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June 13, 2005

Medicare For All

I've been trying to decide whether or not to link to Krugman's column today.  On the one hand, it's a nice restatement of the liberal position on health care.  On the other, it's pretty simplistic -- you guys have heard this before.  But it does inadvertently make a point that needs to be said louder.  Some single payer advocates think the very idea is simple enough, that just bringing it out into the world will give us a comprehensible and broadly supportable strategy.  Not so -- single payer is actually quite odd  The idea of a government takeover in health care turns folks off, at which point we have to explain that no, the government isn't taking over health care, just all forms of health insurance, and no, that won't change health services, and no, nothing will be different in this wholly new structure where everything is funded differently and there are no more insurance companies.  It's all quite counterintuitive.   

That's why Medicare-for-All is such a great banner.  Medicare happens to be a very good, though deeply underfunded program.  It keeps costs down better than the private sector, it enjoys sky-high satisfaction ratings from those on it, its administrative costs are dirt cheap, and so forth.  Problem is, the program is on bad financial footing, though that's the government's fault, not the program's.  Nevertheless -- Medicare is understandable.  People have it already.  Seniors protect it like an especially precocious grandchild.  It's just normal health care that the government pays for.  Simple as that. 

Better yet, Republicans can't demonize the idea because it already exists andeverybody's parents and grandparents use it.  The commercials on the television just don't trump the matriarch in the living room.  So Republicans can go after its financial footing and call it unsustainable, but the first hurdle, the conceptual one, is cleared.  That's why if Democrats want to push for single payer, using Medicare, rather than the undefined "single-payer", is the way to go.  The final program, of course, could be changed so that nationwide Medicare only looks somewhat like the current incarnation but using a program already in place makes it more likely we'll get to that legislative point.

June 13, 2005 in Health Care | Permalink


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I think that healthcare needs to be pushed as part of a movement, somewhat independent of the Democratic party, in the same way that civil rights and women's suffrage were. The only way to get past the power of the lobbyists is to make support so broad and deep that politicians risk their jobs if they vote against it.

Posted by: Abby | Jun 13, 2005 3:20:53 PM

Medicare part B costs $78 a month and only pays 80% of hospital and docter bills. That's with no Rx. If you include the Rx payment of $35 a month you still have $3,600 a year in just Rx Out-Of-Pocket. So now you are up to $113 a month with a program that still needs a Medigap plan which my mother is paying over $170 a month for. That's a total of $283 a month with $3,600 out of pocket just for drugs.

Then you have the problem that Medicare pays doctors so little that they shift the cost to the private patients. If everybody is in Medicare where will the docs shift the cost to? Plus, you forget that Medicare currently has an unfunded liability of $27 trillion dollars.

In the free and open market Ezra, my son who is about your age pays $55 a month for insurance that pays 100% to $8 million after his deductible. Plus his insurance company answers their phone. Try and get the government to answer their phone. I'm sorry Ezra but you really have gone over the deep end this time. Plus if you put all insurance companies out of business who is going to sell the Medigap plans. I think you better go back to the drawing board and come up with another plan without the help of Paul Krugman. Everybody here will probably love your idea though.

Posted by: Ron Greiner | Jun 13, 2005 3:40:06 PM

Yeah... I think the secret benefit of Krugman's wacky suggestion - should anyone take it seriously - is to draw Republicans into a Catch-22 of saying "we can't roll out Medicare to everyone, because it's already out of money," thus introducing a debate that could truly do themselves in. If they're reckless enough to fall for it. Realistically, the slogan of Medicare for Everyone is beyond DOA - more like already in rigor, possibly decaying.

PS I think Krugman's most outlandish statement is that there's somehow more public pressure for govt. run healthcare than there was in the forties. I don't buy that for a minute.

Posted by: weboy | Jun 13, 2005 3:54:06 PM

1) The docs will make less, or we'll turn more over to NP's.

2) Your son's health insurance is probably going to cost a little bit less than my 86-year old grandmother's. For an insurance agent like yourself to make such a blazingly dishonest comparison is quite sad.

3) I don't forget Medicare's unfunded liability, I actually address it directly.

4) My insurance company isn't so good about the phone thing either. In any case, customer satisfaction with Medicaid is MUCH higher than wiuth private insurers, so your point just falls apart on those grounds.

Posted by: Ezra | Jun 13, 2005 3:55:01 PM

Exactly right. I think wonks are tempted by the elegance of other systems (like the French and German ones). It's our desire to create an opportunity to "do it right" (which, ironically enough, would include far more market-mechanisms than are in Medicare) that leads us astray.

Three words: Medicare. For. All. Just keep it simple, and work out the details within that framework.

Posted by: theorajones | Jun 13, 2005 4:24:25 PM

Ezra, just today I added a child on to his parent's plan that is are clients of mine. The cost to add the child was under $35 a month. The reason I'm adding the child is because Medicaid is dropping him. I bet Medicaid was costing 15 times more.

Good point about that a Medigap plan would probably be less for my son than for my mother. That's because it comes from a private insurer though.

So you want the docs to make less and the insurance industry to go out of business. Sounds like a winner. I'm sure this will fly so e-mail your congressman and tell them you have a plan.

Posted by: Ron Greiner | Jun 13, 2005 4:31:59 PM

The problem with Ron's issues is that he assumes all things are equal once this plan is implemented. Obviously, if you implement a nationwide health system, then you must also implement a nationwide call system to handle any problems that might arise. Of course, this all assumes that you'd actually have to call them. What would be the reasons to call your insurance company. Hmm, lets see, you submit a claim and they won't cover it. Aye! But this doesn't happen in Medicare-For-All!

As far as doctor pay is considered, yes, it is something to take into account. But its also two-fold. Part of the reason salaries are high is to cover loans incurred in medical school. If there were a program to bring down educational debt, a certain cut in salary would probably be acceptable ("certain" TBD.)

As far as insurance companies are concerned, well Ron, I am sorry you would be without a job. Your job after all, is redundant, is it not? Of course, the question you ask of whether insurance companies will accept this is a political one. Obviously, if extra insurance is needed, companies would stick around to offer the gap, albeit not as much. In the end, you have to believe in the cause of providing health care for all to come up with a solution at all. Otherwise, you are just like the people you work for, trying to squeeze every last buck.

Posted by: Adrock | Jun 13, 2005 5:32:08 PM

You forget that their isn't one Democrat who has a plan that is "Medicare for All", except you and ezra. I'm afraid you guys don't count.

So I won't email the company's 150,000 agents and tell them they are out of business just yet.

Name one Democrat with a plan, come on.

Posted by: Ron Greiner | Jun 13, 2005 5:50:33 PM

Sigh -- Ron, if you're going to pretend to be informed, I'd stop getting things so wrong. Medicare for All has been introduced in both the House and the Senate, H.R 676, which has 38 cosponsors. Kennedy introduced the partnerv bill in the Senate. You also failed to answer my points, then made a non-sequitur about private care being cheaper despite the fact that that's know not to be true. Not only is it not true, but my grandmother would cost more than your son in any case, private or non, because she's higher liability. Admit it -- you don't really work in the health industry, do you?

Posted by: Ezra | Jun 13, 2005 6:26:34 PM

Well actually Ron, here in California those Medicare patients are highly prized by providers because compared to most of the big insurers Medicare pays so damn well.

Posted by: J Bean | Jun 13, 2005 10:15:42 PM

Is it possible that the biotech/nanotech revolution will bring down the cost of healthcare? That would help either side in the argument. A drug-bot which can specifically target a tumor saves a bundle by avoiding surgery. Individual genetic profiles will help preventitive medicine enormously.

Posted by: Steve Mudge | Jun 14, 2005 12:02:53 AM

Medicare for all could be an intermediate step. It has the advantages of low administrative costs, familiarity. In the longer term we need to think about ways to construct the health care delivery system such that it is integrated, and has appropriate incentives.

Medicare has incentives for doctors and hospitals to perform more procedures which without any other forces for utilization management will cause costs to explode.

As much as people like Medicare now - how much of that is just because of their problems and anxieties about their health care coverage previously. Medicare in and of itself doesn't really do anything about our fragmented delivery system.

Posted by: Rebecca S | Jun 14, 2005 5:30:58 AM

It’s good to know that somebody besides public health officials are aware of it.:)

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Posted by: Alisya | Mar 22, 2007 3:30:11 AM

I see that these comments are almost two years old.

Much has happened since 2005. There is more momentum for a guaranteed quality Medicare for All than there has been in 50 years or so.

People are dying for healthcare. Almost 1/3rd of us are uncovered or partially covered. And the insurance companies' greed and waste come to about 1/3 of the money we spend on healthcare.

Medicare is a totally American program. It is good. It can be and should be made better. But we can do it. We are just as smart as the 37 other rich countries in the world who have solved this problem.

Marilyn Clement, www.healthcare-now.org

Posted by: marilyn Clement | May 27, 2007 9:21:01 PM

HR 676, a bill introduced in 2003, by Conyers and Kucinich, appears to be exactly what is called for: Medicare for all. Not rocket science. And not Socialism.
With CBS news rating the US health care system at 66% (That's a "D" in my classroom) and Cuba's as better than ours, I believe it's time to act!

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Posted by: mike praado | Aug 5, 2007 5:10:32 AM

Good argument for medicare for all. One payer system that is predictable would lower my over head in paper work, billing issues, nursing staff, and headaches. Many other things to consider: 1. I would love to stop pleading with a low level employee that has no clinical back gound to get a proccedure done. 2. Many private insurance companies like to try to pay medicare rate or just below. 3. Even if a prive payer payes, I sometimes get a letter wanting there money back because of pior exsiting condition. (ie, sinusitis). 3. Drug coverage: Well walmart has fixed that issue. Many drugs that I frquently use are $4.00 a month. Not to mention medicare can negotiate cheaper drug cost. Do You think other socialized countries pay $200.00 a month for advir. 4. When you account for deductable, monthly premium and co-pays it is cheaper for most people to just be a self pay. 5. We have system in place that works. It just is in trouble finacialy. This would be fixed when we (users fo private ins.) pay our preimum to medicare. Instead of just insuring high utilizers we now include low utilizes to ofset cost. (Hence, the original design of ins.)
I could keep going.

Dr. Michael Geile Internal Med.

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