Why I DO want "medicare for all" and DON'T want "Medicare for all"
"WTF, Bright, you gone schizo all of a sudden?" Bet that popped into the head of many DU peeps who clicked on this post.
But a subset of DUers already suspect (accurately) that capitalizing "Medicare" in the second citation means I'm differentiating between "medicare for all" as a shorthand for "publicly funded and administered primary health insurance" and "Medicare for all" as the precise term for the current Medicare program.
And it matters.
And not making it clear *exactly* what we mean when we're talking about "M/medicare for all" produces a lot of heat and not much light.
The easy one: I do NOT want "Medicare for all" because, frankly, as wonderful as the Medicare program is, and as grateful as I am for it, it would simply not meet the needs of most Americans. It's designed very specifically for elderly Americans. Coverage for pediatric medicine, obstetrics, and other services used by non-elderly people might be quite problematic.
In addition to that, while over the past few years the darling esposo and myself have learned, with professional help, to navigate the various plan offerings at annual renewal, it DID take professional help to sort out which of many options is best for us.
A system that requires professional help to navigate the choices is more in the "part of the problem" territory than in the "solutions" box.
So, grateful as I am for "Medicare", I don't believe "Medicare for all" is a viable solution to America's health care crisis.
On the other hand, I am absolutely gung-ho about "medicare for all"!
That is, a system that provides universal access to a fairly comprehensive array of commonly-needed and cost-effective health, dental, etc., services for Americans of all ages, funded through taxes and administered by a central agency with the multi-faceted mandate of:
a) assuring everyone is signed up and understands how to use the program and get good health care;
b) assuring covered services are accessible to everyone;
c) monitoring the quality of services and ensuring they are safe and effective;
d) identifying and addressing 'high cost' areas (such as emergency-room use, over-testing, price gouging by drug and device makers, etc., etc.,) devising and implementing cost control strategies that don't shut people out of needed care; and
e) working constructively with private insurers and health care professionals who provide supplementary insurance and additional private-pay care (just, for example, as Medicare now works with private-insurer providers of Part C coverage).
I suspect, given their existing experience with case management and administration, such an agency would end up being a combination of the existing Medicare administration and the existing Medicaid administration, with the Feds taking on certain parts of the mandate and State-based branches doing the actual customer service.
And since back in 1986 the Community Action Agency I worked for was part of an administrative cost analysis survey that found private insurance costs between 13 and 28 cents of every health care dollar to administer, 'HMO' type insurers cost between 15 and 21 cents, Medicare (at the time) costed about 6 cents per dollar, and Medicaid costed THREE OR FOUR CENTS of every dollar to administer, we would see pretty substantial savings just from that. I'd bet that even if those numbers have changed in the last forty-some years, the proportions remain similar.
Yes, it's complicated. Yes, I'm oversimplifying a bit.
But not all THAT much. This is not make-a-successful-moonshot-with-1960s-tech or devise-a-superweapon-with-1940s-tech complicated. We have all the elements we need to make such a system work, and work well.
What's lacking is political will.
And we won't overcome the problem of too many elected officials being in the pockets of profit-greedy health care ghouls until we have some consensus about what we want and how to express it in simple terms.
If that's "medicare for all" then fine. If not, someone come up with a better, clearer, more pithy and descriptive term. I'm happy to accommodate.
opinionatedly,
Bright
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