The Nuts and Bolts of Medicare for All
Gainesville, Florida — On July 30, 1965, US President Lyndon B Johnson signed the Medicare Act into law. The law created two new programs, Medicare for those who had reached the social security retirement age of 65 years, and Medicaid for those whose incomes were below specific levels. In the long history of struggles to obtain national health insurance in the USA, this was a momentous act that provided health insurance for people ages 65 and older and the disabled regardless of income or medical history. In the 57 years since, Medicare has become living proof that public, universal health insurance is superior to private insurance in every way. Medicare is more efficient than private health insurance and is administered at a cost of 3 percent to 4 percent, as opposed to private, for-profit health insurance, which has administrative costs above 15 percent.
In light of the burgeoning, severe losses of jobs/employment/health insurances caused by the ravages of the COVID-19 pandemic, it’s very Important to remember that Medicare is still providing stable coverage for everyone 65 and older. If the new and improved Medicare for All, as outlined below, were in place today, everyones health insurance, in spite of the COVID-19 pandemic, would continue uninterrupted because the Medicare for All insurance system is not based on employment.
IMPROVED MEDICARE FOR ALL IN 2022
The U.S. Senate’s new Medicare for All Act of 2022, has been introduced by Sen. Bernie Sanders and 14 co-sponsors. The list of features in common between S. 4204, and the most recent House Bill (H.R. 1976) is substantial .Each of these bills provides all residents of the United States and its territories with a nationally consistent comprehensive benefit design, eliminates nearly all copays and deductibles, is funded through an equitable tax model, protects current benefits and services for veterans and Native Americans while also including them in Medicare for All, and dedicates expanded resources towards improving equity and justice in health care/health insurance.
2021 was a very special year in the history of single-payer health insurance and public health in the USA because Reps. Pramila Jayapal (D, WA) and Debbie Dingell, (D., MI) introduced the modern MEDICARE FOR ALL ACT of 2021 (H.R. 1976) in Congress. M4A 2021 is new legislation establishing a single-payer national health program in the United States that addresses decades of health/mental health-related injustices that have been made even more painfully apparent by the COVID-19 pandemic.
MEDICARE FOR ALL MEANS EVERYBODY IN, NOBODY OUT !
HR 1976 upgrades Medicare with a 21st century modern and improved “Medicare for All” health insurance system that covers all age groups, cradle to grave. Newborns will leave the hospital with their new Medicare card, and drop it off years later at life’s end. Benefits of HR 1976 health insurance include the following new items and services if medically necessary or appropriate for the maintenance of health or for the diagnosis, treatment or rehabilitation of a health condition:
(1) Hospital services, including inpatient and outpatient hospital care, including 24-hour-a-day emergency services and inpatient prescription drugs.
(2) Ambulatory patient services.
(3) Primary and preventive services, including chronic disease management.
(4) Prescription drugs and medical devices, in- cluding outpatient prescription drugs, medical de- vices, and biological products.
(5) Mental health and substance use treatment services, including inpatient care.
(6) Laboratory and diagnostic services.
(7) Comprehensive reproductive, maternity, and newborn care.
(8) Dentistry/Oral health, audiology, and vision/ophthalmology services.
(9) Rehabilitative and habilitative services and devices.
(10) Emergency services and transportation.
(11) Early and periodic screening, diagnostic, and treatment services.
(12) Necessary transportation to receive health care services for persons with disabilities, older indi- viduals with functional limitations, or low-income in- dividuals (as determined by the Secretary).
(14) Hospice care.
(15) Services provided by a licensed marriage and family therapist or a licensed mental health counselor.(In addition to psychiatrists, licensed clinical psychologists, licensed clinical social workers, psychiatric nurses.)
Co-payments and deductibles paid at health professionals’ offices are ended because payment for health insurance is fully prepaid directly into Medicare, just like pre-payment into Social Security, and covered at first dollar amounts. This means the obsolete 80 percent/20 percent payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100 percent.
All residents are guaranteed access to quality health care while achieving significant overall savings compared to our existing Medicare system by lowering administrative costs, controlling the prices of prescription drugs and fees for physicians and other health/mental health-care professionals and hospitals, reducing unnecessary treatments and expanding preventive care.
Good health care is established as a basic human right, as in almost all other advanced countries. Nobody would have to forego needed treatments because they didn’t have insurance or they couldn’t afford high insurance premiums and co-pays. Nobody would have to fear a financial disaster because they faced a health care crisis in their family. Virtually all families would end up financially better off and most businesses would also experience cost savings compared to what they pay now to cover their employees. Health insurance is based on residence, not employment.
With M4A, citizens are guaranteed access to health care while achieving significant overall savings compared to our existing obsolete system. This is accomplished by lowering administrative and eliminating profiteering Big Insurance costs, controlling Big Pharma prices of prescription drugs, fees for physicians and other health-care professionals and hospitals, reducing unnecessary treatments and expanding preventative care.
Co-payments and deductibles paid at health professionals’ offices are ended because payment for health insurance is fully prepaid directly into Medicare, just like pre-payment into Social Security, and covered at first dollar amounts. This means the obsolete 80 percent/20 percent payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100 percent.
We finance our new and improved Medicare for All system by eliminating profiteering by the private health insurance industry and slashing the system-wide administrative waste they generate, with a single streamlined, nonprofit public payer health insurance system. Such savings, estimated in 2017 to be about $500 billion annually, would be redirected to patient care.
More than two dozen independent analyses of federal and state single-payer legislation by agencies such as the Congressional Budget Office, the General Accountability Office, the Lewin Group and Mathematica Policy Research Group have found that the administrative savings and other efficiencies of a single-payer program would provide more than enough resources to provide first-dollar coverage to everyone in the country with no increase in overall U.S. health spending.
According to a 2016 study in the American Journal of Public Health, tax-funded expenditures already account for about two-thirds of U.S. health spending. That revenue would be retained and supplemented by modest progressive taxes based on ability to pay, taxes that would typically be fully offset by ending today’s very high premiums paid to the for-profit private insurance industry and out-of-pocket expenses for care. The vast majority of U.S. households — one study says 95 percent —would come out financially ahead. The system would reap savings by dealing with drug and medical supply companies for lower prices.
M4A is a solid investment in our country because it promotes a social service for universal access to affordable health insurance for everyone. The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the death and illness ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it.
OPPOSITION TO MEDICARE FOR ALL
The real boogeymen opposing M4A are the private health insurance and pharmaceutical industries who have the most to lose if their profits are redirected to direct patient care. Beholden members of Congress want to protect the interest of their insurance and Pharma donors — these two industries spent $371 million on lobbying in 2017 alone. Big Pharma and Big Insurance industries have literally bought most of our legislators (both Democrat and Republican). A massive disinformation/fear campaign has promoted the myth that Medicare for All would limit choice of doctors and hospitals, create unsustainable costs, and expansive, uncontrolled bureaucracy. These myths better describe the reality of our present system based on the private insurance industry.
If we are a society that cares enough to see that everyone receive the health care they need, the basic point of Medicare for All, then it’s important that citizens reject catastrophic expectations and predictions, false fear and scare tactics of the M4A opposition. Citizens now better understand that the real cause of high US health insurance costs is the private insurance industry’s need for high profit. A record number of Americans reject our fractured, profit-based health insurance system and support programs like House Bill H.R. 1976 or Senate Bill S.4204, which improve Medicare’s benefits by adding in previously uncovered services such as dental, hearing, vision, and long-term care while eliminating cumbersome out-of-pocket fees with prepaid health insurance.
Although Medicare for All supporters are often derided as unrealistic, in fact it’s not realistic to expect that Americans will continue passively accepting ‘how much money is in the bank account’ as the most significant factor in their mortality. By seeking to weaken Social Security, Medicaid and Medicare to fund tax cuts for the rich during a time of the Covid-19 public health crisis, the one percenters have elevated self-interest even further above life itself for the ninety-nine percent.
The USA is a country where health insurance for medical and mental health care is a function of socio-economic status. Everyone knows that this inhumane system should have been corrected long ago, but the ravages of the pandemic crisis makes it impossible to any longer avoid reality. We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it. In addition to strickly following the basic principles of public health and epidemiology, the very best way to cope with the vast dangers of COVID-19 to everyone is to immediately implement improved Medicare for All legislation now filed in Congress, H.R. 1976/S.4204.
A majority of Americans support Medicare and want expansion of this program to provide health insurance for all. Write to your senators and representatives and let them know how you feel about expanding Medicare. The very best way to cope with the vast dangers of COVID-19 to everyone is to immediately implement improved Medicare for All with H.R.1976/S.4204. By making health insurance available to all age groups, we can enjoy and celebrate Medicare’s 57th birthday with the assurance that this life-saving health insurance program will continue.
F. Douglas Stephenson , LCSW, is a retired psychotherapist and former instructor of social work in the University of Florida Department of Psychiatry. He is a member of Physicians for a National Health Program.