Bernie Sanders and other lawmakers have proposed that America expand Medicare to cover all Americans. This is a very interesting idea. It would lower the cost of healthcare and it would ensure that every American citizen has access to affordable healthcare.
Medicare is a system that pays part of the medical bills for Americans age 65 and older. Medicare enrollees get their medical care from the doctors and hospitals of their choice just like everyone else. 55 million Americans have part of their medical bills paid by Medicare right now. Medicare-for-all is a proposal to let Americans of all ages enroll in Medicare.
Americans now pay for healthcare four different ways:
- A few Americans just pay cash for their medical expenses without assistance from health insurance or a government program.
- Working Americans are usually enrolled in a private health insurance plan. Private health insurance may be obtained through an employer or it may be purchased by individuals. Obamacare is made up of private insurance plans.
- Americans 65 and over use Medicare to pay for their healthcare. Medicare enrollees pay a monthly premium and deductibles and co-payments, and Medicare pays the rest of their medical bills. Medicare is funded by payroll taxes of 1.45% on employees and employers. There are now 55 million Americans enrolled in Medicare.
- Some low income Americans qualify for Medicaid which is a state government program that pays for basic healthcare for those who qualify. Medicaid rules vary from state to state.
The proposal would not affect how doctors and hospitals perform medical care and it has nothing to do with medical research and developing new medicines and treatments. It is just a better and more efficient way for Americans to get affordable healthcare.
WHAT IS MEDICARE?
Medicare was enacted by Congress in 1965 to help pay healthcare bills for Americans who are 65 and older. Medicare patients use regular doctors and hospitals. Most doctors and hospitals in America accept Medicare. Medicare is paid for by a combination of monthly premiums, deductibles and copays paid by Medicare enrollees, plus a 1.45% payroll tax. (There are no “Medicare clinics” or “Medicare Doctors”. Senior citizens use the same doctors and hospitals as everyone else.)
Expanding Medicare to cover more Americans involves expanding a system that has worked for over 50 years that all doctors and hospitals and millions of Americans are familiar with. Medicare works.
No Conflict of Interest
Under Medicare the actual work of processing claims is performed by private contractors that bid to do the administrative work on competitive contracts. Medicare contractors receive a few pennies for each claim they process. The contractors do not make any extra money if they deny a claim. This eliminates the conflict of interest that private profit-seeking insurance companies have with their customers.
Private Insurance Companies Can Compete For Medicare Business
Medicare includes an option called Medicare Advantage where private insurance companies offer insurance plans to compete with standard Medicare. Basic Medicare Advantage plans cost the same as standard Medicare. Insurers also offer enhanced Medicare Advantage plans that provide richer benefits than standard Medicare for enrollees willing to pay a higher monthly premium. About 30% of Medicare enrollees decide to enroll in a Medicare Advantage plan instead of standard Medicare. Enrollees can change their plan every year.
WHAT IS MEDICARE-FOR-ALL?
Medicare-for-all is a proposal to expand Medicare to cover American citizens of all ages. It would replace most of the private individual and group health insurance plans and eliminate all of their different rules, procedures, forms, schemes to deny claims, and the provider networks that limit patients choices of doctors and hospitals. Under expanded Medicare every American that enrolled would be covered by standard Medicare or an optional Medicare Advantage plan to pay their medical bills. Most doctors and hospitals in America accept Medicare.
Any change to Medicare must not reduce benefits or increase costs for existing Medicare enrollees.
HOW MUCH WOULD IT COST?
The premiums that individuals and employers now pay to health insurance companies are more than enough to pay for Medicare-for-all to cover those same individuals. Medicare costs less that than private insurance because Medicare does not collect money for profits, executive salaries, and advertising. Medicare administrative costs are only 2%, whereas private insurance administrative costs are 18%.
Medicare users would most like pay a monthly premium plus deductibles and copays under Medicare-for-all. The final details of how Medicare-for-all would be implemented need to be discussed and decided in Congress.
WHY MEDICARE FOR ALL IS BEST FOR AMERICA
Relying on Medicare to pay for medical care rather than the assortment of private insurance plans would improve American citizen’s access to affordable healthcare because it would:
- Cost less due to the elimination of insurance company profits and executive salaries.
- Cover everyone including individuals with preexisting conditions.
- Eliminate the conflict of interest that insurance companies have.
- Eliminate the insurance company tricks and schemes insurance companies use to not pay claims.
AMERICAN HEALTHCARE COSTS
The United States pays far more per person (and total dollars) for healthcare than any other nation on earth. In 2014 America paid $9,024 per person for healthcare, compared to $4,506 per person for Canada, $3,971 for people in Great Britain, and an average of $3,620 for all developed nations. No nation on earth pays more for healthcare than America.
Citizens in the United States do not live longer or stay healthier for the extra money they spend on healthcare. Medical practice standards are the same in all developed nations of the world. The procedures, treatments, and medications available to Americans are the same ones available to citizens in Canada, France, Great Britain and all other developed nations.
The extra money that America pays for healthcare goes for excessive profits. America has more healthcare billionaires than any other nation on earth. America cannot compete in the world if we let healthcare costs keep rising far above what the rest of the world pays.
MEDICARE IS MORE EFFICIENT THAN PRIVATE HEALTH INSURANCE
This may seem impossible but it is true. Medicare pays claims more efficiently than private insurance companies because Medicare does not have to collect money for corporate profits, income taxes, or executive salaries and Medicare does very little advertising compared to private insurance companies. . Insurance companies spend about 18% of revenue on administrative costs. Medicare spends only 2% for these costs.
Medicare claims are processed by government contractors who bid very competitively for the business. As a result Medicare only pays a few pennies to process every medical claim. The contractors are paid for the number of claims they process and they do not get to keep any extra money when they deny a claim.
MEDICARE LETS YOU CHOOSE YOUR OWN DOCTOR
“Do you accept my health insurance?”
Every health insurance plan restricts which doctors and hospitals you can use. Health insurance only pays the bills for doctors and hospitals in the provider network. They will not pay your medical bills if you use a doctor or hospital that is not in the provider network.
Medicare is accepted by almost all doctors and hospitals in America. Obviously there are some doctors who do not accept Medicare such as plastic surgeons and others who provide optional medical services that are not covered by Medicare.
HEALTH INSURANCE CONFLICT OF INTEREST
When a health insurance company refuses to pay a claim the money they save is profit. This means that health insurance companies have a conflict of interest between their duty to maximize profits for investors and their obligation to pay customers’ medical bills. Most American adults have had the experience when their health insurance company denied a medical claim with some insurance company the excuse (“Exceeds reasonable and customary amount”, or “You did not obtain pre-authorization for the treatment.”)
DENIED HEALTH CLAIMS CAN LEAD TO PERSONAL FINANCIAL DISASTER
When the health insurance company denies a medical claim it can have a catastrophic effect on the financial situation of the patient and his family.
At the time the patient decided to go get medical treatment they believe that the insurance company will pay the bills. When the insurance company denies the claim, the medical treatment has already been provided and the patient is unexpectedly obligated to pay all of the medical bills using their own financial resources. Sometimes denied claims can impose bills on a family that exceed their ability to pay, resulting in the loss of all of their liquid assets. It made matters worse when in 2006 big business lobbied Congress to change bankruptcy laws to make it harder for individuals to dismiss medical bills through bankruptcy.
INSURANCE COMPANY TRICKS AND SCHEMES
Over the years health insurance companies have engaged in countless schemes and strategies to collect premiums and avoid paying claims. Here are details for some of the worst scheme (where they were caught).
The UnitedHealthcare Group Scams (NYSE:UNH)
UnitedHealthcare Group (NYSE: UNH) is the largest health insurance company in America. To understand just how ruthless and unethical some health insurance companies can be you need to know about the illegal things that America’s largest health insurance company was caught doing.
Back-Dated Stock Option Compensation Scam
In 2006 the CEO of UnitedHealthcare Group was a man named William W. McGuire. In 2005 Dr. McGuire was paid $125 million as CEO of UnitedHealth Group. In 2006 the SEC began investigating Dr. McGuire and several other UnitedHealthcare executives and found that they participated in a scheme to back-date stock option compensation awards to steal from investors and fraudulently enrich themselves. Not only did Dr. McGuire created the illegal scheme to cheat and steal millions of dollars, he persuaded UNH director William G. Spears, General Counsel David J. Lubben, and several other UNH senior managers to go along with the scheme and illegally enrich themselves.
Under pressure from the SEC and prosecutors (that is, the government). McGuire resigned from UnitedHealth Group but he was still paid about $1 billion in severance pay; the UnitedHealth Group board of directors apparently decided that McGuire’s behavior was not bad enough for him to lose his severance pay. McGuire was never prosecuted.
Think about that: One crooked senior manager was paid a billion dollars in one year by the UnitedHealthcare corporation.
The “Reasonable and Customary” Scam
Did you ever have the health insurance company deny your medical claim because they said the amount that the doctor charged exceeded the “reasonable and customary” amount?
In February 2008, New York State Attorney General Andrew M. Cuomo announced an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reasonable and customary rates. Cuomo found that incorrect health care cost records had been stored in a database maintained by a company named Ingenix (that was created by UnitedHealth Group) so that they could be used by health insurance companies as fake proof to deny medical claims. For example, if your doctor charged $65 for an office visit and that was the normal amount where you live, the insurance company would use the fake Ingenix reportto say that $20 was the reasonable and customary amount for an office visit and they would refuse to pay more than $20, so you would have to pay the remainder of the bill and the insurance company kept the difference as profit. In October 2009 UnitedHealth Group paid a settlement and agreed to shut down its fake medical cost database.
WE NEED TO GET INSURANCE COMPANIES OUT OF THE HEALTHCARE BUSINESS
Now you understand why some the executives of health insurance companies will do anything to stop Americans from adopting a better system to pay for medical care, and how crooked and ruthless they can be in pursuit of their goals.
Many developed nations do not use insurance to fund healthcare because of the inherent conflict of interest and the cost of profits. America needs to get insurance companies out of the healthcare business.
WHY INSURANCE COMPANIES HATE IT
Health insurance companies have things the way they want it right now. They are the middleman in the healthcare business where they make billions of dollars from the healthcare business every year. Healthcare insurance company executives have gotten extremely rich off of healthcare, but their schemes have imposed never ending chaos, confusion, and frauds on the American people.
Medicare-for-all would disrupt this business model and reduce the cost of healthcare for Americans. Plus it would eliminate the insurance company tricks they use to deny claims and keep the premiums as profit.
THE INSURANCE INDUSTRY WILL DO ANYTHING TO STOP MEDICARE-FOR-ALL
Health insurance company executives are smart, motivated, energetic, ruthless, and they have enormous amounts of money to spend to preserve the current system. They will pay people to lie. The will publish articles full of false information. They will pay off politicians.
David Merritt, an executive vice president of America’s Health Insurance Plans, a lobbying group for health insurers, condemned Medicare-for-all saying:
“Whether it’s called single-payer or Medicare-for-all, government-controlled health care cannot work. It will eliminate choice, undermine quality, put a chill on medical innovation and place an even heavier burden on hard-working taxpayers.”
In this short statement David Merritt uttered six lies.
1) “government controlled health care” – Medicare is not government controlled healthcare. Medicare cannot tell any doctor how to do his or her job. Medicare pays medical bills like health insurance but without all the insurance company tricks and schemes to avoid paying claims.
2) “cannot work” – Since 1965 Medicare has paid the medical bills of Americans 65 and older; it works better than private insurance, costs less, and generates fewer complaints. 55 Million elderly Americans are using Medicare right now. If it can work for 55 million elderly Americans who need a lot of healthcare, it can certainly work for the other 200 million younger healthier Americans.
3) “eliminate choice” – Medicare enrollees can use almost any doctor or hospital in America unlike insurance plans that restrict choice with their hundreds of tricky provider networks that limit which doctors and hospitals you can use.
4) “undermine quality” – Again, Medicare in no way changes the way doctors and hospitals perform medical care.
5) “chill on medical innovation” – Innovation (new medications and treatments) are developed from medical research which is performed at universities, pharmaceutical companies, and research institutes, not at insurance companies. Switching to Medicare to pay medical bills will not affect the research institutes. This is just a scare tactic.
6) “place an even heavier burden on hard-working taxpayers” – Medicare will cost less than private health insurance and it will eliminate the tricky scams that health insurance companies use to collect premiums and deny claims and avoid paying medical bills. In all likelihood, the cost of Medicare-for-all will be paid in full using the health insurance premiums that employers and individuals now pay to insurance companies.
MORE INSURANCE COMPANY LIES
No insurance company spokesperson can speak up and say that the health insurance business is good for America because the truth is, utilizing profit-seeking insurance companies as middlemen to pay bills in the healthcare business is a terrible system. The fact that every developed country in the world provides healthcare for less than half of what Americans pay proves that we have a problem, and we need to change.
To fight Medicare-for-all, health insurance companies will spread lies and propaganda to confuse and scare Americans, and they will contribute large amounts of money (bribes) to those Congressional Lawmakers who will take it and protect the insurance company profits.
Here are some of the lies that the health insurance industry has published.
“Government Healthcare Takeover”
Health insurers use this term to try to make people think that Medicare-for-all means that they will have to go to some dreary understaffed government office on the other side of town and wait in line to see a slow-moving government doctor. It is a complete lie. Medicare-for-all would not make any change to how doctors and hospitals work in America.
Medicare-for-all is a system to pay medical bills for Americans without the limitations and denied claims and other schemes health insurers use to collect premiums and avoid paying claims. Medicare enrollees pay a monthly premium, deductibles, and copayments. Government programs that make America a better place to live are not Socialism.
“Medicare-for-all will take away your freedom to choose your doctors”
Health insurance companies restrict the doctors and hospitals that you can use with their out-of-network provider restrictions and pre-authorization rules. Medicare is accepted by almost every doctor and hospital in America.
“You must wait 122 days to see a doctor to see if you have cancer!”
Medicare enrollees can make an appointment and see a doctor just as quickly as anyone else in America. There are 55 million retired Americans currently enrolled in Medicare. Do you think they would quietly put up with 122 day wait to see their doctor?
“Medicare is going broke!”
Medicare is paid for with a payroll tax that is 1.45% on employees and another 1.45% on employers, plus the premiums, deductible and co payments that paid by those enrolled in Medicare. There is a Medicare trust fund. Every month money goes in and out of it.
“We will have healthcare rationing and death panels!”
Medicare has been in effect since 1965 covering only the elderly and there is no rationing and no death panels. Why would these things be added to Medicare just because we let younger, healthier people join in? This is just a lie to scare people.
“Canadians have to wait for years to get bypass surgery.”
Canadians are happy with their national healthcare system but we are not talking about adopting the Canadian system. Medicare-for-all means letting all Americans use the same medical payment system your parents, grandparents and great-grandparents enjoyed in their golden years.
“Only 30% of Doctors Accept Medicare and Medicaid”
Medicare is accepted by most doctors and hospitals in America. Medicaid is accepted by fewer doctors.
“It Will Cost $32 Trillion Dollars!”
This misleading statement is based on a sentence in a study by the Urban Institute taken out of context. It is the total estimated cost of healthcare for all Americans over the next ten years without considering any premiums, copayments, or deductibles paid for by the patient. Medicare-for-all will cost less than the health insurance premiums Americans now pay to cover the same individuals over the same period of time.
The insurance industry pays a lot of people to speak out and write articles to oppose any proposal to improve access to affordable healthcare and change the current system. Whenever you hear someone say that Medicare-for-all won’t work remember that it has worked great for American senior citizens since 1965.
What doesn’t work well anywhere in the world is using profit-seeking insurance companies to pay medical bills. America is in last place among nations of the world with our out-of-control healthcare costs.
WHAT EVERY AMERICAN SHOULD DO
1. Contact Your U.S. Senators and Your Representative
Whenever the issue of health care is being discussed in the U.S. Congress every citizen should contact their representative and each senator once every week to tell them what you want. You can call their office, mail a letter, send an email, or fax a letter. I suggest you do all of these things.
You need to contact your representative and each of your senators regardless of their political party.
The power of democracy is that American citizens can vote representatives and senators out and replace them.
When you contact your representative or senators, tell him or her:
- “I am a registered voter and I vote in every election. I want you to support Medicare for All. Can I count on you to support expansion of Medicare to cover all Americans who can pay the premiums?”
Every American has one Representative and two Senators in Congress. There is a Representative for every 500,000 citizens, and there are two Senators for every state.
The Representative is elected every two years so they are very sensitive to the opinions of the people in their district.
Senators are reelected every six years and they become most sensitive as their time to be reelected approaches.
- You can find out the name and contact information for your U.S. Representative by going to Find Your U.S. Representative.
- You can find out the name and contact information for your two U.S. senators by going to Find Your U.S. Senator.
( You also have representatives and senators that serve in your state legislature but they are not the involved in passing healthcare reform.)
2. Vote In Every Primary And General Election
You must vote in every primary election . Here is why.
Insurance companies are allowed to give unlimited amounts of money to U.S. lawmakers. This has allowed insurance companies to buy politicians in both parties who are dedicated to serving their interests.
Most voters never vote in primary elections. Because of this, corporations have often been able to give big money to corporate-friendly primary candidates in both parties to overwhelm all of the other candidates in the primary election.
If you do not vote in the primary elections, the only candidates on the ballot in the general election are candidates that are owned by corporations.
We must all vote in every primary election for the candidate that promises to support access to affordable healthcare for all Americans. I switch my party affiliation as needed so I can vote in the Republican or the Democratic primary to help the candidate I want to help.
3. Register To Vote
If you do not vote, you do not count. You do not matter.
A long time ago when you registered to vote you would often be called to serve on a jury. That is not done anymore because it discouraged people from registering to vote. If you are not registered to vote, get registered now, before the end of the next week.