What “Medicare for All” Actually Means

Language is important. Since I’m a language guy, and since I know a great deal about how Medicare works since Jenn spent 10 years on Medicare prior to her death at 45 years of age in 2017, I’d like to bring some clarity to the Healthcare Reform debate.

When Bernie Sanders–and, generally, the press–talks about “Medicare for All,” he’s not talking about Medicare as we know it. Why journalists are not pointing this out is beyond me.

As Medicare works today, retirees and those on disability qualify for Parts A and B. These are the parts that involve payments by the government to providers.

Part A is wholly paid for by Social Security. When you retire or go on disability it’s “included” with your benefits, and provides limited coverage of hospitalization expenses.

If you opt for Part B coverage (limited non-hospital medical care), premiums are deducted from your Social Security check. You are still paying for this coverage–it’s just that the government administrates payments rather than private insurers. (You still have the option of using private insurance for Part B coverage.)

But there’s one helluva lot that’s not covered by Parts A and B.

Part D, prescription drug benefits, has to be procured independently. Properly speaking, Part D is not a Medicare benefit. It’s a provision of Medicare wholly provided by private insurers.

Vision and dental benefits are also not covered by Parts A or B, and either have to be paid for out of pocket or via private insurance.

To provide coverage options for these uncovered expenses plus the share of other medical expenses NOT covered by Parts A and B — which are SIGNIFICANT — Medicare calls for two private insurance options: “Advantage” plans (which are, truth be told, a horrible scam best avoided entirely) or Part F (and related) plans.

And again, Advantage and Part F plans are not, properly speaking, Medicare benefits at all. They are benefits for which you pay monthly premiums to private insurers.

If our existing Medicare system were to be opened up to all taxpayers rather than just Social Security recipients, a typical family would still need to pay the equivalent of Part A and Part B premiums (since they are not retired or disabled) AND the equivalent of Advantage Plan or Part F premiums.

If a family of five opted for truly comprehensive Part A / Part B / Part D / Part F coverage, unsubsidized combined monthly premiums would still amount to well over $1500. And would still involve insurance companies.

The best thing in the world for insurance companies would be pushing another 80 million people into Advantage plans. The only Advantage to these plans is the advantage given to insurers–which is the ability to change what’s covered and what isn’t at the drop of a hat, based on what’s most profitable for the insurers.

So when you hear “Medicare for All” understand exactly what is being proposed. That catchphrase means different things to different people, and, as usual with politics, you are being manipulated by its use.

Bernie Sanders, for instance, is not talking about “Medicare for All” in the least. He’s talking about fully nationalized health, a concept which goes way, way beyond what Medicare provides.

And he’s not talking about paying for it through premiums; he’s talking about increasing taxes and closing tax loopholes. Details can be found in this white paper, but middle-income families would be taxed at 4% as “copay” into the system while low-income families would pay nothing.

Depending on your perspective, that may be either a good or bad thing; but I have to question why he describes it as “Medicare for All” when it is not. I suspect it’s because he knows if he called his bill the National Health Bill, it would be completely dead in the water. As long as he sticks with Medicare for All, even though the name is completely deceptive, he can get traction with those who are comfortable with “framing” debates rather than conducting them honestly with real words that mean real things.

Personally, I find Medicare to be a flawed system, deeply flawed when you consider the sick sham of Advantage plans, and the fact that they are an integral part of the system’s current design.

We do not need this flawed system for everyone. That’s like campaigning on the slogan “Broken Down El Caminos for Everyone.”

We need, and can afford, so much better–as long as we accept (as do other nations’ nationalized health care systems) that we can’t provide boundless health benefits for everybody. Medical technology is far too advanced and expensive for that.

If that means “National Health,” then be honest and call it National Health. If that means a “Health Care New Deal” that still involves private insurers, then be up front about it.

What we don’t need is more obfuscation or outright lies about health care. We need actual health care.

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