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Sunday, July 8, 2012

MEDICARE for ALL?

As long as we’re talking about Health Care and the Affordable Care Act, let’s be honest.  The Affordable Care Act was a valiant effort, but it falls short of what we so desperately need in this country: adequate health care coverage for everyone!  We remain the only major nation that does not provide health care for every man, woman and child as a right of citizenship, and it’s time we did the sensible thing by establishing a single-payer system.  Wikipedia offers a definition of such a system: “Single-payer health insurance collects all medical fees, and then pays for all services, through a "single" government (or government-related) source, typically extended to all citizens and legal residents.”

Why does the ACA fall short?

1)    Because it still allows private insurance companies to dictate too many outcomes: premiums, benefits, levels of coverage, etc.  Why do you think that since the passage of the ACA, premium costs have gone up dramatically?  Because those same private companies are trying to make huge profits before many of the provisions of the law kick-in in 2014 and beyond.

    And, right there is the rub: private companies putting profits before people or before quality.  Is that what we really want?  Or do we want to take the profit-motive out of the picture and rely on the non-profit public sector to reduce costs, increase coverage, and push effective outcomes for all, including preventive care?

2)    A whole new structure of state Exchanges where many people can go to get their health care coverage.  But why, pray tell, do we want to put in place a whole new structure when we already have structures in place that are working: the VA system and the Medicare system.  Think about it: in order to placate and enhance the private insurers, we are willing to go to the extreme of establishing Exchanges so that the private companies can still sell their over-priced packages and their under-financed coverage.   

3)    A built-in penalty for all those who can afford it, but decide not to purchase coverage.  This is a needless invention to achieve universal coverage when we could have such a system through payroll deduction or direct payment to the Revenue Service for the self-employed, charging everyone a Medicare tax that goes toward universal health insurance coverage.  It’s already in place and working, but will need attention to achieve universal coverage and near universal participation.  Have you noticed?

4)    Although some reform of Medicaid is involved, the ACA does not solve the problem of its major costs, nor its inadequate reimbursement schedule.  Medicare for all would necessitate incorporating Medicaid’s most important provisions so that we could eliminate health care for the poor as a separate system.

MEDICARE for All.  It’s not rocket-science, folks, but a matter of adjusting an existing system to meet the needs of a larger constituency.  Here’s what National Nurses United has to say:

“The Affordable Care Act still leaves some 27 million people without health coverage, does little to constrain rising out of pocket health care costs, or to stop the all too routine denials of needed medical care by insurance companies because they don’t want to pay for it.”  NNU co-president Jean Ross, RN echoes: “The continuing fiscal crisis at all levels of government and the anemic economic recovery remind us that rising healthcare costs and shifting costs to workers burden our society, cause (many) of these fiscal problems, and limit the opportunities for working people. Only real cost control through a national health program can solve this crisis. Improved  Medicare meets that challenge.”
Adds NNU co-president Karen Higgins, RN: ‘Medicare is far more effective than the broken private system in controlling costs and waste that goes to insurance paperwork and profits, and it is universally popular, even among those who bitterly opposed the Obama law.  Let’s open it up to everyone, no one should have to wait to be 65 to be guaranteed healthcare.”

Let us be clear upfront that single-payer systems do differ.  “The term "single-payer" only describes the funding mechanism—referring to health care financed by a single public body from a single fund—and does not specify the type of delivery, or for whom doctors work.”  So, while the fund holder is usually the state, some forms of single-payer use a mixed public-private system, and that is what some critics do not realize.  Some single-payer systems do contract for healthcare services from private organizations (as is the case in Canada).  Thus, advocating for a single-payer system does not automatically mean a system in which doctors and nurses work for the state!

So, what are the basics?  Here are just ten of them.

1)    Universal coverage guaranteed.
2)    Administrative costs dramatically lowered
3)    A system under scrutiny by the peoples’ representatives
4)    Care begins at birth and continues through a lifetime
5)    As with Medicare now, you can appeal decisions
6)    Paper-work is minimal for the patient and for the doctor
7)    No co-pays, such as a co-pay for doctor or specialist office visit.
No deductibles. And no coinsurance, such as bills from a hospital
8)    Small and large companies won't have to spend money managing the employee benefit of health insurance. That one factor means that the cost of operations for business units in the United States will be more competitive with businesses in other countries
9)    The natural result of no major medical bills is that patients will not over-mortgage or lose their homes; along with not needing to declare bankruptcy because of excessive medical bills
10)    Improved Medicare for all will cover all medically necessary care. Examples: primary care; inpatient; outpatient; emergency; prescription drugs; equipment; midwives; long term care; palliative; podiatric; mental health; dentistry; hearing, vision; chiropractic; substance abuse treatment as per H.R. 676.

Many Americans living abroad have begun to wonder why the USA is still worried about preserving the multiple private payer system that currently dominates our country.  Here are a few testimonials (in brief) from some of those Americans, as found on www.medicareforall.org.

— “(Our family) … can’t understand a developed country without universal coverage — Everyone is insured … (about) $67 a month. (Americans in The Netherlands)
That’s it. This includes doctor’s visits, medications, physiotherapy, even things like visits to a nutritionist or a problem overseas.
— Linda, April 2009.

Exceptional Care. (Americans in France)
In 25 years, our family has only had two major emergencies and in both cases, the medical care was exceptional and cost us nothing.
— Christine, July 2009

Excellent Care at Low or No Cost. (American in Australia)
Wife’s mother had terminal cancer and received excellent care with no worry “that her treatment would bankrupt us. … I … made use of their national health care system numerous times … (with the care being) of the highest quality at no cost …”
— Isaac, March 2008

Excellent Care; No Bills. (Americans in Germany)
” … (my mother’s multiple) eye surgeries … all paid for (in) Germany … (My mother in later years) received excellent care at the university hospital (for 3 weeks) and … we did not have to pay any bills ….”
… and, from another American in Germany: “(no) limit as to how long they would pay for it as long as the doctors said that the therapy was required.”
— Natalie, June 2008

Absolutely Superlative Care; Zero Cost. (Americans in Scotland)
“… correctly diagnosed the disease (in Scotland, after suffering for years in the U.S.). Since then, she has been hospitalized for a month, given two very expensive courses of IVIG treatment, and had her thymus removed in major, open chest surgery. Recently, we flew back to New York to consult with perhaps the world expert on Myasthenia. … he declared that the doctors in Scotland were doing all the right things. He then asked how much this cost. He had a bit of a hard time understanding that the cost was exactly zero. … I spent about two months paying various bills associated with that one visit to his office. Is the system in the UK perfect? Of course not. Did they provide superlative care for our daughter? Absolutely.
— John, August 2009 (question marks added)

So what can we expect from this system of improved Medicare for All?  According to the MedicareforAll.org website, we can look forward to the following:

“Based on the cost per person results of other free-market countries and based on our system being the best, we will cut costs by 60%. We will eliminate unnecessary administrative functions; negotiate drug and equipment costs. The results of cost-cutting include these: no premiums, co-pays, deductibles, or major medical bills, such as those that result from coinsurance.
Businesses, states, counties, cities and school boards will no longer be burdened with the topic of managing health insurance as an offered benefit ... and no longer be burdened by an excessive cost of providing it to employees.
Health care with dignity: no hardships, fund-raisers or applications to charities.”

Sign-up on www.medicareforall.org to further this reform of our health care system!