Medicare for All? Medicare for Us Is Different

Power (And Free Stuff) For the People!

Blame this one on four wasted evenings watching the Democratic presidential debates.  As Senators Bernie Sanders and Elizabeth Warren and the rest were describing their promise of “Medicare for All,” my wife and I were deep in the process of learning about and registering for “Medicare for Us,” which kicked in this month.

The big discrepancies between the two inspired my column (here) in today’s Richmond Times-Dispatch.

The debate over health care policy and payment systems is a perfectly valid one for national politics.  Everyone sees the problems.  Like it or not the country is about half-way, perhaps more than half-way, to a fully federalized health care system.  Medicare, Medicaid and the military-related programs covered about 33 percent of Virginians in 2018, and federal regulations including but not limited to the Affordable Care Act dictate many policies for the rest of that sector.   Both political parties have added to the structure. 

It is also a debate where both political parties can put their operating ideologies to the test.

Republicans, including the current leader of that clan in the White House, can claim they favor personal responsibility and choice, more openness in pricing by hospitals and other providers, and using the power of government to bring the greed of the pharmaceutical industry under control (a focus of the current administration.)

Democrats, led by the most ambitious cadre of social engineers in their history, can claim they favor a total government takeover (like the now-dead postal monopoly), which will then set prices for hospitals and other providers, including the pharmaceutical industry.  This will relieve the huge pressure on individual finances, and (seldom recognized) also provide a huge benefit to employers, many of whom will jump at the chance to pass off this burden.

Right now, our system contains elements of both approaches, but neither dominates, the moneyed interests manipulate both, and the resulting monstrosity satisfies no one (except those getting rich off it.) Both political camps point to the elements popular with their opponents and blame that for our continued frustrations, ignoring any failings in their own approach.

Neither approach is the solution if the goal is health, because in that arena like many others, the major problems – cancer, obesity, diabetes, heart disease – are largely due to our own bad habits, terrible diets and exercise-averse lifestyles.   You can’t cure stupid, but we all share the cost of treating the long-term effects of stupid, either through the insurance pools or the tax system.

Are all the diseases or injuries people face lifestyle-driven?  No, but the congestion and shortages within the health delivery system which drive up the costs are made far worse by the lifestyle diseases.  That plus the outrageous end-of-life expenses, another feature of American health care not replicated everywhere around the world.  Mention that and you hear “Death panels! Rationing!”

Medicare charges higher taxes in working years and then higher annual premiums in retirement if you have been financially successful.  So far, I’ve seen no sign of any financial cost or penalty for the obvious risky behaviors (except some of the Medicare advantage plans do use medical underwriting exclusions and siphon off healthier retirees.)

Health itself is an issue no political party will focus on, because telling voters the truth about that will not earn their votes.  On that one, Marianne Williamson is the Democrat making sense.  She probably won’t make the cut for the next debate.  A prevention and wellness approach to Medicare would be worth exploring.  Don’t hold your breath.


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18 responses to “Medicare for All? Medicare for Us Is Different”

  1. LarrytheG Avatar

    A good post but misguided.

    First – more than 30 other countries (who do have smokers and other bad lifestyles as us) manage to cover ALL of their citizens at 1/2 what we pay AND they ALL have longer life expectancies.

    Those are facts.

    And they DO PAY TAXES to pay for it – the govt does not “subsidize” it any more or less than any other taxpayer-funded service or infrastructure in those 30+ countries nor this one.’

    these are facts also.

    And YES, they DO “ration” – We do too. Every hear of insurance that “will not cover” something or only part of it or has annual or lifetime caps?

    And what do we call it when people have pre-existing conditions NOT due to lifestyle “choices” and one political party has up until now – never worried about who was denied insurance or could not afford it – and that political party STILL does not have answers – and it’s been that way since BEFORE TRUMP as they chose to do nothing about it and enough of them would have voted to kill the ACA under TRUMP had there not been ONE vote to not do so.

    I know we all have biases but we need to use facts when we discuss this – and not just try to ratioinalize our biases.

    It’s a simple thing. What do you want to do about people who cannot get coverage because of pre-existing conditions or they can but they cannot afford it? Those other 30 countries have the same problem by the way but their choice is to include them all.

    In this country – we keep insisting that “transparency” and reining in the drug companies will “fix” the problem. And I ask, WHAT COUNTRY out of 200+ on the planet does this? Are we advocating something that no country on earth does right now as a fix while totally ignoring what the 30 other countries do and are successful at?

    Truth be know, I’d be FINE with those proposals IF they would actually stop talking about it and do it AND if those things did nt work – they DO have a plan B instead of what they’ve done for more than 30 years – i.e. TALK and blame the Dems.

    And yes, I’m ALSO FINE with charging MORE for Medicare on a sliding income basis – like we do for a lot of other entitlements.

    You did not mention how much “more” the richer folks pay for Medicare right now but if not mistaken – it’s about $350 a month and about $165 for the beginning tier. Do you think you could AFFORD health insurance over age 65 if they made it “transparent” – or would the insurance companies just dump most everyone over 65 because they are KNOWN bad risks?

    What exactly ENTITLES people over 65 to guaranteed health insurance and essentially denies that access to folks under 65? What national policy says that people over 65 DESERVE health insurance (no matter their lifestyle “choices”) and denies coverage to those under 65 because – well they’re not 65?

    We just take it for granted that we’re guaranteed that entitlement and NO, we do NOT pay for it with FICA. We pay for Part A with FICA (that’s hospital) but we do not pay a penny for Part B from FICA – that’s why you pay for it when you retire.

    So exactly WHY are you entitled to be able to buy Medicare in the first place and others are not? What makes you more deserving of it than someone who is 50 and cannot get insurance?

    1. “I’m ALSO FINE with charging MORE for Medicare on a sliding income basis – like we do for a lot of other entitlements.”

      Cat’s out of the bag — Medicare For All is another income-redistribution scheme. We’d move from a health care system in which half the population is in means-tested insurance programs (Medicare and Medicaid) to one in which 100% of the population is. Prediction: As the cost of the program becomes increasingly onerous and impossible to afford, the income-redistribution element will become increasingly progressive.

      Sanders and Warren just aren’t open and honest about it, like Larry is.

      1. djrippert Avatar

        Of course it’s another income redistribution scheme. That’s all the Democrats (and LarrytheG) have. Take from the makers and give to the takers. In other words, socialism. I can’t count the number of people I know from high school and college who went out, got college degrees, sometimes graduate degrees and accomplished nothing with their lives. They bounced from job to job looking for the mythical occupation that would somehow make them happy and complete. They not only failed to save any money they didn’t fund (or fully fund) their 401k programs. Now they’re in their 60s and their lack of success is due to how unfair everything is. It seems only right to them that those who enjoyed “the rigged system” give them the money the makers saved.

        America has become a country of losers and the standard bearers for the loser class are Elizabeth Warren and Bernie Sanders.

        1. LarrytheG Avatar

          re: ” In other words, socialism”

          balderdash! If you don’t think the Va, Medicare, public roads and public schools, pipelines, airports, transit, are not “socialism” then you’re a couple cards short of a full deck!

          Depending on how one wants to “define” socialism – just be consistent with it – if ONLY the “makers” got publicly funded schools, roads Medicare, etc then yes, we’d have a true system where only the “makers” benefited but that’s just not the reality.

          Even employer-provided health insurance is “socialism” in that the govt (all taxpayers) subsidize it by not taxing the money spent for it; it is by far the biggest tax expenditure in the tax law AND beyond that it REQUIRES that insurance cover everyone for the same premium price instead of pricing it per individual risk – that’s GRADE A socialism, bub.

          What we like to pretend is that the things the government already provide us is “grandfathered” socialism and “okay” but anything else is “bad” socialism… and we can’t have it because we’re not a “socialist” country.. more make-believe from deniers… 😉

  2. LarrytheG Avatar

    The lifestyle thing is totally bogus and here’s why. People who bring that argument up use to advocate AGAINST someone to get insurance but they do not say what they FAVOR for the folks who did NOT make “bad” choices – and through no fault of their own cannot get insurance. When you tell me what you’d do for them – I’ll take your argument against more seriously. Otherwise, it a handy excuse to argue against and blame the Dems , etc, i.e. non-responsive to the issue which typifies most Conservatives opposed to health insurance; they, like the GOP, essentially have no answers other than “price transparency” or govt control of drug prices (stated so it does not sound like govt “control”).

    When you guys come up with an answer for folks who do not have “bad” lifestyle choices and cannot get insurance, let me know because to this point – it’s not an honest conversation.

    It’s not about what you don’t want – anyone can do that; it’s about what you DO WANT that will address the issue – not “ideas” but things that actually DO WORK. “Ideas” are like butts – everyone has one – it’s actual solutions that we seem to lack and of course because we do not have solutions – it’s the Dems “fault”.

  3. Steve Haner Avatar
    Steve Haner

    You know, Larry, setting you off was half my motivation for writing this. 🙂 And your two points come together, because the reality is that those other countries do NOT have the same pathetically unhealthy population, fattest and sickest and laziest in the history of the world, and are not totally beholden to Big Pharma, Big Tobacco and Big Sugar. Admittedly some of them are starting to show the problems we’ve got. Our tobacco sure kills all around the world.

    Did I blame any Democrats for the situation we are in? Did I praise any Republican so-called solutions? No, we have met this enemy and it is us. My basic point in the RTD is that what we’ve seen ourselves bears virtually no relationship to what is being promised, so it isn’t Medicare at all. My basic point in the posted “revise and extend” is that everybody talks past the real problem and that’s our own bad behaviors. You included, apparently. I was being told the other day that even Parkinson’s is now being tied by research to diet and digestive issues. Parkinson’s starts in the gut. My suggestion there is the whole system be revised, top to bottom, to focus on wellness and price in the consequences of bad behavior as a strong disincentive.

    Medicare? Why am I entitled to take a monthly Social Security payment somewhere between my 62nd and 70th birthday? I didn’t set any of this up. The taxes were taken, I didn’t die, so now the benefits start. We are moving to Medicare because that’s what my wife’s previous insurance plan required, and it was an excellent (we’re quite lucky there) retiree system while it lasted. I can’t blame them for saying that retirees at 65 switch to Medicare or Medicare Advantage and get off the group plan.

    1. djrippert Avatar

      Americans are fat, unhealthy and lazy. There are only so many pounder bags of peanut M&Ms you can scarf down watching The Biggest Loser on TV before you find yourself with health problems.

      Sort on the “health consequences” column in the following article. Hampton Roads is the 30th worst American city for health consequences of obesity while Richmond clocks in at 35. The DC metro is well down the list at 75 (although I’d bet that without DC it would be far lower). Meanwhile, Virginia has the second lowest state tax on cigarettes in the country.

      Let’s be honest – the Republicans in Virginia are as big a bunch of socialists as Elizabeth Warren and Bernie Sanders. Tax NoVa to death to pay for everything everywhere else – including the health care for people who don’t care about themselves.

  4. djrippert Avatar

    Roanoke – 12th most smokers of any city in the US …

    1. Steve Haner Avatar
      Steve Haner

      That was just the Roanoke Times newsroom back in the day! Pipes in my case, and no question the double bypass two decades later was at least partly caused by that (and the way I ate in those days.)

      1. djrippert Avatar

        At least pipe smoke smells good. I don’t care if people smoke pipes, cigarettes, cigars or pot. Just tax it!

  5. Jane Twitmyer Avatar
    Jane Twitmyer

    “Neither approach is the solution if the goal is health … A prevention and wellness approach to Medicare would be worth exploring.”

    Absolutely, but there are 2 other problems … Big Pharma and the medical establishment. For Big Pharma … look no further than the Oxicodone addiction problem. The makers knew that addiction can occur in 2 weeks. Like Exxon and their knowledge of climate change in the 80’s, they hid the facts from the medical profession who followed the hydro/oxicodone promotions and prescribed liberally. I was a victim who got a 3 months prescription from the DR. who botched my hip replacement surgery. Luckily, I knew enough to phase out use when my brain started feeling flaky.

    The medical issue is more complicated than just lying pill manufacturers, but it too appears to be tied to money. 20 years ago I started reading about a group of Drs. who were working to change medicine and to look for cures, and not just treat symptoms. They are called Functional Medicine practitioners. According to the Cleveland Clinic, which has a Functional Medicine Center, their physicians are applying a new model that focuses on treating your body as a whole system. While we all appreciate the quick acting resources of modern medicine, “jumping in with drugs, surgery and other acute care treatments, too often does not succeed in helping those with chronic, debilitating ailments, such as diabetes, heart disease or arthritis. Another approach is needed. … Functional Medicine better matches the need to improve the management and prevention of chronic diseases.”

    So there’s an answer that goes beyond ‘personal responsibility’ for nutrition and lifestyle changes. These guys are making headway but …. Take Type 2 Diabetes. It affects 20 million Americans, and its prevalence is rising to epidemic proportions. When will their approach, which has cured or alleviated many affected, make it to the mainstream of medicine? Diabetes management means big dollars to the pharmaceutical industry and keeps the insurance companies busy.

  6. Steve Haner Avatar
    Steve Haner

    The concierge practice I mentioned in the RTD column has MD’s with the above board certification. “Anti-aging” medicine. My current doc is moving to that practice and I think I’m going with him. Will be costly….

  7. Currently, those who drink alcohol or who do illegal drugs so much that they damage their liver, kidneys, etc., are denied transplants. The denial is a form of rationing based on life-style. I think it is a reasonable approach. The incendiary issues pertain to STD’s that arise from the sick person’s life-style choice.

  8. Peter Galuszka Avatar
    Peter Galuszka

    I am a little surprised by your piece. I went through the Medicare thing two years ago (just me, not a spouse, which admittedly changes things) and I spent a lot of time on the supplement. There was no “surprise” at all. I understood what Part A was and Part B and so on. I realized that the supplement was the variable and it could change. I was lucky and got a good supplement and found that my medical premiums went down by several hundred dollars a month from being a sole, self-employed person to one on Medicare. The savings for me were significant. Luckily, I am relatively healthy and do not have the problems that could soon wreck this regime. Are you telling me you didn’t understand this? Are you blaming the ever-blamable Democrats for this? I admit the system is a mess but for me, it is far better than being self-employed and getting expensive medical insurance on my own dime. Anyone with any familiarity with the system should know this.Why, apparently, don’t you?

  9. Steve Haner Avatar
    Steve Haner

    Well, having always been on an employer plan one way or another, life was very simple and frankly not the financial burden you see with individual coverage. There were many things we had to learn. But again – the point is that Medicare as it is and the Medicare for All being promised to the masses are not the same thing at all. My wife and I were sitting listening to a debate and wondering just what they were describing….sounded totally free and so, so simple. Sanders was clear that vision, hearing and dental would have to be added, but he isn’t always so clear on that even.

    But that’s still my point. What we have, and the promises being made, are worlds apart. Then there are the crap promises in the robo phone calls….a whole additional level of confusion, not the politicians fault directly, but somehow tolerated.

    I’m usually pretty clear when I’m blaming Democrats for something. Don’t think I blamed anybody for the way Medicare is, given it has developed over 50 years. Most people like it. We probably will, too. Not sure we’d like what those candidates are promising, or that we can afford it.

  10. Steve Haner Avatar
    Steve Haner

    Just got an email off line from a local doc, probably a great doc, who really supports the proposals in Congress for “Medicare for All” who went on to list all the ways it will be better than the current system. But she was making my point. What they are promising is NOT the current system for all, but something very different. Voters might also be excited to sign up for current Medicare at any point in their life, but the vision being sold is idyllic.

  11. TooManyTaxes Avatar

    Employer-funded health insurance is compensation for work. At the present time, my wife, who is retired from the federal government, covers us with the same health insurance she had when she was working. It’s a worked for retirement benefit. We aren’t on Medicare Part B. I reimburse her for half the premiums as I did for the 20 plus years we’ve had this insurance. Before that I had coverage from my employer. We switched when I left that employment.

    I regard anyone, including the good senators from Mass and Vermont, who wants to take away my private health insurance the same as if they broke into our house and stole property. Or hacked my bank account and stole my money on deposit. When I hear Medicare for all, I feel like exercising my Second Amendment rights by arming myself. You don’t take people’s compensation away from them to support vote buying.

    Big Pharma is a big problem. There is no reason why a pharmaceutical company should be permitted to sell a drug in the United States for a price that exceeds what it sells the same drug for in any OECD nation. Trump’s going after Big Pharma is a policy I like.

  12. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    “Medicare for All” is one of those simplistic political slogans that captures the imaginations of many people, but ignores the complexities of reality. (Sort of like “Build the Wall”.) As David Brooks argued several months ago, a single payer system would be possible, and might be preferable, if we were starting from scratch. But we are not doing that and our health care system is so complex that “you can’t get there from here.”

    My wife and I just made the transition to Medicare at the beginning of the year. So far, I am happy with Part A and B. Our total premiums are lower than the state policy I had before and the coverage is about the same. (I did not experience any quick increase in the premium for the supplement. I expect that will come next fall during the renewal period.) The kicker is the prescription drug coverage. The company I settled on had three tiers. I picked the middle tier, which covered all our prescriptions, and was cheaper than what I paid earlier. However, during the year, my wife has had to go on two new prescriptions that were not included in our coverage. The co-pays are hefty. So, there are surprises, but, all in all, I am satisfied so far. It was nice, however, being able to just go with the state employee plan, and not have to worry about making all the price and coverage comparisons!

    Like others on this blog, I like the Trump administration’s policy about taking on the pharmaceutical industry. But, I don’t see much happening, just a lot of rhetoric. If nothing else, he could have pushed for legislation that would have allowed the Medicaid and Medicare programs to negotiate drug prices with the manufacturers. And then there is the question of buying medicine from Canada. When Americans form caravans to travel to Canada to buy insulin at about a tenth of its cost in the United
    States, something is wrong.
    I hear a lot of ranting and tweeting, but haven’t seen any action.

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