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My Medicare For All Question
Having watched the Democratic debates a few weeks ago, there is one thing I cannot understand. There was a lot of talk about Medicare For All, and most of the candidates want some version of this. Although I disagree with people who want MFA, I can understand the motivation for it. A low-income Democrat – or even Republican – might say, “If the plan necessitates an approximate doubling of federal income taxes and I’m currently only paying $2500 a year in said taxes, who cares if those taxes double? I’ll be paying an extra $2500 a year, but saving $5-12K per year by not having to buy health insurance. Yeah, it stinks for the people who are already paying $100K in income tax and will see that double, but that’s not my problem.” If they are a hardcore leftist, they may see that as a feature, not a bug.
I don’t condone this kind of selfishness, but I understand that a lot of people will be motivated by it. Here’s what I don’t understand. Why do politicians like Bernie Sanders and Bill DeBlasio insist that we also outlaw private insurance? What harm would be done to the public if a small percentage of Americans decided that they want to keep and pay for their current health insurance policies? Either way, they’re still paying the taxes for MFA. And if they are using private insurance they’re not costing the government any money at all, like those who are signed up for MFA would be. I should think that such people would be applauded.
Of course, the emotionally satisfying answer is to simply declare that socialists are just stupid, but there’s got to be more of an answer than that. There must be some semi-logical reason for wanting to go beyond providing everyone with “free” healthcare, and also outlawing private health insurance. What am I missing?
Published in Healthcare
There’s probably the feeling that those paying for private health insurance will get better care than those on the government plan. And they’re probably right, though it shouldn’t be any of their business.
Maybe they know that Medicare for all will result in rationing (long waits, denials) and a reduction in quality of care. Then, people of means will opt out and we’ll have a two tier system, where the bottom tier gets worse and worse. It is not enough that the poor get something for free, the wealthy must also be punished.
What I wonder, if the Dems outlaw cash paid medical, what will Canadians do when they get desperate? Afterall, our medical system is their backup.
It’s an ambit claim, something that can be ‘given up’ when making the sausage. I can’t see any reason for it otherwise, and I am pro universal medical cover by the State.
The only ones they want to have the option of private care are themselves. You will know how serious they really are by whether they exempt only themselves from the hard requirement of participation in the Government Plan.
It is not logically possible for socialism to deliver on the only promise that would justify the sacrifices it requires: a better material condition for the masses.
As long as two sectors of human societies exist, one relatively free and materially well-off and one relatively socialist and miserable, the political class deriving its happiness and existence from socialism is faced with the unmanageable task of keeping its victims unaware of either the well-being of the freer people, or the cause of their relative happiness.
Stupid? I was going to go with evil.
Efficiency, I guess?
Or else they believe there’s something intrinsically immoral about making a profit off of health care:
This raises the question, though: if it’s wrong to make a profit on providing health care, is it also wrong to profit from providing other essential needs like food and housing? That line of thinking leads inevitably to the nationalization of all major industries, which is after all the classic definition of socialism.
It’s because they see private insurance as competition and that’s something they can’t abide. Just ask the parents of Alfie Evans.
My health insurance rolled over this month from private to Medicare. After months of being bombarded with a dozen or so pieces of mail a week, and phone calls galore, all from private insurance companies interested in picking up my business for the Medicare Advantage and Prescription Drug components, I did what I suspect a lot of people in my situation do, which is just let the same health insurer I’ve been paying exorbitantly to for the last nine years, since I retired, cover the additional pieces. And I’m still somewhat baffled. I will say, though, that Mr. She’s Medicare coverage, which also includes private components, works very well. Hoping that mine (different private insurer, because we had different employers and different plans, and we both stuck with the same ones after retirement) works as smoothly.
But basically:
Medicare Part A–is the Uncle Sam hospital insurance component. It’s “free” to those who paid into Medicare taxes while working for (I think it’s) ten years total. Those who do not meet the qualification for “free” coverage must pay on a sliding scale of between approximately $250 and $450 per month for Part A. (Mr. She and I get Part A “free.”) There are substantial deductibles and copays for Part A, especially for long-term hospital care.
Medicare Part B–is the Uncle Sam medical insurance component. Everyone (I think) on Medicare pays for this. It’s $135 per month, this year. That’s deducted directly from each of our Social Security checks. There’s a sliding scale for this which caps out at about $450/month if you’re married and your annual income is above $750K. Hahaha. Medicare Part B “covers” preventive care, outpatient care, ambulance service, and durable medical equipment. It also covers intermittent home health and rehabilitation, in limited amounts, and doctor office visits. There’s a small deductible of a couple hundred dollars. After you meet that, you pay (out of pocket) 20% of the Medicare approved amount for most provided services. When you’re a geezer like Mr. She, those costs add up fast.
Medicare Part C–is an optional Medicare Advantage Plan, administered by a private insurer contracted with Medicare. It “covers” through the mechanisms above, hospital and medical insurance which is already “covered” by what you’ve paid and are paying to Uncle Sam, and covers additional things like dental, hearing, and vision (which are not covered by Uncle Sam’s version of Medicare). Usually, Part C has different deductibles and cost-sharing than A & B, and lower co-payments, and different schedules for coverage for things like home health, rehab and long-term care. (There are also “Medigap” plans which cost more, and may result in lower out-of-pocket expenses for certain covered services. It’s a bit of a crap shoot, which you select.) You pay the private insurer directly for Part C coverage. The private insurer coordinates care and payments with Uncle Sam.
Medicare Part D–is an optional component, administered through private insurance companies, and provides coverage for prescription drugs purchased at retail pharmacies and administered at home. (These are not covered by Uncle Sam’s version of Medicare.) Many people who purchase Part C (private) use the same insurer to purchase Part D. Those who cannot afford Part C, can purchase Part D separately. There’s a deductible of several hundred dollars a year, after which you move to paying the co-pay of between $7 and $40 per prescription. Once you and the insurance company have spent in the neighborhood of $4K a year, you’re in the infamous “donut hole” where you pay an significantly higher copay until your (not you and the insurer, just your) total out-of-pocket drug costs are $5100 for the year (in 2019). If you ever get out of the gap, your Plan D coverage will pick up 95% of the cost of the drugs from then on. You pay the private insurer directly for Part D coverage.
According to the HHS, about 21 million people (38% of total Medicare enrollment) are enrolled in the optional Plan C. Enrollment in these plans (remember, they are private) is growing faster than the number of enrollees that Parts A and B are picking up due to either age (vast majority) or disability status. Enrollment in Part D (optional private prescription drug coverage) is about 46 million.
Net net: The current Medicare system, which most people view favorably, and which seems to work for its beneficiaries fairly well, is, under the covers, a rat’s nest of connections between government, private, HMO, PPO, plans which are administered and managed for over 1/3 of the enrollees by private insurance companies. About 3/4 of Medicare enrollees are enrolled in a private prescription drug coverage plan which is administered by the private insurer.
And although, starting this month, my monthly health insurance premiums have dropped considerably, I’m still spending a few hundred dollars a month on Parts B, C, and D. So it’s not “free” at all.
So. It’s hard for me to see how these ignorant loons who babble on stage about “eliminating private insurance,” “single payer,” and “Medicare for All” have any sort of grasp on reality, and I am perfectly certain they have no idea about costs, benefits, and consequences.
What they are really talking about, when they talk about completely eliminating from the picture any sort of private insurance, work requirement, age requirement, disability requirement, citizenship requirement or any other sort of requirement is Medicaid for All.
But if they called it that, it would be a much, much harder sell.
PS: And of course, anyone who wants to evaluate Uncle Sam’s capacity to reliably and humanely manage a single-payer system, run to benefit those who’ve already paid far, far more into it than they’ll ever get from it, and in which doctors offices, hospitals and other providers work directly for the government, only has to contemplate the specter of VA Care for All. For anyone with a shred of humanity and sense, that should end the discussion. Right there. [Runs screaming into the night]
Socialism keeps prices down doesn’t it? Besides competition is messy and unfair. They won’t actually do what they say, but who knows what havoc they might do. Look where we are now? But Republicans won’t move toward private competitive markets either.
Thanks for finding that, Joseph. It seems like a pretty weak argument. If doctors and hospitals found the paperwork for private health insurance companies to be burdensome, they could just choose not to accept it. After all, the vast majority of people would be covered by the government so they wouldn’t be turning away that many customers.
It’s like we share one brain. Several years ago my cousin said maybe health care is too important to allow companies to profit off of it. I asked what about food? You need that every day, while there are people who haven’t seen a doctor in ten years. Should we criminalize making profit from food sales?
And Bernie Sanders is right, that insurance companies are in the business to make profit. I know when my wife and I meet with the guy who runs our retirement accounts we don’t ask him to please see that our money is put into companies who only want to break even. But what’s stupid is that Sanders thinks that the insurance companies are working to make profits for drug companies.
That’s an impressive demonstration of Mr. Sanders’ ignorance of the history that the desire to make money has led to vast improvements in and increased availability of, pretty much every thing and service humans use.
As you note, food is a pretty good example, as the desire of various supermarkets and their suppliers to make more money has led to selections on the shelf that 30 years ago I couldn’t imagine, and families are currently spending a smaller portion of their income on food today than they did a few decades ago.
There is an astounding number of people who are happy with poor service as long as everyone suffers the same. I’ve see it at the micro level in small organizations and this is the same thing at the macro level.
I do not believe that the vast majority of that segment of the public which wants what is being referred to as “Medicare for All,” believe they’ll get poor service at all. They see “Medicare,” which most recipients are quite happy with, and don’t believe they’re suffering under, and they think that’s what they’ll be getting, for free, forever, whoever they are, whatever their age, whatever their condition, and wherever they’re from. A moment’s sensible reflection would disabuse them of that notion, but that’s not what they’re about. They just want the handout. And no one wants to put on the table that what the candidates are describing is really Medicaid, or, actually, VA Care. About which far more people have a negative opinion, and which wouldn’t, as a universal solution, be popular at all.
If “Medicare for All” gets through, it’ll make the 2010 rollout of Obamacare look really good.
With Medicare For All, you become simply a line item on someone’s budget. When you become too expensive to maintain, they cut you off. I wish Bernie Sanders to be covered by such a plan.
In addition to the already expressed appeal to principle (avoiding the appearance of a two-tiered system), I think the advocates of government medical care legitimately fear two risks.
One risk is that the economics and statistical outcomes go awry if mostly healthy people choose private coverage, and the government system is left with mostly sick people.
Another risk is that if many more than a few people will opt for private coverage, political support for an ever larger and more expensive government system will diminish.
Two reasons:
Banning private insurance puts the government in total control of your health care, and totalitarianism is about control.
A large percentage of Americans would want to keep their current plans intact (I predict close to 100%). This way, they have more control over their health care. Disputes with health insurance companies can be won, but not a dispute with the government.
It won’t be “Medicare for all”. The reason Medicare works is that there are a limited number of the elderly and it is parasitic on the rest of the medical system. Ask any doctor or hospital if they can stay in business with a 100% Medicare population.
What you will end up with will be “Medicaid for all”. Poor access, poor service. Even worse reimbursement for hospitals and doctors. If you allow an escape path, like private insurance, doctors and hospitals will concentrate on those patients, and the Medicaid patients will get pushed to the back of every line.
I don’t mind paying more for better coverage and better care, but Medicare for All will cost me significantly more for significantly worse care. VA hospitals for Everyone! They should eliminate the VA hospital system and just give the veterans a low deductible Blue Cross / Blue Shield policy and let them find their own care
Old Russian proverb.
Vasil is a peasant who God wants to reward.
He tells Vasil ” I will give you whatever you want, but because Yuri is a better man, I will give him twice what I give you”.
Vasil thinks about it and says ” I want to be blind in one eye”…..
Or worse: VA care for all . . .
Amen!
It’s always amazed me how many older vets are happy with VA care. My WWII vet father was one of them. I’ve visited a local VA hospital when we did a fundraiser to provide simple care items that the hospital was unable to provide, and it was a very depressing place. I’m sure that individual experiences can vary, but the recent scandals alone show how awful and corrupt the system is.
Yes, which is why it’s advertised as “Medicare for All”, since to the average desperate person with medical bills, what “Medicare for All” sounds like is “Medicaid for all — but better!”
I know several people with the same chronic degenerative disease, many of whom are, through no fault of their own, “medically retired” early in life and hovering between no coverage at all, Medicaid, and sometimes (if they’re “lucky”) private coverage through a job they’re not sure they can physically keep, or a spouse’s coverage. They know how much Medicaid sucks; they know how Byzantine private medical billing can be; and so they’re desperately rooting for “Medicare for all” simply because it sounds better.
In the abstract, there’s no reason why medical expenses, which are for most of us, less of a necessity than food or shelter, are a “need” that the market can’t provide. But in the monstrous public-private-cartel-hybrid we actually have, many otherwise responsible people find medical billing the kind of Kafkaesque nightmare where it’s fairly normal to not even be informed of what you “really owe” until a bill has hit collections and wrecked your credit. (Indeed, the latest iteration of FICO has taken this into account for a few years now — too bad many major financial institutions are stuck on older iterations of FICO indefinitely.)
Most of us manage to go to the grocery store, and pay our mortgage or rent, in a fairly straightforward process where we know what we’ll owe and can plan for it. This simply isn’t true of medical billing — in large part, I think, because medicine has already become an unholy hybrid of public and private. That desperate people, who quite sensibly doubt that a public-private hybrid would ever be successfully dissolved in favor of an actually working private system, would gravitate toward Plan B: not private at all, but instead wholly public, is understandable — and that’s the hell of it: how understandable it is.
But the Sanders plan isn’t collecting money by selling Medicare subscriptions, it’s collecting it through income tax. So whether you sign up for the plan or not, you are paying for it. It would be in the goernment’s interest if lots of people don’t sign up for it, since Uncle Sam would be taking their money whether they use the service or not.
This is the most plausible explanation I’ve seen so far. Thanks, Kozak.
Mostly because they’re stuck in a 1970’s version of Medicare that doesn’t exist anymore. Medicare itself is predicted to be all private insurance in another 25 years. So killing private insurance doesn’t even make sense, since thats what Medicare is too.
I doubt liberals care much if private insurance still exists. If thats your argument, you’ve basically conceded 90% of the game to them. Medicare Supplements already exist. Liberals will be OK with controlling only 90% of the health insurance market.
Just so, the same article I referenced above mentions:
Apparently at least 1/3 of people who support “Medicare for All” think that somehow the government can provide health care for all without raising taxes or rationing (requiring waits). That scares me.
It’s also just inherently less predictable. The grocery bill doesn’t change that much month-to-month, rent is also fairly stable but can increase suddenly in some urban areas which is why there’s so much support for rent control laws. But health care, who knows when someone in the family is going to get seriously ill and how much their care will cost?
Insurance is supposed to solve that by making unpredictable costs into a predictable monthly bill, but there are 2 problems:
I think it’s the unpredictability that makes people so fearful and receptive to ideas like Medicare for All.