Angry About Your Healthcare? Medicare for All Might Help


With the failure of Piedmont Healthcare and Blue Cross Blue Shield of Georgia to reach an agreement by March 31, the time seemed right to post this blog entry from A4E member Tom Weiner, which argues for Medicare for All. (Note: Rep. Deborah Gonzalez introduced a Medicare for All bill in this year’s Georgia General Assembly legislative session, but it didn’t even get to the floor for a vote.)

Most of us don’t think about health insurance until we need it. Even if you can afford the average  monthly premium of $300 to $400 for an individual (or around $1,000 a month for a family), it can be difficult to justify the expense if you are healthy. But health is fleeting, and a bad car accident or cancer diagnosis can be a financial catastrophe for a young, previously healthy uninsured patient. Costs can accumulate suddenly and often balloon to mind-boggling amounts.  A short hospital stay can easily cost tens of thousands of dollars, or even more if emergency surgery or an intensive care unit stay are required. Unanticipated medical costs such as these can easily lead to bankruptcy or losing a home.

Private insurance plans can be complex and confusing

Choosing a health plan can be surprisingly complex. You have to compare premiums, deductibles, maximum out-of-pocket expenses, co-pays (ER, medications, office visits and specialist office visits), percent coverage of payment of hospital stays, ER facility fees, coverage of ER doctor services, coverage of imaging, coverage of medications, coverage of ambulance services, coverage of injections, coverage of maternity care, coverage of hospice… all presented in different ways depending on the carrier. Insurance A may have a low premium but a huge deductible, large copays and minimal medication coverage. Insurance B may have a modest premium and low copays, but very high maximum out-of-pocket expenses. Insurance C could have a high premium, no copay, and free “tier I” medications. Any one could be the “right” plan depending on your income, health needs and age. If you are confused, overwhelmed, or even bored at this point, you are not alone. Many people pick a plan only based on monthly premium because they do not want to deal with the hassle of poring over the details, which can end up being more expensive.

The US healthcare system ranks 37th in the world according to the World Health Organization–just above Slovenia but below Costa Rica–despite the fact that we spend more on health care than any other country.* Obamacare (the Affordable Care Act) has helped some, making coverage more accessible to working-class Americans. In Athens, the choices of coverage are limited and the number of doctors taking the plan is even more limited. Most specialists in Athens do not take any ACA plan, requiring people to drive to Atlanta or Augusta for specialist care. Medicaid offers a decent safety net in some states, but not in Georgia. The maximum income requirements for adults are set far lower than minimum wage, making it impossible for most Georgians to qualify. Some are lucky enough to have affordable coverage through their employer and those over 65 qualify for Medicare, which provides hospital care for a $0 monthly premium. For less than ⅓ the cost of private insurance, Medicare patients receive comprehensive health coverage, including outpatient services.

Is Medicare-for-All the solution?

Some have advocated expanding Medicare to cover everyone. Currently, if you lose your job, you are often left uninsured. With Medicare for all, you would have catastrophic insurance for $0 per month and comprehensive coverage for about $130/month per person. You would be free to follow your dreams of being an entrepreneur or an artist without having to worry about losing health coverage. Furthermore, there would be a simple, consistent option that would always be available and widely accepted. Medicare also sets its own rates for doctors and hospitals based on location, making your financial responsibility transparent before a test is completed. Trying to get a quote for healthcare procedure is often impossible. Administrators are often unable or unwilling to give out prices. Even when facilities and doctors want to make rates transparent, doing so can prove challenging. There can be a self pay rate, a Medicare rate, a Medicaid rate, and 30 individually contracted rates with private insurers. Medicare rates can easily be looked up on the internet.**

Creating “Medicare for All” would not be easy, but every other developed country in the world has a similar healthcare system that covers the healthcare of all its citizens or provides a safety net for those who lack private coverage. Since Medicare is an existing infrastructure, it could simply be expanded to everyone under 65 rather than starting a completely new single-payer model. Furthermore, a Medicare for All model could allow people to keep their private insurance plans. Medicare has also been cooperating more with private insurance plans, so there might be less resistance from the private sector. Finally, Medicare is very popular across political lines. It is something people over 65 are very familiar with and already rely on. The Medicare for All model would greatly expand access to healthcare for Americans with an existing infrastructure without completely dissolving the private health insurance market, making it a practical and politically feasible option.

* (as a percent of GDP)

** While doctors can charge more than Medicare rates in some instances, there are limits on doing so and the patient must be notified prior to treatment.

Tom Weiner
4/1/2018
Athens for Everyone

 

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