For more than 50 years, Medicare has been America’s remarkable, government-run “single payer” public health insurance program for tens of millions of Americans age 65 and over.
With a half-century of proven success and popularity, there is now a growing movement — including among Democratic candidates for President — to expand the Medicare health insurance program to those under 65. How? By letting younger Americans purchase Medicare coverage through a “public option” or to even become part of a more comprehensive, national “Medicare for All” single-payer program that displaces private health insurance companies.
With Medicare as popular as it is, it is shocking that the Trump administration sent a budget to Congress proposing a cut of roughly $60 billion per year in Medicare funding — that’s a funding cut, on average, of $1,000 per year for America’s 60 million Medicare beneficiaries! This is all the more shocking since President Trump campaigned in 2016 on a promise to never cut Medicare.
Trump’s budget proposal claims that elimination of Medicare fraud will cover a substantial portion of the proposed funding cuts. I say, nonsense! No doubt there are fraudulent payments being made by Medicare, exposed from time to time in big news articles. However, if it is known that massive fraud is taking place, why hasn’t it been addressed already? Clearly, finding tens of billions of dollars of fraud to cover the proposed enormous cuts is just plain absurd.
In addition to cutting actual services, the Trump budget proposes cutting extensive research programs that are intended to reduce costs while improving patient outcomes. Those programs provide financial incentives and alternative payment plans such as Accountable Care Organizations and payments for successful treatment outcomes rather than for individual procedures. These incentives reduce re-hospitalizations, reduce unnecessary procedures such as excessive imaging studies, and optimize physician time.
The proposed Trump cuts would surely “throw out the baby with the bath water!” In any case, services — especially preventive care — should be expanded rather than cut. Keeping people healthy saves money!
While Medicare can certainly be improved, it is already very efficient compared to private health insurance, and is very successful. My own experience is that I have had far fewer problems and far greater flexibility with Medicare than with the private healthcare insurance I had during an earlier part of my life.
How to pay for Medicare for All
A major misunderstanding about expanded Medicare is where the funds will come from to pay for it. Right now, individuals and companies are typically paying large monthly healthcare insurance premiums and co-pays. These costs to businesses and individuals would be eliminated, and replaced by taxes. Those taxes would just be the premiums paid, but under a different name, since money paid to a government is typically called a “tax.” When paid to an insurance company it’s called a “premium.”
The arithmetic to pay for Medicare for All has already been worked out. One proposal from an extensive University of Massachusetts-Amherst study (discussed in my July, 2018 article: “The Healthy California Act”), worked out the details to replace premiums and co-pays with progressive taxes that cost less for the individual or the employer, while also covering the currently uninsured — all from the savings generated by largely eliminating private, for-profit insurance companies!
To those who complain about expanding “socialism,” I must point out another misconception: Medicare provides only healthcare insurance, not healthcare services. Private sector medical services providers (physicians, hospitals, etc.) won’t change with an expansion of Medicare coverage. Ironically, it is the government-run Veterans Administration that provides both insurance and medical services, which is the socialist model.
In the end, the arguments against an expanded Medicare program are supportable neither by arithmetic nor other evidence. Thankfully, now that the Democrats are in the majority in the House of Representatives, it is unlikely that Trump’s proposed cuts will be enacted by Congress. But, let’s be vigilant!
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