With health care becoming increasingly unaffordable, “Medicare for all,” the proposal to improve and expand Medicare to all Americans, is gaining support. In the words of Public Citizen, “Americans are sick and tired of our broken health care system.” Corporate health insurance is costly and too often restricts access to needed care, while Medicare, government health insurance for older adults and people with disabilities, is more cost-effective and offers better access to needed care. As a first step towards a saner health care system, what about Medicare for those who choose it?
As proposed by Sen. Bernie Sanders (I-Vt.) and others, Medicare for all provides all Americans the right to use physicians and hospitals of their choice anywhere in the country, eliminates premiums, deductibles and copayments, and is projected to drive down national health care spending by trillions of dollars over a decade. Medicare for all replaces corporate health insurance entirely, and for good reason.
Corporate health insurance requires Americans to spend a lot more on health care than our peers in Europe and Japan for significantly worse health care outcomes. The health insurers’ priority is a big return for their shareholders, not the health of their enrollees. In fact, in the privatized coverage system we have private insurance companies have a legal responsibility to serve their shareholders, not patients enrolled in their plans. The insurers are responsible for roughly $500 billion a year in administrative waste in addition to billions they take in as profit and dividends. They cannot contain health care costs, and have no motivation to.
What’s most concerning is that, even with corporate health insurance coverage, millions of Americans are forced to forgo care, either because they can’t afford their deductibles or copays or their insurers deny them coverage for the care they need. And, when they opt for care, they often end up with medical debt.
At this juncture, with a Democratic Congress and a Democratic President, Medicare for all should be doable. But, it would mean Americans accepting that the government can deliver better health care coverage than corporate health insurers at a lower price. And, since most people don’t use a lot of health care and many people do not trust the government, helping the public recognize the enormous value of Medicare for all is still a heavy lift. So, offering Medicare for those who choose it as a first step seems a common sense way to go and could offer the best chance at getting to Medicare for all in the future.
The question becomes how to design Medicare for those who choose it so that it delivers good affordable access to care and gets us closer to Medicare for all. Medicare for those who choose it only works if the government contains provider rates and prescription drug prices for every one, not only older adults and people with disabilities with Medicare. And, that’s not even enough.
Medicare for those who choose it only works if the government regulates corporate health insurers far more than it already does, so that they cannot game the system. So long as insurers can undercut the Medicare program, attracting healthy enrollees and steering people with costly conditions into Medicare, a Medicare option becomes excessively costly and untenable.
Insurers must be required to offer comprehensive coverage, not high deductible plans that make health care unaffordable and keep people from getting needed care. Insurers must be required to offer robust provider networks that cover people wherever they are in the United States and don’t force them to travel long distances to get needed care. Insurers must be required to operate under standardized, public, evidence-based prior authorization rules that don’t allow them to deny and delay care and second-guess treating physicians, as they please. Our government also must have the power to impose stiff penalties when insurers violate the law.
With insurance regulations in place, Medicare for those who choose it, including for employers large and small, would be a big step towards Medicare for all. It would not capture anywhere near the health care savings that Medicare for all would capture because it would leave hundreds of billions of administrative waste in the system. But, simply rationalizing and standardizing provider rates and prescription drug prices and decreasing administrative waste–three essential features of Medicare by choice–could bring down health care costs by 20 to 30 percent.
It makes no sense that Americans would opt to retain a corporate health care system that leaves millions of Americans with no guarantees that they will be able to get the care they need when they need it. Corporate health insurance generally means limited choice and high costs. And, who loves UnitedHealthcare or Aetna?
In stark contrast, Medicare for all guarantees all Americans access to health care, with freedom to see the doctors we want, throughout our lives, wherever we live, wherever we work and whenever we are out of work. And, Medicare for those who choose it could get us far along that path
It is more than likely that the corporate insurers have too much money and power for our government to take down their industry in one fell swoop. Their campaign contributions alone bring them substantial influence and significant Congressional support. Still, it is critical we fix our broken health care system. Americans should understand that the best way forward is Medicare for all. The first step should be Medicare for those who choose it and major insurance industry reforms.
Here’s more from Just Care:
- Medicare for all would save $600 billion a year in administrative costs
- Poll: Two-thirds of Americans support Medicare for All
- 2026: Five things to think about when choosing between Traditional Medicare and a Medicare Advantage plan
- Ten ways to improve Medicare Advantage
- Well-kept secrets of Medicare Advantage plans
