I have a challenge for you.
Before I say what it is, let’s consider all the things Americans don’t like about health care – cost, availability, insurance companies, third-party involvement, high deductibles, premiums, etc.
NOW, the challenge.
Tell us why you will or will not support a form of Medicare for All replacing all the payment systems currently in place, public, employer and private plans to be funded by a combination of employer and individual taxes, income based premiums and cost sharing at the point of service.
Go‼️
QUINNSCOMMENTARY 
Medicare for All is a typical government, socialist solution – anticipating a static economy, not the dynamic economy America has. I would be happy to support such a system if each person covered actually shouldered the same nominal dollar amount of premium – er taxes. Try that and see who would vote for that.
Americans are unwilling to pay the true cost of health care. They say that our health care spend is 18% of Gross Domestic Product. Expressed as a percentage of Personal Income, that would be 22%. Do you have a 22% deduction from your paycheck, your pension, your social security and all income you receive – earmarked for health care spend?
Americans are certainly unwilling to do as individuals what we are already doing as a society – in large part because we are shifting hundreds of billions of today’s medical expense to future taxpayers – increasing our annual deficit and national debt.
That is certainly true when it comes to the 150`million or so individuals who are currently covered by Medicare, Medicaid and the VA. Those programs only work because the government fixes provider reimbursement rates, fixed prices at below cost – shifting a substantial portion of the cost to those of us who are not covered by a government plan that fixes prices.
Putting every provider – doctor, technician, hospital, drug manufacturer – in a Medicare-like plan would trigger one of three results:
First, assuming the Medicare for All plan raised reimbursements for all in a government plan today to cover the acual cost plus a margin for profit, taxpayers who fund those plans would scream about the significant increase in costs to provide coverage for others. Remember that 100% of the cost of Medicaid and the VA, and 75% of the cost of Medicare Part B and Medicare Part D are paid with general revenue monies – where American households at the median or below, 50% of all households, only contribute 3% of income taxes. Income taxes make up the vast bulk of all general revenues. Working Americans who pay FICA-Med on their wages provide the vast majority of Medicare Part A funding for hospitals – and workers would likely see the combined rate of 2.9% – no cap – increase more than 50%.
Second, the alternative to the first, would be to fix prices for everyone in the Medicare for All scheme – forcing providers into a form of indentured servitude where the government would set their reimbursement rates, for all 330 million – not just for the 150`million or so in the current government sponsored plans – Medicare, Medicaid (where reimbursements average only 72% of Medicare), and VA – but also fix prices for the 170 million or so currently enrolled in employer sponsored plans, and
Third, once the government fixes prices for all in the Medicare for All system, many providers would opt out of the universal government system and provide private care, or offer care only through supplemental insurance policies – as we see in the UK.
Today, more than 98% of all licensed providers accept Medicare, including nearly 100% of all hospitals and urgent care facilities, where the Medicare Allowable charges typically only cover 86% of the actual cost to deliver services.
Myself, I expect such a Medicare for All system would trigger the second outcome, fixed prices for all, followed soon thereafter by the third outcome, opting out of the government system by as many as 50% of all providers – once they are not allowed to charge folks currently covered in employer sponsored plans an average of 254% of what Medicare allows. I would expect to see a dramatic expansion in what we call Direct Contracting today. See: https://www.rand.org/pubs/research_reports/RRA1144-2-v2.html
The alternative, of course, is simply to add another trillion or two to our annual deficit to pay providers what they want.
Prior to Health Reform, the joke about health insurance, among actuaries for commercial health plans that competed for members, used to be that “we lose a little on every policy, but we make up for it in volume.” Any wonder why most insurers left the marketplace? Any wonder why the cost of commercial health coverage is what it is today?
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Okay, give us a viable alternative that includes every citizen at every income level.
Medicare today only works because fees it pays are offset by the private sector so that needs to change and fees need to go up in M4A system but not to private ins levels.
Every part of the system including patients needs to change something. We need to rethink paying for medical education too.
Medicare is not socialism
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Agree, Medicare is not socialism, however Medicare for All is likely to lapse into socialism – in that Americans don’t want to pay what health care costs. They want the best health care coverage YOUR money will buy. Their motto: “Don’t tax you, don’t tax me, tax that guy behind the tree”. Or, “The best tax is the one I owe and YOU pay.”
Here is the solution I favor:
Amendment of EMTALA, the Emergency Medical Treatment & Labor Act, which requires Medicare-participating hospitals – pretty much all hospitals – to provide emergency medical screening and stabilization to anyone who requests it, regardless of ability to pay, where the Act would be amended to require every individual who is lawfully present in America to have health coverage in the form of stop loss and provision for expenses up to the stop loss attachment point:
Stop Loss: A universal health care stop loss system for all lawfully present with Medicare Allowable reimbursement rates and an attachment point of $25,000, which would include every American, whether or not they have Medicare, Medicaid, VA, exchange coverage, individual coverage or employer-sponsored coverage or otherwise uninsured. The premium would be a per capita, per month amount. The premium would be paid by each individual, however, it would be included as part of any health coverage – Medicare, Medicaid, VA, exchange, employer-sponsored plan – and, where covered under an employer sponsored plan, it would be separately identified and paid by the worker with pre-tax contributions using a cafeteria plan. Everyone else who is not covered by one of those plans would pay the premium as a nominal, per capita tax. Where they do not have any income to pay the tax, it would remain due and be subject to interest at the regular IRS rate.
Financial Responsibility: Supposedly, all but thirty million or so Americans who are lawfully present in the country have coverage under Medicare, Medicaid, VA, exchange coverage, individual coverage or employer-sponsored coverage. All who lack that coverage would be defaulted into exchange coverage – with a PPACA taxpayer subsidy for premiums in excess of the greater of ten percent of income or a nominal dollar amount. Those individuals who are defauled into exchange coverage can only opt out if they self-insure by presenting a bond of $25,000. Those defaulted into exchange coverage would pay the premium through the income tax system – the quarterly “withholding” system would apply where payroll withholding is not sufficient. Every lawfully present individual would be required to file an income tax return where coverage would be certified for every day of the year, and where exchange and stop loss premiums would be calculated and paid. Failure to pay the premiums would remain due, accumulate interest at the regular IRS rate. The IRS would pursue collection on the same basis as it would for any other taxes due. The only forgiveness is at death.
Lawfully present includes those who claim asylum, those who are here with visa’s etc. All lawfully present would be required to be covered every day of the year, stop loss and financial responsibility coverage. So, those who come to America penniless and without employment would need a sponsor – just as it was a hundred years ago.
Everyone who is not lawfully present in America should leave, as hospitals and all other providers, would not be required to treat them. There would be no taxpayer support for uncompensated care. Non-profit hospitals, organized under 501c3 could solicit charitable donations.
Sound harsh? If you want universal coverage, you need universal sharing of the financial burden. Setting the stop loss attachment point at a low level makes a bronze or silver exchange health plan affordable.
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Per usual Jack you lay it all out and makes one think. Sharing the financial burden makes sense for a number of reasons both financially and morally.
One concern is Medicare For All will replicate the other broke social programs like SS, Medicare, and Medicaid. They blow up when folks add benefits with no source of spending.
Thanks for your time and effort. It is greatly appreciated.
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My opinion is clouded by being on Medicare and having a supplement. I don’t like the monthly costs but in relation to what I receive I shouldn’t complain, so I don’t. I don’t worry about the internal workings of the system. I present my Medicare card and get treatment. What’s not to like?
Is this doable for the whole of the population? I think one big system would cost more than we think and not be as easy as I have it now. I’m including all current Medicare recipients when I say that.
I’m reluctant to turn the entire system over to CMS. Medicare works for a subset of American people but to throw everything into the hopper seems to me to be risky at best. Sorry o wasn’t up to the challenge.
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