As soon as someone says “Medicare for All” or “single-payer healthcare” or “universal coverage”, someone else will argue about definitions. And there are important differences.
But today, we are going with what most of us mean when we use one of those phrases: a system of health care under which everyone is covered, however it is paid for.
Most western democracies use some form of this system. As VeryWellHealth explains:
”...several countries have achieved universal coverage, with 100 percent of their population covered. This includes Australia, Canada, Finland, France, Germany, Hungary, Iceland, Ireland, Israel, the Netherlands, New Zealand, Norway, Portugal, the Slovak Republic, Slovenia, Sweden, Switzerland, and the United Kingdom.”
No one in these countries worries that a major illness will bankrupt them as happens in the United States.
Currently, in 2018, about 88 percent of Americans, according to Gallup, are covered to one degree or another depending on what they can afford from private insurers.
Among that number, however, there is one group of people in the U.S. who do enjoy universal, single-player health coverage. It's us old folks, 65 and older. It is of course, called Medicare and as it happens, over the past 15 months I've had a crash course in how it works in real life when something deadly serious comes along.
First, back up to 1965 when Medicare went into effect. I paid into the program from that time forward until I stopped working in 2004. Currently, the Medicare tax is divided between employer and employee, 1.45 percent each.
Many people believe that the Medicare tax covers it and that Medicare, once you are old enough to join, is free. Not so. Use me as an example (this is about traditional Medicare, not Medicare Advantage Plans which I'm not discussing today):
Part A - hospital insurance: free.
Part B – medical insurance: a premium, calculated on income, is deducted from the Social Security (or railroad, etc.) benefit each month. There is a deductible, $183 in 2018. Part B covers about 80 percent of Medicare-approved expenses.
Part D – prescription drugs: provided by Medicare-approved private insurance companies. Premiums vary dramatically.
Supplemental (Medigap) coverage: helps pay the 20 percent of medical costs Part B does not. Premiums currently range from about $74 to more than $400 per month.
In addition to all the personal fears and concerns I had when first diagnosed with pancreatic cancer last year, I was terrified at what the surgery and accompanying care would cost me, and if I could even afford it. I decided to deal with after I recovered from the surgery.
What I learned is amazing: Medicare is a whole lot like universal coverage in those other countries: So far, I have paid not a dime for medical treatment.
My biggest expense has been Part D, prescription drugs. Just this month, I finally climbed out of the so-called “donut hole” having paid $5,000 out-of-pocket for drugs this year. I am now in what the program calls “catastrophic coverage” where I pay a small fee for each prescription until next year when the process begins again.
Until I was thinking about this blog post, I had never added up what I pay per year for Medicare coverage. I was surprised to find that the premiums for Part B, Part D and supplemental come to just over $4500 per year.
That sounds like a lot until you know that my treatment costs are, so far, close to $1 million.
Most of the objections to Medicare for All are about cost. I have seen estimates of between $2.4 trillion to $2.8 trillion per year. Who knows if that is anywhere near what the reality would be.
For decades, in certain quarters of the population, a few politicians talked about Medicare for All. Recently, during the 2016 presidential campaign, it was presidential candidate, Bernie Sanders, calling for Medicare for All. The idea began to spread and catch on.
In April this year, Paul Waldman wrote in the Washington Post:
”Right now Democrats are coalescing around a new model for health-care reform. This November’s election could validate it in a way that practically settles the issue among Democrats. That will then determine the discussion in 2020, and in 2021 it could become the basis for a hugely ambitious overhaul of the system.
“Right now we could be witnessing the genesis of one of the most important domestic policy changes in our history.”
Also in April, Democratic Senators Jeff Merkley of Oregon and Senator Christopher Murphy of Connecticut introduced S.2708, the Choose Medicare Act, that would open up Medicare to anyone who wants it and isn’t already eligible for Medicare or Medicaid.
It is such a good idea to just expand Medicare to everyone rather than start of scratch on a new program. The main infrastructure is already in place, it works well, and could be built upon for the entire population.
Of course, the Choose Medicare Act has gone nowhere due to the Republican control of Congress but if there turns out to be a blue wave in the November mid-term election, that bill – or some others with similar intentions - could come to the floor of Congress.
It won't happen that easily or that quickly, but it would be a fine start to the conversation and eventual reality.
Those countries that have had universal coverage for decades pay a lot more in taxes than we Americans do but I sure wouldn't care if everyone could be as free of economic worry as I have been granted, thanks to Medicare, during the wildly expensive treatment I've received.
Most of all, it is the right thing to do. Health care is a human right and the United States, that so glibly repeats that all men are created equal, that the rights of all persons are diminished when the rights of one are threatened, etc. etc., cannot possibly claim those principles if some cannot afford health care.
The United States desperately need this policy change. If you put more than a minute's thought to it, how can we do differently. Are people without coverage or inadequate coverage just allowed to die in the U.S.? I can't find the answer to that question – or maybe it would be too painful to know.
You might want to think about all this as you consider who to vote for in November.