During the campaign I received a political anti Harris e-mail which included the following:
She co-sponsored Bernie’s socialist “Medicare for All”, which threatens to bankrupt the country.
I get a laugh when I read something like this. It could be credible if 66 million Americans were not already using Medicare for the last 60 years
There is not a thing socialist about Medicare or expanding it to all Americans. It’s insurance for Pete’s sake.
Bankrupt the Country? Compared to what? At the very least Medicare for All would be cost neutral.
Don’t get me wrong, the Bernie Sanders version with its greatly expanded benefits and outrageous claims of savings is laughable, but the concept of extending universal insurance to all is not only sound but the only viable answer for universal coverage and fair cost sharing across the population.
If there is a better, practical way that includes all Americans at every income level, let’s hear it.
If there is a better way that provides patient choice in receiving health care services, let’s hear it.
If there is a better way to pay for health care based on ability to pay, let’s hear it.
If there is a better way not linked to employment, let’s hear it.
How do we pay for it? Just as we do now.
Payroll taxes shared with employers, premiums, deductibles and co-pays for services rendered, general tax revenue for low income – all geared to household incomes.
It sure isn’t free health care and never will be, but it’s universal and much fairer than the non-system we have now and much easier for health care providers and patients to navigate.
Of course, over the next four years at least, the effort will be to move in the opposite direction, even efforts to privatize existing Medicare, but no matter what that direction is, it won’t solve the basic problem of universal coverage and fair cost sharing for all Americans and it won’t control costs.
QUINNSCOMMENTARY 
“How do we pay for it? Just as we do now.”
Obviously, not! Keep in mind how we fund Medicare (and for the dual eligible, Medicaid) today. We take money from workers and taxpayers and use it to cover the vast majority of the cost of Medicare and Medicaid coverage. Remember that M4A wasn’t Medicare, but a 100% coverage without any contribution or cost sharing by beneficiaries.
Medicare (and for the dual eligible, Medicaid) is an income transfer process where those who are working and paying FICA-Med, and those who pay income taxes and other general revenue, shoulder the vast majority of the cost of coverage for a minority of the American population.
In fact, most American workers with employer-sponsored coverage and those with coverage through the public exchange (almost all receive taxpayer subsidized coverage) pay more out of pocket (from their take home pay) for other people’s coverage than they pay out of pocket (from take home pay) for their own health coverage. That is, FICA-Med and FITW, all by themselves, have a greater impact on take home pay for the everyday employee than the employee’s own contribution for their own individual coverage.
Here’s the calculation for FICA-Med: Median wage (2022) was $46,367. Deduction for FICA-Med $672.32 Reduction in Wages for employer contribution for FICA-Med $672.32, Total $1,344.64 Kaiser Family Foundation survey of average employee contribution for single coverage (2022): $1,327. Note that the median employee contribution would be less than the average contribution – unfortunately, we do not have that information. Where taken on a pre-tax basis via a cafeteria plan, the reduction in take home pay (@25% marginal rate, FITW, SITW, FICA, FICA-Med) would be $995.25.
FITW and SITW are the primary funding sources for Medicare Part B and Part D – where taxpayers shoulder 75% or so of the cost of coverage.
Finally, there is a dramatic cost shift to employer-sponsored plans that drives up the cost of that coverage. The most recent study by Rand confirms that employer-sponsored plans pay 253% more for the exact same treatment from the exact same provider when compared to Medicare. And, Medicare pays, on average (varies by state) about 143% of Medicaid reimbursement rates. Congress and the states fix those reimbursement rates, so, to cover the true cost of treating Medicare and Medicaid beneficiaries, providers must charge everyday American workers with employer-sponsored coverage MORE, MUCH MORE!
No, socializing health coverage through single payer would not be better – unless you are going to conscript or enslave all medical providers.
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Rich, I appreciate all your help with PSEG matters, etc but I think you are getting a litt
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Not much knowledge of health care but it seems like big government runs big deficits with so many programs like Social Security and Medicare. I don’t have a lot of confidence that we wouldn’t run into major issues with this government run system.
You read and hear that the British love their national health care but there are super long waits for hips and knees as an example. Same with Canadian health care and rationing.
I think the German and Swiss health care combine private and public so if you had time for it a future column might be a brief how they work and your opinion of suitability for here.
Of course you are right that we are not going anywhere for 4 years at the least with Medicare for all. So maybe use your time on topics that are suitable for the foreseeable future.
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I don’t see how Medicare for all would be affordable, even tossing all private healthcare premiums into the pot with current Medicare taxes. Spending would go up as people who are reluctant to go to a doctor now because of cost would not have that concern under universal Medicare. The current Medicare payment rates would have to be adjusted upward. I just don’t see it.
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