Viewpoints: That Democratic health care debate

Published: 8/16/2019 12:05:30 PM
Modified: 8/16/2019 12:05:18 PM

Let’s just stop all this squabbling about whether or not anyone candidate’s health care plan will or will not take away private insurance. (The insurance companies will do a pretty good job of that themselves if left to their own devices. Take away insurance, that is, especially when you sick.)

Most folks would probably stampede their way to Medicare if they could. Ask anyone over 65. But even Medicare is not 100 percent coverage. You need to buy at least a Medigap and an Rx plan. 

One direction this whole effort could take would be to make a 100 percent Medicare option that included long term care, that folks like me could buy, instead of my Medigap. If no such plan is available, when I’m old, need nursing home care, and am stripped of all my assets, I’ll be covered by Medicaid anyway. Like a lot of my Boomer cohort, who are underprepared financially for retirement.

But back to all those plans proposed from Medicare for Most, Medicare for Anyone, Medicare Extra Select, or Medicare for Us Too (Medicare4US2). The debate seems to boil down to an incremental plan -- build-out Obamacare with a Public Option — to an all-out overthrow of current system, replaced by a single-payer, government-financed Medicare for All.

Well, guess what. Incremental is the way it’s going to happen, even if the ultimate destination is universal Medicare, with or without Medigap/private insurance. Any plan will have to go through Congress.

Certain clear actions can happen first: 

1. Drop eligible age for Medicare to 50 on a buy-in basis. Set premium as a percentage of income, much like Obamacare targeted with subsidies. Later, this just becomes the Public Option for anyone.

2. Cover all children, 100%, through Medicaid, regardless of parents’ employment. Children are cheap to cover because they are the healthiest cohort. Vaccinations and broken bones. If a child does have a serious illness, it’s probably genetic, or a cancer, or environmentally-induced hazard, and extremely costly to treat/manage. No parent should have to financially cope with this. Their emotional involvement with their child needs all the support it can get; it’s all they should have to worry about.

3. Break down the silos: Medicare for the elderly and disabled, Medicaid for the poor/low income, something else for the military or government employees, an Obamacare Public Option (TK). Make all government-financed health care fall under one structure, with the same payment levels, one set of paperwork, going through one government agency. With the power to negotiate reimbursement rates with drug companies.4. Make that government plan the default plan for anyone, anytime, anywhere. You just lost your job? You’re covered by Medicare. You just got disabled? You’re covered by Medicare. You’re a college student whose parent just lost their insurance coverage? You’ve got two part-time jobs and just barely making it? You show up in an ER with no insurance? You’re covered by Medicare. (We’ll do the paperwork when you’re feeling better.)

5. By unifying government payment for all that healthcare (at this point, we’re way up over half the cost in this country) we have strong bargaining power to direct the way health care is delivered: first to focus on keeping people healthy; second on proper management of chronic diseases; and finally, prompt intervention in crises. (We’re really only good at the latter. Private insurance makes the first two into out-of-pocket expenses, thus disincentivizing them.) By stressing the first two in our healthcare system, we will bring down overall health care costs in our economy, and save lives. Medicaid expansion in the states has already shown this. Non-expansion states have lost 16,000 lives.

By building a strong, viable public health-financing system that covers most people in this country, we can establish the economic effectiveness such a system offers. We can verify that we will support a world-class healthcare delivery system without excessive cost.

With that in place, more individuals and many small business will gravitate toward it, seeing their personal costs and tax dollars used appropriately. 

In the meantime, we don’t need to take anyone’s insurance away. Those union members some candidates talked about, employees who worked hard to negotiate the “benefits” in their contract with the corporations, and who work hard to keep them, will come to understand the paradigm shift. When healthcare is a right, you shouldn’t have to “bargain” for it.

When that corporation shuts down a plant and moves operations to a right-to-work state or even overseas, those workers will find that they are still covered. By a government plan that they had been supporting with tax dollars all along. 

Heck, maybe the corporations will buy-in, too. Wouldn’t that be wonderful? Medicare for all.

Jill Shaffer Hammond is a former three-term State Representative for Peterborough


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