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Single-payer healthcare advocates march in a Medicare for All rally in Los Angeles on February 4, 2017. (Photo: Ronen Tivony/NurPhoto via Getty Images)

Single-payer healthcare advocates march in a Medicare for All rally in Los Angeles on February 4, 2017. (Photo: Ronen Tivony/NurPhoto via Getty Images)

Happy Birthday, Medicare: You Showed That Public, Universal Health Insurance Is Superior

We must immediately end our moral crime of having the greatest health system in the world, but only for those who can afford it.

Fifty-six years ago Congress enacted Medicare to provide health insurance for people ages 65 and older and the disabled regardless of income or medical history. Since 1965, 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% to 4%, as opposed to private, for-profit health insurance, which has administrative costs above 15%. 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, everyone's health insurance, in spite of the Covid-19 pandemic, would continue uninterrupted because the Medicare for All insurance system is based on residence, not employment.

2021 is also a very special year in the history of single-payer health insurance and public health in the U.S. because Reps. Pramila Jayapal (D-Wash.) and Debbie Dingell (D-Mich.) introduced the modern Medicare for All Act of 2021 (H.R. 1976) in Congress. M4A 2021 is new legislation establishing a cutting edge 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!

H.R. 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 H.R. 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, including outpatient prescription drugs, medical devices, 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 individuals with functional limitations, or low-income individuals (as determined by the secretary);
  13. Hospice care; and
  14. 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%/20% payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100%.

All residents are guaranteed access to quality healthcare 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 healthcare professionals and hospitals, reducing unnecessary treatments, and expanding preventive care.

Good healthcare 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 healthcare 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.

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.

With M4A, citizens are guaranteed access to healthcare 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 healthcare 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%/20% payment split between private health insurance companies and Medicare is eliminated, with Medicare for All 2021 covering 100%.

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%—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 healthcare 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.

When Medicare was enacted 56 years ago, following a broad grassroots campaign, many believed the dream of a full national health insurance system was right around the corner. Five decades later, Medicare still has not been expanded. Most of the changes have been contractions with higher out-of-pocket costs for beneficiaries and repeated attempts at privatization by Big Pharma, the health insurance industry, and its champions in the White House and Congress.

It's time to end inadequate and dangerous health insurance programs. Insist on real health insurance reform essential for individuals and families. American history is filled with examples of fundamental, democratic change brought about by successful mass action and public pressure against the counseling of the go slow, vested interest crowd. No more waiting! Ask your legislators to fully support Medicare For All. 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 2021 with H.R.1976. By making health insurance available to all age groups, we can enjoy and celebrate Medicare's 56th birthday with the assurance that this life-saving health insurance program will continue.

Bonus Video added by Informed Comment: Majority Report with Sam Seder: "Explaining Medicare For All To Conservatives"


© 2021 Juan Cole

F. Douglas Stephenson

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.

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