| Medicare is, at heart, a single-payer health insurance plan (So is Medicaid and SCHIP). Throughout one's working life, a portion of both employee and employer social security taxes go toward the Medicare program. That money theoretically covers the cost of Medicare Part A, which insures hospital stays and other costs while hospitalized, with the exception of about $1300 per hospital stay that is the patient's responsibility.
Additionally, after a person reaches 65, Medicare Part B, major medical coverage, is available - as a choice - for a monthly premium that is approximately $97 this year (annually adjusted for inflation).
When Medicare recipients go to the doctor, their bills get paid (80%) by Medicare Part B. The other 20% is the responsibility of the patient. Guess what? That is single-payer health insurance. One entity pays the bills, with the exception of the amount due from the patient.
So, has that single-payer program, which covers over 35 million Americans, driven private, for-profit health insurers out of business? Hardly. For years, policies called "Medigap" with various levels of coverage have been offered. For example, my huband has the best Medigap policy he could find and pays $225 per month for it. It makes financial sense for him. It wouldn't for everyone.
Additionally, when Republicans controlled both the presidency and Congress recently, they passed a "Medicare Advantage" system of insurance that is absolutely great for seniors but financially a very bad deal for the government and for the Medicare trust fund. That's what the purpose of the legislation was...to slowly starve the Medicare trust fund until it would go bankrupt. Or, at least, that's what I think the purpose was...
My point is that Medicare actually has created a diverse new program of private insurance, whether it is for Medigap policies or for the Advantage plans that the government is subsidizing.
Now, let's move on to that "socialized medicine" right here in the good ole USA. Any veteran who receives medical care through the Veterans Administration is participating in "socialized medicine." Now, I define that term the way many do, as medical care dispensed by doctors and other medical practitioners who are on salary and working for the government. In such a system, the government also owns and operates the hospitals and clinics in the system.
In 1999 the Veterans Administration served 3.5 million patients. Since the wars in Iraq and Afghanistan began, the VA has seen a huge increase in its patient load. The system also serves the families of active-duty members of the armed services, thus providing care for additional millions of Americans.
So, has the existence of the VA socialized medicine driven out private, for-profit methods of receiving health care for all veterans. Certainly not. Many veterans have other health insurance and prefer to use that for their health care.
Now, on to my point that Medicare could be the cheapest and most reasonable way to have a "public option." If Medicare became open to all, with some changes, we would have a public option up and running in no time.
What are the changes necessary to be fair to the private insurers? First, since people below 65 have not paid fully into the system to justify giving them full coverage under traditional Medicare Part A for under $100 per month, a new premium would have to be devised that would cover all the cost of providing care, both in-hospital and for major medical coverage. Said another way, this form of "public option" would have to pay for itself.
Second, physician and hospital reimbursement rates should not be what Medicare pays. (That's something for another article...reasons why Medicare reimbursement is causing far too many doctors to refuse Medicare patients.) It should be comparable to what private insurance pays and derived the same way private insurers get their payment rates - by negotiation with providers.
Will my dream "public option" ever be implemented. Nope. It's too simple and to obviously destined to run for-profit insurance with its bloated profit margins and huge executive salaries and enormous advertising budgets out of the market. But a body can dream, can't one...:-)
"Politics in the art of the possible." |
