Medicare for All?
Terry H. Schwadron
Sept. 14, 2017
Well, Bernie has shown up, and people of all political stripe are taking notice.
His bill introduced on Wednesday would expand Medicare into a universal health care program, guaranteeing insurance coverage to all Americans in what surely must be one of the country’s broadest swipe for social equality. The Vermont independent managed to line up 16 Democratic co-sponsors for the effort, which looks as if it will shake up politics from the progressive side rather than from the conservatives.
It may have arrived just in time, and I, for one, am glad to stir the health care pot with something other than what have become familiar Republican arguments to push millions of people off their health insurance in the name of free markets and smaller government. Universal health care is something I’d be happy to pay more taxes to obtain, and frankly, I don’t understand why the nation’s wealthy class would not. Instead do they need another vacation trip? Another new car?
Republicans are pushing to move ahead with other efforts in Congress that are well short of repeal and replace Obamacare politics, but which over time will lessen benefits for average Americans.
And it comes just as Team Trump has doubled down on non-congressional efforts to use deregulation and overturning of Obama-era health rules in an effort to free up doctors, hospitals, nursing homes and others in the business of medicine from government limitations. The would-be rationale: Fewer rules, less cost, with cost improvements eventually to pass on to consumers, a contention rather difficult to show will actually happen. Rather, it would seem, the changes are the direct result of various industry lobbying with a pliable Department of Health and Human Services Secretary — Tom Price.
But the excitement for the moment is on the Bernie Sanders bill, the result of his campaign promises, with the various inputs of the Hillary Clinton campaign and two dozen Democratic senators who offered suggestions if not an offer to co-sponsor the legislation. It took exactly no time at all for the proposal to draw a denunciation from the White House, with Press Secretary Sarah Huckabee Sanders offering the approbation that the country needs less government in health care, not more.
Bernie’s basic argument: Medicare works. Let more people buy into Medicare over four years, and treat health care as a right not a limited legislative handout. And unleash Medicare overseers to negotiate with drug companies.
All that said, this bill, too, is light on what will and won’t be covered, on exactly how it would roll out, how much it really would cost, and, indeed, whether it will ever come to a full congressional vote. However, it will push the debate for single-payer health systems and change the nature of what the health care debate has been until now during these contentions months.
Let’s break the alternative down:
The Sanders bill: Medicare for All would eliminate nearly all private health insurance in favor of a government-run system that ensures comprehensive coverage to every single individual through Medicare. In the first year, the eligibility age for Medicare would be lowered to 55, and those under 18 would immediately receive access to the program. Adults not currently eligible for Medicare would be phased in over four years.
The legislation proposes eliminating co-payments and granting all enrollees comprehensive benefits that include coverage for emergency surgery, mental health services and prescription drugs. The federal government would bear the cost of the program, which it would pay for through higher taxes and money not paid to insurers. During the campaign, Sanders said it might cost $10 trillion over 10 years, but others said it is closer to three times that.
Medicare Buy-In: Some Senate Democrats led by Debbie Stabenow are backing legislation that would expand Medicare to allow individuals as young as 55 to buy into the government-run program, a reduced version of Sanders’ bill. The proposal aims to provide Americans aged 55 to 64 with another, potentially lower-cost health insurance option, by allowing them to forgo private health coverage in favor of purchasing a Medicare plan. The bill would also add to government supports to make Obamacare markets. Hawaii Sen. Brian Schatz is writing a proposal to allow states the option to buy into the Medicaid program as a “public” option for people who make too much money to qualify for Medicaid.
State flexibility: Republican Senators Lindsey Graham, Bill Cassidy, Dean Heller and Ron Johnson offered an Obamacare repeal bill, framing it as the Republicans’ last, best hope. It basically gives the states much more flexibility to administer bloc grants, and over time, would reduce the payments to the states, but in the short run would equalize health spending to the states. Meanwhile, in a separate effort, the Senate health committee led by Sen. Lamar Alexander continues to try to balance short-term government supports to stabilize Obamacare with eventual reductions in the supports.
Team Trump: While Congress wrestles with Obamacare, the Trump administration is pressing ahead with plans to gut major Obama-era rules and relax federal oversight in the health care industry. Top health officials have signaled intentions to end mandatory programs making hospitals more accountable for their patients’ health, slowed the transition to a system that pays doctors based on quality rather than quantity, and indicated they will reverse a high-profile rule blocking nursing homes from forcing residents to sign away their right to sue. The effort has become the Trump administration’s chief weapon against Obamacare, and has been a lure to lobbyists who seek trimming of selected federal rules.
Targeted have been regulations that scrutinize physicians, insurers and home health care facilities in an effort to return power to the states. Medical equipment companies will get a boost from a pending rule likely to halt Medicare’s move to a new bidding program that would cut government payments to the industry.
The Sanders bill should help paint the Republican repeal and replace efforts for the sham that they push: Repeal and replace is meant to denude people of their health, to serve as a tax cut for the wealthy, and not a prescription for better health.