Medicare for All

Medicare for All (Final addition to TOE & LIT)

This is a last minute addition since Medicare for All was one of the most important issues to Americans before incompetent people leading ignorant people destroyed our economy.  Medicare for all requires the creation of a new program and the expansion of an existing program.  We want to ensure that people who cannot afford coverage will have coverage, and people who want the option to create a public health insurance program because they believe they can produce a better quality of coverage or more affordable rates.  

A single payer system should not be desirable.  Single payer is where there are no private insurance companies and people pay into 1 public fund that covers the cost of people who get sick.  This is not desirable because of the potential for delays in services, and the government being able to control the price of coverage as opposed to having a market that is able to introduce options and innovation for coverage.  If all people have health coverage like they do in Canada, health service is on a first come first serve basis.  When there are delays a market will still exist even if not within the country for those who can afford expedited services, but most people will not be able to afford it.  The same as some people from Canada can afford to have procedures done in the US that they would otherwise wait years for in Canada, but very few Canadians possess the means to pay for the cost of major medical procedures out of pocket.  

I’m for a public option for health insurance but not a single payer system.  I’m for a fast and a regular speed health care system to maximize access and allow the market to balance demand.  A public option serves two purposes.  A public option for health insurance creates insurance rates that reflect the cost of care whereas private insurance is the cost of care plus 15 to 20% for profits.  When the ACA was being debated, the health insurance industry through the media and politicians were talking about government death panels.  The lack of logic that goes into that assertion highlights how people develop strong opinions without understanding the subject that those opinions pertain to.  In any health coverage arrangement there are going to be people who interpret what the policy covers.  In a private company there is a profit incentive to use the language of the policy to deny coverage for care.  Public run insurance has less of an incentive to deny coverage than private run health insurance, where the public coverage is concerned with executing the policy to ensure efficiency and viability, not profit.  A public option for health insurance may offer better coverage at a better price.     

Some hospitals will only serve patients with private insurance.  Private insurers who already must charge premiums that are greater than the cost of services to maintain a profit, will be able to justify that cost by providing access to hospitals that will likely have a shorter wait time for services.  The market will reflect demand for services.  When the wait time for procedures increases, more people will be inclined to purchase private insurance for expedited care.  When the wait time goes down, more people will switch from private insurance to public insurance either because it is cheaper, or because they understand that using public insurance will reduce their tax burden or at least free up money in the federal budget.  Which brings us to the second purpose of a public option for health coverage.  

Medicare for all as mentioned is one part covering people who cannot afford insurance and one part creating a public option for health coverage.  The public option portion of the program will have to be separate from indigent care.  While insurance companies typically have profits of up to 20% the public option can still deliver the same range of coverage for less while making a profit of 5 to 10%, or perhaps more.  This profit can be used to cover part of the cost of indigent care.  The consumer has an incentive to purchase public insurance when wait times and prices are similar, since the profit can be applied to the cost of indigent care.  

As wait times increase less people will purchase public insurance and require services, and more people will move to private insurance that affords them the option of expedited service.  Some will purchase private insurance for the exclusivity of care facilities.  By that I mean people prefer to be around people of similar or greater socioeconomic status, meaning some will pay more for private insurance and access to facilities that only accept private insurance so when they receive their treatment they don’t have to be around poor and middle class people.  The same reason people go to Target and pay more for the same items they could buy at WalMart for less.    

Fast and regular service health care doesn’t change the quality of care.  Medicine is a well regulated field and service which guarantees a standard of care whether it is a hospital that accepts the public insurance patients, or if it is an exclusive hospital catering to the demand for expedited services.  Quality of care is guaranteed through regulation.  A private market with a public option helps us avoid the long wait times that have been observed in single payer systems, and helps to increase the speed of service to the public by creating expedited service which decreases demand from the public care network.    

I haven’t really looked at the medicare for all proposals, but if what it is proposing is single payer then it doesn’t matter because they won’t be able to pass that bill, both because of industry’s aversion to it and public aversion for some of the reasons I mentioned.  The reason I haven’t read the plans or the bills is because it isn’t a priority to me.  Most states have programs for coverage to cover indigent people already.  Is there a need to provide insurance to people without coverage?  There is some need but it isn’t great.  People without coverage have access to emergency treatment thanks to Bill Clinton, one of his few accomplishments as president that served a popular interest.  Even the few who slip through the cracks (I don’t have health insurance) still have access to emergency treatment.      

Hospitals treating uninsured patients who cannot pay their bills does not increase the cost of services because the hospital isn’t taking a loss on providing that service.  The hospital writes the bill off, so uninsured people who are treated are paying the hospitals taxes by not paying the bill.  If a hospital made 100 dollars and had a 5 dollar tax liability and they treated a person without insurance for 5 dollars, it’s the same to the hospital whether they collected 100 dollars for 100 dollars worth of services and paid 5, as it is if they provided 100 dollars worth of service and only received 95 dollars and didn’t owe the 5.  

Medicare for all is primarily a middle class interest.  What it will accomplish if passed is a slight decrease in premiums for quality coverage for middle class people who purchase their own health insurance or purchase it through their work.  It may also be beneficial to employers who presently pay a portion of their employees health coverage.  The middle class is not a priority, and I’m referring to the 50 to about 80 percentiles of income earners.  The bottom 50% are priority because the greatest disadvantage in this country is financial.  The first priority after addressing the Covid-19 hysteria is creating income opportunities for poor people which I believe requires a balance stimulus as described in this book.  

When we get to creating a public option the only way this passes is if there are incentives to private insurers.  The affordable care act was supposed to create a public option and this was shut down in favor of the voucher system that funneled billions of public dollars to private insurancers.  A public option has to be designed to create an incentive for private insurers or it will not pass.  How can private insurers be incentivized to allow a public option which creates unwanted competition in the marketplace that will undoubtedly affect their market share?  There is one inherent incentive in the creation of exclusive expedited care facilities and insurance accepted by these facilities.  It means that insurance companies can charge more for these kinds of policies which in itself could make up for profits lost to consumers choosing the public option.  Second, is deregulation, where insurance companies have more freedom to deny service to people that appear to be at higher risk for requiring care since the public option will be available.  If there is the potential for private insurers to make more money they will be for it.  If it is an uncompromising take over of market based insurance it won’t pass because health insurers make enough money to protect their interests in congress, and enough of the public will oppose it to ensure it doesn’t pass.  

I thought I’d add these few thoughts on healthcare since in 2019 it was the most important issue among many democrats, although much of it is the promotion of the idea more than it is the actual need of the people who are for it.