How to Fix It: Build a Bigger, Better Medicare
Before Medicare can serve as a bridge to a single-payer system, Medicare Part D needs to be addressed.
Any meaningful health care reform will have to overcome two major political obstacles: First, while polling shows that about 60 percent of Americans favor "a national health insurance program for all Americans, even if this would require higher taxes," most still resist the concept of a Canadian-style single-payer system. Second, few politicians are willing to embrace reform that interferes with the insurance and pharmaceutical industries.
As an alternative to the timid, complicated, and inefficient insurance-based proposals that currently prevail in the Democratic Party—most of which envision a government-run plan to compete in the marketplace with private ones—a new administration would do well to turn to the nation's only existing single-payer plan for a wide range of citizens: Medicare. The program, which is widely accepted and liked, could provide the framework for a gradually expanding system that would not only provide coverage for the mushrooming senior population, but extend to include people over 60 (and later 55) and children up to age 18 (or 21 if enrolled in higher education), with the aim of someday meeting in the middle. At the same time, Medicare could be made immediately accessible to all disabled people—who currently have to wait two years to qualify—and to all veterans, as John McCain has proposed.
One 2008 study by the Commonwealth Fund estimated that a broadly available "Medicare-like option with enhanced benefits" would cost only $259 per month for individuals and $702 for families—considerably cheaper than many private plans. While the self-employed could enroll directly in such an option, Commonwealth suggests that employers be required to either provide insurance to workers or pay into the government system. It also advocates tax credits to offset costs for those with lower incomes—though a better option would be sliding-scale premiums starting at zero.
Commonwealth estimates that this system would cover 44 million of the 48 million Americans currently without health insurance, and improve coverage for some 60 million more—while increasing health spending by no more than 1 percent.
But before Medicare can serve as a bridge to a single-payer system, flaws in the existing program need to be addressed, including Medicare Part D, the new industry-operated drug program. The loophole known as "Medicare Advantage," through which the government pays private insurance companies a premium rate to provide plans it can offer cheaper and better itself, also needs to be closed.
yeas: A "transitional" plan with a Medicare-based government option that aims to take business away from private insurers—rather than mop up their leftovers—is bolder than anything leading Democrats, including Barack Obama, have proposed. But with a strong congressional majority, such a plan might just gain support from cautious Dems, along with the grudging endorsement of single-payer advocates.
nays: The insurance industry and Big Pharma will surely see the writing on the wall in any transitional plan. Some single-payer advocates will also remain opposed to what Harvard Medical School's Steffie Woolhandler calls "tepid" reform.
chances? A Democrat in the White House will have to tackle this issue within the first year in office; in an increasingly desperate economic environment, a bolder plan just might float.
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Thanks for your editorial on the expansion of Medicare under a Canadian Single Payer System. It is also appreciated that you pointed out some very serious problems with the existing Medicare System.
As you already know there is Legislation before congress that would implement a Single Payer System. HR 676 author by Representative John Conyers staff would create such a system. It's popular name is "Medicare for All". And that is the way it is known. What is not known is HR 676 cleans up the difficiencies of Medicare as they now exist. It specifically addresses the scandal of Medicare Part D by doing away with it and folding prescription Drug coverage into Medicare Part B. HR 676 also mandates adequate funding of the system and specifically prohibits the sale of "Medicare Gap Insurance" so the Insurance Industry never slips their claws back into our wallets. Although I can't quote you chapter and verse there is little doubt in my mind, given the comprehensive nature of the legislation, the matter of "Medicare Advantage" is also addressed.
Jim, regarding your time frame for a resolution it sure would be nice if the current crisis could be addressed as quickly as you suggest but I have worked on the issue since 1994 and can tell the Insurance Industry is going to fight this matter tooth and nail because their lives depend on it. Any proposal that does not eliminate them from the equation is nothing more than a band-aid. They will use every dirty trick in the book to stop Single Payer and make up a few of their own when the book doesn't work. Welcome back our "friends" from the National Federation of Independent Business. It's been 14 Years since we last saw "Harry and Louise" and you can bet they have a new Ace up their sleeves. Barack Obama states explicitly up front his health care "solution" will leave the insurance industry in place. And while there are hopeless romantics within the Democrat Party who insist the leadership can be pressured to alter course there are to many reason why they will not. To be exact there are 2.2 Trillion reasons why Obama will not change course. Nothing short of Ralph Nader being elected in November will yield us a top down solution to this problem.
With my cynicism now expunged let me outline how I see the healthcare crisis playing out. The support for Single Payer is shifting dramatically. Support at the legislative level is fading like a mirage. But support at the Grassroots is growing very rapidly. Single Payer Support groups on the local level are sprouting up like weeds. We in California have our own Single Payer initiative "California One Care" that has cleared both Houses of the legislature twice. It is now awaiting the signature of the Govenator who will most likely veto it the same way he did the first time. That makes no matter because the Citizens and Legislators of California will keep renewing it until we get a Govenor who will sign it. Arnold is term limited out after 2010. The current Lt Govenor, John Garamendi, has said he will not only sign the bill but fight the insurance industry to see it implemented if elected Govenor. And Garamendi has enough experience dealing with the insurance industry as Insurance Commissioner that he can be taken at his word.
If a dozen states can pursue the same course of action succesfully the feds will be compelled to step in and implement HR 676 as a means to avoid a hodge-podge system of different state insurance schemes. It may take until mid 2011 but that is how I see this battle ending.
Medicare, social security, etc-it's simple mathematics. None can survive as long as there are more taking out of the system than contributing to it.
I agree with the need for a system as close to a single payer type as possible. Then all we will have to do is get physicians to accept that as payment. Many docs are not treating Medicare patients because the reimbursement for primary care providers is so low.
