Though I no longer have a dog in this fight because this month I finally got to enroll in Medicare, my hair still ignites when I hear the Democratic presidential candidates misleading us — whether in ignorance or intentionally, I don’t know — about how to reform health care.
If you’re confused about Medicare for All (a.k.a. “universal coverage”), let me explain the jargon…
Insurance – The crux of the problem. Candidates say “insurance” and “health care” interchangeably, but they’re totally different. Insurance is a piece of paper. Health care is visiting a doctor. The company who sold you the paper may not pay for your doctor’s visit.
Private Insurance – Candidates say this to mean insurance individuals buy for themselves AND insurance that employers provide for workers. Again, two completely different things. When dissing Medicare for All, candidates say, “People don’t want to lose private insurance they love.”
NOBODY loves true private (individual) insurance. It’s expensive because insurers cherry-pick and jack premiums based on age and health. It often has a high deductible, it can be canceled without warning when you get sick, and it can pay little to nothing on claims.
Employer-provided insurance is controlled solely by employers, who can change it, cancel it, or shift its cost onto workers. If you quit or get laid off or fired, you lose that insurance.
To control costs, both types of private insurance may lock you into “provider networks.” You see the doctors the insurer wants you to see, or go elsewhere and pay most or all of those medical bills yourself.
Affordable Care Act (ACA) a.k.a. Obamacare –Obama and Biden managed to pass this in 2010 over Republicans’ dead bodies for people who can’t get employer-provided insurance. It has an online marketplace a.k.a. “the exchange,” where you can buy insurance. Because the ACA didn’t go live until 2014, insurers spent four years royally screwing people (like me) who already had individual insurance by raising premiums astronomically.
ACA insurers on the exchange offer no discounts (see “Subsidies” below). Policies available on the exchange depend on which insurers do business in your area. It’s totally up to the insurers. There may several, one, or none.
Subsidies – Insurance premiums under the ACA are cheaper for people with low incomes because the federal government shovels billions of dollars in subsidies to insurers to make up the difference and keep them profitable.
Public option – Today, the ACA offers insurance only through insurance companies. The proposed “public option” is insurance provided by the government. The easiest way to have that option is to let people under age 65 enroll in Medicare.
Single-payer system – This would create a central federal billing and payment hub (think Medicare) that doctors would bill for providing health care for all Americans (universal coverage). There would be no paperwork for patients and it would have no co-pays, no deductibles, and no surprise bills. England, France, Canada, all of Scandinavia, and many other countries do health care this way because it’s more efficient and cheaper.
Medicare for All – The universal, single-payer system that eliminates insurance and pays for all Americans to receive health care from birth to death.
Here’s where some of the Democratic candidates stood in last night’s debate…
Joe Biden wants to keep the ACA and add the public option. Problem: insurance companies continue getting billions in federal subsidies that could otherwise pay for actual health care.
Pete Buttigieg wants “Medicare for All Who Want It.” He says people should keep private insurance if they like, which is bullshit if it’s employer-provided. He wants to keep subsidies to control costs, still shoveling taxpayer money to insurers to keep their profits up instead of paying for actual health care.
Amy Klobuchar wants to reduce premiums. She thinks punishing Big Pharma will do that. Insurance and drugs are separate industries; they have nothing to do with each other. The only overlap is when your insurance doesn’t cover your drugs and you have to pay full price.
This morning on Morning Joe, Klobuchar complained about Medicare for All kicking “149 million people off of their private insurance.” She’s another one confused about employer-provided insurance that workers have no control over.
Elizabeth Warren wants Medicare for All, but must be unsure of the numbers because she won’t say how she’d pay for it.
The ONLY candidate who fully understands the problem and how to fix it — because he “wrote the damn bill” — is Bernie Sanders. Under his plan…
No American will need health insurance. Instead, we’ll channel what we now spend on premiums, co-pays, deductibles AND surprise health care bills into one system.
A single, centralized billing and payment system will drastically cut administrative overhead and expense for the entire health care industry. This federal system will also have clout to negotiate lower rates for health care services.
You can go to any doctor. Networks won’t exist.
Not a penny from taxpayers will be wasted on subsidies to boost insurance company profits.
I believe, with Bernie, that not only will we all come out ahead financially, but no one will have to go bankrupt from disease or illness.
Check out this publication from the White House from March 2018 called The Profitability of Health Insurance Companies. It says insurance companies have done just dandy since the ACA took effect (emphasis mine)…
“As government policy amplified eligibility and per-enrollee spending, the stock prices of health insurance companies rose by 172 percent from January 2014 to 2018 resulting in improved profitability and outperforming the S&P 500 by 106 percentage points.”
And its conclusion says…
“Despite an initial rough patch in the ACA marketplaces, the ACA Medicaid coverage expansion and subsidies to insurers have resulted in a large increase in health insurer profits. Health insurers’ stock prices more than doubled the impressive gain in the S&P 500 since the law’s main provisions took effect on January 1, 2014. Much of insurers’ increased profitability has resulted from increased Medicaid enrollment and increased payments per enrollee in Medicaid expansion states where the federal government pays nearly all the costs. While insurers initially incurred losses in the ACA marketplaces as they adjusted to new regulations and a relatively unhealthy risk pool, insurers are now profiting on the individual market as well, with higher premiums that are largely covered by federal premium subsidies.
Bottom line: Any candidate, Democratic or Republican, who talks about subsidies, or even insurance, is for squandering our taxes to keep the biggest obstacle to health care — insurance companies — profitable.