out, and it guarantees more choice for the consumer making it an easier sell politically.
I’m profoundly grateful to Bernie Sanders and Elizabeth Warren for all they’ve done to identify the underlying structural and economic problems of our society. These issues must be addressed if we hope to restore greater equality, opportunity and security to all Americans. Moving directly to a single-payer health care system won’t advance these goals and may very well hinder their chances of success.
Be well, everyone; until more is done, the alternative can be costly.
