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Health Care Reform

Submitted by Marty Neft

Hopefully, it is time to stop playing endless defense of the Affordable Care Act, and to work towards much needed coverage expansion.  There is a head spinning array of suggested plans out there – who would ever think that health care could be so complicated?  We all need to be knowledgeable about which plans  make sense and may be viable.

I suspect that we all should support plans that will cover as many people who  need health coverage as possible, keep costs under control, make sure that covered health care is quality health care,and put us in position for health care to be a major campaign issue for us in 2020.

Expansion of Medicare in some form is where most of the action is now.  There is good reason for this – Medicare has been around for a while; has many of its bugs whittled out over time, is run by an efficient bureaucracy (in sharp contrast to private payer plans), and is generally popular.

The public should be aware that Medicare is not a single payer system, like the Canadian system.  It is a series of defined benefits, (Part A), which is mandatory for all members of specific groups – age over 65, and disabled.  It is heavily supplemented by optional private coverage – which fall under the categories of Part B (outpatient coverage managed by the federal government), Part B supplemental, managed by private insurance companies; Part C, Medicare Advantage, also known as HMO’s; and Part D – prescription drug coverage.

Some of the proposed federal Democrat sponsored plans stratify into a suggested complete overhaul of  the current system, replacing insurance insurance and private pay service with a government sponsored single payer plan. These are more analagous to the VA, military,  and Indian Health Service plans. Here’s a good summary of all of the plans being considered at the federal level:

I am intrigued by a Medicare Buy in Plan recently submitted to both houses. The measure was introduced by Sens. Sherrod Brown (D-Ohio), Debbie Stabenow (D-Mich.) and Tammy Baldwin (Wis.) and Reps. Courtney, Brian Higgins (D-N.Y.) and John Larson (D-Conn.).   It allows for persons 50-65 to buy into Medicare coverage.  It leaves the current system intact.  Medicare has its flaws and detractors, but it functions at substantially  less cost than existing plans.  It would be an incremental increase in current coverage.  It would cover a group currently  particularly vulnerable to concerns about pre-existing conditions and becoming sick while uninsured.   And it would lower the cost of insurance for the remainder of the population by taking the most expensive cohort out of their pool.

Senator Bernie Sanders and Rep. Pramila Jayapal (D-Wa) have both introduced and sponsored single payer, totally comprehensive health plans.  Sponsorship and momentum for both are growing.  Since they represent a complete overhaul of current health services, I’ve got to question whether the time is right for these.

Now the big question – who will  pay for this?  Sticker shock hits when we find out the cost to the governments of covering health care.  Please do not just look at the tax bite.  Consider the administrative savings these plans could have over current high overhead insurance programs. Consider how much employers will save but not covering employee insurance; savings that would more than offset a tax they may need to pay to cover health care. Also consider some not so obvious cost benefits – such as auto liability insurance, which could go down substantially if uninsured drivers did not have to be covered.

None of this will be easy.  There are a lot of stakeholders in the status quo,and the battles may get vicious. But health care is really important, and worth the fight.



  1. The article from the Kaiser Foundation linked to in the article above is dated October of 2018. It talks about legislation that is not currently under consideration. Opinions of Foundations like the Kaiser Foundations must be taken with a grain of salt. These foundations have in their very DNA the inability to be fair in their assessments of legislation that eliminates the profit made by health care insurance companies from the illness of the American people. See this article to explain why.

    • Scott Johnson on September 29, 2019 at 7:02 pm
    • Reply

    Looks like there are now some Medicare buy in bills introduced in Congress. This makes the article linked to in Marty’s forum piece outdated because dated Oct 09, 2018 it only address the proposed legislation from the 115th congress.
    Here is a link to the current Medicare buy in legislation.

    I wonder how allowing private insurance to continue will effect the viability of these buy plans and of Medicare itself. The advantage of Medicare for All is that it not only covers all patients, it also includes all providers including all doctors. Under the buy in plans a greater number of patients will be seeking care from the same number of doctors who currently take Medicare. M4A also expands coverage to include dental, eye care, including glasses, and mental heath care as well as hearing aids. The buy in plans do not expand Medicare to cover those health care needs because they do not change Medicare according to the article.

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