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Medicare for All: No Country for “Can’t”

| February 4, 2019

medicare for all

It’s black and white. (Molly Adams)

By Michael Lighty

I have a request for the pundits, editorial boards, and especially politicians, seemingly sympathetic to Medicare for All, but who dwell on its supposed infeasibility and limitations: please take a time out.

When it comes to seeking universal healthcare in the U.S. since the 1940’s (decades behind Germany even then), we have literally tried everything except what is popularand works: Medicare for All.

So let’s do what everybody benefits from, on behalf of everybody. It’s literally true, and why it scares the elite so much: universal healthcare is… wait for it… universal!

Who knew?

The non-universal character of our present healthcare industry may be the biggest barrier to achieving an improved and expanded version of Medicare, the most efficient, cheapest, and provider-friendly—but not perfect—part of what could be a health system that promotes health, saves lives, and creates a sense of social solidarity.

Many of the nation’s insured still feel real health insecurity . As examples: 29 percent of those with insurance in 2016 didn’t get some type of care due to cost and 40 million US residents are classified as under-insured. According to a new survey from the International Foundation of Employee Benefit Plans, cited by Benefit News, even the 160 million workers with employer-sponsored insurance are subject to increasing costs—an average deductible of $1,491 for individual coverage and $2,788 for family coverage.

Employer-based insurance, by the way, is far from guaranteed. As policy analyst Matt Bruenig put it over the weekend:

In addition, the unsubsidized insurance premiums the worker must pay for a family are not subject to any cost-sharing limits. Thirty-six percent of Americans are in high-deductible plans with an average deductible of $4,347 or higher. Co-pays vary, and a few exceptional employer plans have no or little out of pocket expenses, typical of executive benefits and those in well-established public sector bargaining units who have foregone raises and successfully fought to maintain benefits.

commondreamsMedicaid was designed to be a safety net but has instead become a lifeline for those who need long-term care, assistance with daily living, services for the disabled, rehab, and children with special needs. Yet because it provides services to the politically disadvantaged, providers receive inadequate reimbursement, states privatize coverage, and the program constantly faces budget constraints. As the pro-industry ideologues in the Trump Administration impose work requirements on Medicaid recipients (75% of whom already work), healthcare is being taken from tens of thousands of people who need it most.

No wonder with so many workers on the edge—literally making choices over getting a broken bone cast or medications for a sore throat, instead of groceries or the water bill—healthcare feels to many Americans like something only other people get. The high cost of healthcare is the central economic fact for most workers, revealed by the comparison between the cost of a “simple” ER visit or insurance deductible and the reality that 40% of Americans do not have $1000 in the bank for an emergency.

Imagine if everyone felt secure that they and their families would get the healthcare they need. We would not need $5 to see a doctor. Imagine not having to hassle with an insurance company to get an MRI, or the daily struggle to get services for a sick or struggling child in the shifting terrain of plans, coverage, public eligibility, and never-ending complexity. Even hospital CFOs are losing confidence they can adapt to new business models.

We do not have to organize our policy choices around the resentment toward those who only seem to have better benefits, and desperation to hang onto whatever plan we have fought to keep (even though 30% of employers switch health plans every year). We would no be longer be riven by the disparities that plague healthcare, which are primarily financial and result in unnecessary deaths, complications, and economic hardship that seep into all areas of our lives. Instead, we would all have a stake and reason to support a healthcare program that isn’t vastly better for some than most, and isn’t based on ability to pay.

In contrast to the current for-profit system, Medicare for All guarantees healthcare based on patient need determined by the professional judgment of doctors, nurses and other caregivers. This is an improved and expanded version of the traditional Medicare model of public financing and administration in a mostly privately-delivered healthcare system. Medicare for All would consolidate the program into one part, replace Parts B and D, mimic the expansive benefits of Medicare Advantage, eliminate all existing co-pays for seniors (and for everyone else), eliminate all commercial insurance premiums paid by employers and individuals. Comprehensive benefits—all medically necessary treatments, including mental health needs, approved by a participating provider and complete choice of any participating provider—would come with a prohibition on balance billing. And while maximizeingthe ability to control costs, the intention is to include all residents of the United States so that nobody is excluded from receiving the care they need when they need it.

Instead of only the healthcare we can afford—leaving tens of millions out and uncertain—let’s guarantee we all get the healthcare we need.

Michael Lighty has organized, advocated and developed policy for Improved Medicare for All nationally and in California for 29 years. He is a founding Fellow of the Sanders Institute. Lighty is currently on sabbatical from the California Nurses Association/NNU where he was director of public policy. During his tenure there from 1994-2018, Lighty coordinated campaigns for an HMO patients’ bill of rights, clean money elections, Healthy California, and nationally, for a Robin Hood Tax. Lighty was the first openly LGBTQ person to lead a socialist organization as Democratic Socialists of America’s National Director in the early 90’s. In 2009 Oakland Mayor Ronald V. Dellums appointed Lighty to the Board of Port Commissioners. For NNU, Lighty coordinated the Peoples Summit in Chicago in 2016 & 2017, and the Bernie Bus campaign, an independent effort to elect Bernie Sanders for President. He currently serves on the Board of Directors of Peoples Action; Progressive Democrats of America; and the Martin Luther King, Jr. Freedom Center in Oakland, CA, where he lives with his husband. Follow him on Twitter: @mlighty60

13 Responses for “Medicare for All: No Country for “Can’t””

  1. Itisthe says:

    Medicare for All guarantees healthcare based on patient need determined by the professional judgment of doctors, nurses and other caregivers…..aka death panels

  2. Agkistrodon says:

    When PEOPLE learn to take care of themselves, from eating HEALTHY to exercising and refraining from excesses, Then maybe MORE would want to take care of EVERYONE. Like a Life or HEALTH Insurance company that will NOT cover you if you say, Skydive or ride a motorcycle or are injured while riding one.

  3. oldtimer says:

    Who pays for it?

  4. Richard says:

    I love how Michael Lighty can “imagine” Medicare for All BUT never once “imagines” who is going to PAY for for this Imaginary Medicare for All plan, at what cost and how is it going to be managed? Another socialist with “pie in the sky” ideas!

  5. Alphonse Abonte says:

    Lighty, who joined the Democratic Socialist Organizing Committee in 1980 and became the national organizational director of the Democratic Socialists of America July 1, 1990. Socialism is the Big Lie of the twentieth century. In the same way that a Ponzi scheme or chain letter initially succeeds but eventually collapses, socialism may show early signs of success. But any accomplishments quickly fade as the fundamental deficiencies of central planning emerge. It is the initial illusion of success that gives government intervention its pernicious, seductive appeal. In the long run, socialism has always proven to be a formula for tyranny and misery. Prove me wrong, Peter.

  6. Alphonse Abonte says:

    Under socialism, the government – rather than individuals or businesses – owns and controls major industries, and the economy is planned centrally. Consequently, the government is the main provider of goods and services for its citizens. Democrats want to go socialism.
    When did the government EVER, EVER, run a program(even Medicare) that run correctly. They failed miserably. Here the Dems want to have EVERYONE to share in the government run fiasco. Look a the countries that tried this. Is there one that is succeeding? Not even Canada has a program that works. Canadians come here for some medical services. Still need a refresher on socialism?
    •Ireland. and lets not forget, Venezuela
    I agree we need a universal medical system that is better that what we have, but Medicare for all. America would be bankrupt faster that Venezuela.

    • Pierre Tristam says:

      Alphonse, all the nations you cite have a way, way lower debt ratio (as a percentage of the economy) than does the United States, all of them but Venezuela and China have considerably higher life expectancy–as good an indicator of health systems as any–and China’s socialism is bankrolling us and your luxurious misunderstanding of words. So who’s bankrupt exactly?

  7. Fredrick says:

    I am glad you mentioned Germany at the beginning of your article and site it as an example of “what works”. I just spent a week there travelling with a German colleague and we discussed politics both German and American and also healthcare. Guess what, all is not “golden” with German health care. If you have money you can get what you want, if not you wait in-line and get poor and limited service and options for care. It costs them a ton of money in taxes. Then ad din the flood of immigrants who are being given housing and monthly payments and FREE healthcare you have a total cluster. You people who taut “Universal Healthcare” as a panacea have no idea what you are talking about. Stop reading books and listening to the “news”. Go out on the street and talk with people. In Germany the same thing that is going on in the US is happening. The silent majority has had enough and there will be changes. Like here they remain silent because as soon as the speak up they are called a racist, homophobic, anti gay blah blah blah… soon they will do what we did and elect an outsider who is will to take care of the German people. Like the US the German people, the silent majority, want and are willing to help those in need but are tired of being taken for granted.

  8. Allison says:

    People don’t realize that they would pay less in taxes for better health coverage than they currently do individually to their insurance companies, which have ridiculously high premiums. No American should face bankruptcy because of health expenses. This is absurd.

  9. Diane says:

    Michael needs to do more research. Medicare for all means everyone will have insursnce/coverage. It does not mean you will have access to your current and/or good healthcare providers. Facilities will start to close down once any government is in charge of healthcare and dictates what the cost of services should be instead of what doctors and nurses deserve. Therefore, you have less options and longer wait times wherein people die waiting for simple treatments.
    Forbes reported the following stats: Canadians are definitely guaranteed” a spot on a waitlist. As the Fraser report notes, in 2017, more than 173,000 patients waited for an ophthalmology procedure. Another 91,000 lined up for some form of general surgery, while more than 40,000 waited for a urology procedure.

  10. Richard says:

    @ Diane – Liberals and Socialists always cringe when presented with those wait-list facts as they don’t have any reasonable answer to that serious downside part of their Medicare for All plan. So then what do they normally do, deflect to some other useless “talking point”. I haven’t witnessed even ONE logical and meaningful discussion from anyone from the left that had something GOOD to say about what their vision is for the American people going forward. Their ONLY vision is to DESTROY Trump by any means possible which consumes every second of their daily lives.

  11. Lana J says:

    Yes, I agree that no one should face bankruptcy because of health expenses. My father died a poor man because of all the medical bills from his youngest son having serious health problems since 6 months of age.
    It devastated our family and left us with no inheritance. Our mother struggled after his death. So very sad…

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