Mar 25, 2019
With so much written about the politics and some about the policy of Medicare for All, it seems we're having a real debate about the key issues.
But appearances deceive.
Instead, it's more of a struggle over the semantics of "Medicare" - #M4A - is it for America or is it for All? Proponents of "Medicare for America," the latest talking point elevated to policy - "you can keep your private insurance!" - claim that it provides universal coverage, and thus insures everyone has healthcare.
But is universal coverage guaranteed healthcare?
To address that question means actually debating the role of US based private insurance, it's business model, relationship to the healthcare industry and finance sector. This approach reveals much more about the bi-partisan politics and policy choices of healthcare reform.
If proponents of Medicare for America had to honestly address the primary elements of the health insurers' business model, it would be tough to defend:
- unnecessary insurance company profits ($5.8 billion in 3rd quarter, 2018)
- huge executive salaries ($81 million for UnitedHealth CEO in 2018);
- reliance on high tax subsidies ($262 billion for employer plans in fiscal 2017-18);
- regular denials of care (1 in 5 claims denied in ACA plans per KFF study, 2019);
- escalating premiums to generate enormous revenues invested on Wall Street, benefiting shareholders;
- largest lobbying operation on Capitol Hill ($3.5 bil in lobbying, $710 million in campaign contributions during ACA period) - healthcare financing is the worst example of "crony capitalism" (Angus Deaton, 2015 Nobel Laureate in Economics).
So then, do you continue to enrich the insurance companies by promoting the growth of for-profit Medicare Advantage plans (as the Medicare for America proposal calls for), and subsidize their revenue model with unregulated premiums and high out of pocket costs (a $5,000 "limit" as proposed is a lot to the 78% of people living paycheck to paycheck, and the 40% who don't have more than $400 in the bank).
A real debate would be about regulating the insurers vs eliminating their role as profit-making intermediaries. Either defend the commercial health insurance business model, or explain how your M4A changes it.
If the real goal of Medicare for America is to unwind these practices, the incremental approach undermines the prospects for success. As we saw during the four year roll-out of the Affordable Care Act vs the efficient, ten month transition to Medicare, lots of lies can be told, the industry can game the system, and opposition can organize. Rather than contort policy into some hybrid, multi-payer regulatory scheme that generates complexity, fragmentation and waste, as it enshrines profit-making and high out of pocket costs, let's stop the care denials and the insurance company dictates to doctors and patients.
Medicare for All represents the best M4A way: lead and be swift. Don't tell... show. Yes, your premiums are gone, your co-pay to see the doctor is eliminated, you don't have to worry about your deductible or wait for insurance company approval to get that test.
Very quickly, peace of mind will overwhelm that forgotten desire to keep your private insurance.
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