How Can We Evaluate & Advocate For Medicare For All?

It seems like a simple principle, but what do we need to know about it to make it a functioning reality.

Hello, friends,

Last week, we talked about both the insane cost of insulin & other diabetes medication, and the way chronic pain is treated.  In both articles, we stressed that one of the main factors for people to be able to get treatment is the ‘affordability’ of care.  I know, I know; there was a whole act dedicated to making care affordable, but it’s simply not.  My experience of $2,400/month for a health care plan that doesn’t cover all of my needs is, frankly, atypical; national averages for health insurance premiums are about $541/month.

Today we’re going to tie our two preceding articles together and talk about a probable solution to this problem:  Medicare For All.

Medicare For All, as presented by the National Nurses United website dedicated to it, would be a national single-payer healthcare program wherein the U.S. Government picks up the tabs for most, if-not-all all medical expenses.  It is, quite literally, the Medicare program beefed up and applied to everyone.

What Is Medicare, And What Does “For All” Mean?

So let’s back up and talk about Medicare a bit:  Medicare is only available to people aged 65 or older.  There are four key parts to the program, covering hospital, outpatient, “managed medicare,” and prescription drugs aspects.  Speaking very generally, it currently covers 80% of the cost for patients once they hit their deductible, with 20% left for the patient to pay.  According to Medicare Interactive, it’s commonplace for Medicare patients to pick up a secondary insurer on the private market, to help cover that remaining 20% of the cost.

Medicare is an intensely complicated subject, as befits its about-a-trillion-dollar size.  I am far from a Medicare lawyer or expert, so I can only speak in generalities, but what’s clear is that Medicare is not entirely a single-payer system.  But such a large system is by its nature going to wield a lot of power, and that power is slowly starting to be unleashed.

Starting in 2023, Medicare will be allowed to negotiate drug prices with producers.  Remember our insulin article?  The costs for Medicare patients will be capped at $35/month.  In theory, this can lead to knock-on effects like lowering the costs for drugs for everyone; although, to be honest, it’s also entirely possible that the pharma companies’ loss of revenue will be recuperate by raising prices on the uninsured.

The concept of “Medicare For All” is rooted in expanding these benefits to all Americans, regardless of age.

So How Do We Apply Medicare For All?

The very first thing people ask about is the cost of Medicare.  Here’s an answer to that, taken from National Nurses United:

The main idea here is streamlining or eliminating the various bureaucratic aspects of insurance companies and ending the roadblocks that “cut costs” but actually create more problems (I.E. Costs) for the system to deal with.  For example:  Ever have to get a referral for a doctor from your Primary Care Physician?  Ever have to get that same referral four or five times per year?  I have!  And it’s fucking depressing.

Yes, I do swear when warranted.

To get a referral, you first have to see your Primary Care Physician.  This might be about a new health condition, but it’s just as likely that if you have a chronic issue, you’ll have to do this repeatedly.  Then, you need to call a doctor in the specialty you need to get their information - and any error in this process can lead to delays and headaches; an incorrect fax number means the referral never gets there.  Then, you need to call your Primary Care Physician’s office and give their staff the information so that they can send the referral off to the new doctor.  Insurance companies keep very close watch for anyone who sees a specialist without a referral.  Oh!  And does your doctor, say, perform procedures at a hospital insurance doesn’t like, or in a setting they disapprove of?  Well, congratulations, insurance might quite literally call your doctor up for a “peer to peer” review of your medical needs, and might still choose to deny you care.

There’s a good reason why medical entertainers like Dr. Glaucomflecken (not his real name, but he’s a real doctor) satirize the insurance industry.

Medicare For All would eliminate the need for referrals.  It would eliminate the medical middle-man deciding whether or not the procedure you need is going to be paid for, and how.  The cost savings there are tremendous.  Does that mean more patients will seek care?  Sure! But that’s the point - providing health care to all means all people get to use care.  And if you’re able to get that nagging chest pain checked out by a doctor at a reasonable cost in advance, you might prevent that very expensive, and very deadly heart attack.

You would definitely see a tax increase when Medicare For All goes through, but you would no longer have to pay your monthly premiums.  Your employer would no longer have to pay  their share of premiums, meaning (in theory) they can pass on some of the cost savings to you in the form of a raise.  Furthermore, since insurance is often acquired through employers, you wouldn’t be at the risk of losing that healthcare if you change or lose your job.

There’s also the question of what form a Medicare For All implementation would take. Would it be Medicare like the current system, where private insurers still pick up part of the tab? Would it be a near-totally universal healthcare system like Britain’s NHS? All of these things make it hard to clearly identify what Medicare For All would really look like. All we have are visions of a possible thing, not a Platonic ideal.

So How Do We Actually Implement Medicare For All?

Well, this is the hard part.  And by hard, I mean hard.

You would need Congress to sign a law making it happen, much like they did with the original Medicare and Medicaid, the program that insures the poorest Americans.  Under our current “rules,” that means there would need to be 218 votes in the House Of Representatives, and 60 votes in the Senate (50 to pass the law, but 60 to overcome the filibuster that exists mainly to protect institutions like slavery and segregation and prevent progress).

Even if all Democrats were in favor of it (and they aren’t all in favor of it), the House Of Representatives is about to fall under Republican control in January, and there are only 50 Democrats in the Senate (with the chance for 51 if Raphael Warnock wins re-election in Georgia), plus Vice President Kamala Harris in the event of a tie vote.

It would be fought tooth-and-nail by insurance companies, who are quite fond of donating money to politicians in order to solicit security against such a law passing.  Anyone who is “anti-Socialist” will fight the bill, mainly because, well, uhhh…I don’t know how else to say it, but Medicare For All is definitely a shift towards Socialism on the spectrum of government control over economics.  That means Republicans are all but certainly going to be against it as a bloc.  There are even unions that are against it because they want to hang on to the benefits they’ve negotiated, even if it’s at the expense of everyone else getting care.

In today’s political climate, so long as the Filibuster exists it is extremely unlikely that Medicare For All will be passing any time soon.  Even if Democrats controlled the House, and even if there were enough votes to pass it there (which, again, not all Democrats are on board), the need for 60 votes in the Senate is simply un-overcomeable.  

With all that said, if Democrats regain the House in 2024, keep the Presidency, and expand their Senate majority enough that nobody who is interested in preserving the Filibuster can stop the rest from abolishing it, there’s a chance that it could happen in the medium-term future, if the advocacy and voter enthusiasm exists to win the next election.

And we have to fight for those chances to make everyone’s lives better.

Thank you for reading The Progressive Cafe.  If this article has helped you, please consider signing up for our mailing list.  This article is by Jesse Pohlman, a sci-fi/fantasy author from Long Island, New York, whose website you can check out here.