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How to Provide Medicare for All


How to Provide Medicare for All

Marcia Angell

Obamacare, aka the Affordable Care Act, became law six years ago. The intention was to ensure that nearly all Americans have health insurance, while controlling costs. How did that work out?

When the law was enacted, about 16 percent of Americans were uninsured. That has dropped to 10 percent. So instead of 50 million uninsured Americans, there are now about 30 million without insurance. That’s better, but hardly universal.


"Health insurance" is a great American Myth. Follow the money.


Since the Clinton camp relies upon Big Insurance, she and her advocates can't honestly discuss the role played by Insurance in the scam that passes for America's version of Health "care."

This deserves repeating:

"The reason Obamacare is unable to expand access and coverage while containing costs is that it made only marginal changes to the underlying factors that make the American health system the most expensive in the world. There are two: First is the spectacularly inefficient private insurance industry, which thrives by refusing coverage for expensive medical conditions and generally denying claims. These companies’ profits, marketing, and other overhead expenditures are so high that when Obamacare restricted them to 20 percent of premiums, it seemed draconian. Compare their costs to Medicare’s overhead of about 2 percent."

Excellent diagnosis, Dr. Angell


No, equating "Health Insurance" to "Health Care" is the myth.


The medicare system is slowly being turned into the same profit generating life sucking squid as the private insurance companies. This started under Bush the village idiot. It is not the answer as it is currently constructed.

Fees and co pays are in the hundreds of dollars per script in many cases, for people who are solely getting by on social security. Just visit your pharmacy, and encounter at least one person a month who is not eating because they are spending their income on medicine they need to survive That is completely legal in both systems.


That's why John Conyers's H.R. 676 is named Expanded & Improved Medicare For All Act.


What Americans do NOT want is universal health care. They want to keep a separate system for the poor. Indeed, it wouldn't make sense to risk expanding comprehensive health care to the truly poor, only to dump them back on the streets. (Not everyone can work, and we don't have jobs for all.) Deprivation of adequate food and shelter take a very heavy toll on human health.

Just to give you some idea of the impact of our current social policies, I read that the overall life expectancy of America's poor has already fallen to around age 60, the result of deteriorating health over a period of years. A big chunk of the population experience the profound stress of living on a tightrope with no safety net below, one job loss from losing everything. Patch 'em up and send 'em out the door isn't a cost-effective strategy.


I am in complete agreement. Another aspect of expanded medicare for all is a reduction in malpractice insurance. While liability would still play a role, costs for additional care would already be covered under the system.

I Bern for single-payer!


Get your facts straight. Medicare Parts A and B are totally public insurance. Part A covers hospital stays and Part B covers treatment by doctors outside of hospitals. Medicare pays the bills. Deductibles and copays are paid by private insurance if you choose to buy supplemental private insurance (the premiums are quite a bit higher than the Medicare Part B premium; there is no premium for Medicare Part A). The nice thing about Medicare is that the Part B premium can only increase if there is a Social Security COLA (the Medicare Part B premium is deducted from the Social Security benefit). My Blue Cross supplemental premium goes up every year, because as Blue Cross tells me, the older I become, the more expensive it is to insure me (not that different than your auto insurance premium going up each time you have an accident).

Medicare Part D (prescription drug coverage) is just like the ACA. When you turn 65 and sign up for Medicare, if you want prescription drug coverage, you must purchase it from a private health insurance company. I chose Humana because it is the cheapest. It is cheapest because I have to have my prescriptions filled at Walmart and Walmart charges less for drugs because they know that people who go into Walmart to get their meds will also shop there and buy other things, so Walmart makes more money by getting people to buy Humana insurance. Ain't capitalism great?

Medicare Part C involves purchasing private insurance from an HMO or PPO (managed care as opposed to fee for service that is traditional Medicare; this is supposed to keep costs down). Your private insurance company pays your bills and gets reimbursed by Medicare. You still have to pay your Part B premium. Medicare Part C is nothing more than private insurance companies feeding at the public trough.


Dental care was not covered by my employer-provided health insurance before I went on Medicare. I had to buy dental insurance.

Now that I am on Medicare, I buy supplemental private insurance to pay for what Medicare doesn't pay and I also buy dental insurance. Other than routine exams, cleaning and X-rays, the copays are very steep (my insurance only pays 50% of the cost of crowns). This was also true of the dental insurance I had before I went on Medicare.

I don't know what my employer-provided insurance paid for vision because I used it so infrequently.


I don't agree. I think a majority of Americans favors single-payer health insurance (what exists in Canada). Conservative politicians, big insurance and big pharma are definitely opposed to public health insurance because this is competition from the government.

Ironically, the very conservative German Chancellor Otto von Bismarck said: "Either the government will enact social welfare programs or the socialists will take over the government." The German Social Democrats (Bernie Sanders is a Social Democrat) produced all kinds of social welfare programs (e.g., national health insurance) by taxing the rich 50 years before FDR came up with Social Security in the US.


so clear now.


Medical errors are the leading cause of death in the US after heart disease and cancer. This won't change under single-payer health insurance. So, lawyers will still sue doctors and hospitals that screw up. To cover their asses, doctors and hospitals will still have to have malpractice insurance.


In the 1930s Supreme Court Justice Louis Brandeis said that the states are the laboratories of democracy. Although the country needs Improved and Expanded Medicare for All, we will not obtain it nationally until we have it in a state or two. It is necessary to show politicians that they can survive supporting it and that it saves money. Numerous states are in the process of doing just that. See SPANOhio.org


How to get affordable health care.

1) nationalise docotors, paying them a decent salary, telling them, as did Aneurin Bevan (UK Health Minister in 1947-48), that those that don't like it may leave.

2) nationalise all hospitals and pay all staff a decent salary.

3) set up a national government-run health insurance fund legislated to be completely different from the annual consolidated revenue budget of the USA.

4) have people and employees pay for this helath insurance from their income in a proportionate manner based on their income; in the UK, one was obliged to buy a health stamp or stamps per week that went in one's health-stamp book and ones's employer bought two or three time those stamps for one and these also were entered into one's book.

5) Legislate so that "Big Pharma" cannot maintain monopolies on required drugs and allow generic drugs into the country.

Easy really. It worked in the UK back in 1948, with the rider that specialists were also allowed private practice with a number of beds allocated to them in public hospitals, as a sop to their resistance, in the UK.

I wonder why it wouldn't work in the USA................................. Don't answer that question; I know the answer. It's "socialism"" Aaaaaaaagh. A socialist! Reach for your Colt 45s! Bring out the burning crucifixes! Put on the white hoods and cloaks and throw a rope with noose over the nearest tree! He's worse than a nigra or Mexican immigrant; he's a socialist!


The Canadians and Scandinavian countries seem to have found ways to keep the level of fraud under control so it can't be impossible, beyond the wit of humankind. Admittedly in the US government programs are seen as cash cows ripe for skimming, and this like most US forms of government corruption elicit only the sighing "yes that's how it is but what can you do." The acceptance of this sort of thing and the general belief endemic to the current incarnation of capitalism that nothing that's done to make money can be in any way immoral enables the wealth transfer scam that is siphoning so much earned income from people who depend on it to live,

At least this election has put the issue on a barely visible corner of the table. But not till most of the people now ensconced comfortably in the "burbs" find that their 401Ks and retirement nest eggs have been mysteriously emptied, their "secure" employment situations have let them go, their mortgaged homes that they had been conned into thinking they "owned" have been foreclosed and they're being evicted with no place but the nearest refugee camp tent city to go to for food and a cot to sleep on, that the state of the art high tech medical treatment plans that their loved ones need to stop suffering and not die miserable painful deaths are priced out of affordability, and that when members of their family do die from neglectful inattention there will be no way to provide them with a funeral and a "decent burial," and when the Tom Petty song "You Don't Have to Live Like a Refugee' seems to be speaking directly to you personally -- then and only then will the realization that the "American Way of Life" was nothing but glitzy packaging hiding toxically shoddy products sink in, and the homeless people who had thought to have earned their fate with their laziness and endemic avoidance of doing "plain hard work" -- then and only then will the set up for "hope and change" be in place,


As I said, the liability portion will still be needed, but the awards for cost of health care will disappear because a person is covered cradle to grave in a single-payer system. I don't know what the percentage of savings is between liability awards and cost of care awards, but I imagine they are close to each other considering how expensive care is.

Because most malpractice is entirely preventable and to make single-payer work efficiently, a process for better prevention will have to materialize. A 1990 study by the National Practitioner Data Bank found that just 5.1 percent of doctors account for more than half of all medical malpractice payouts. Of the 35,000 doctors who had two or more malpractice payouts, only 7.6 percent of them were disciplined. More strikingly, only 13 percent of doctors with five medical malpractice payouts have ever been disciplined. (Source.

$7.1 billion is spent defending and paying malpractice claims. That's a lot of money, even though it it's only .03% of the total cost of healthcare. Preventable errors represent $29 billion annually, so addressing practicing doctors with multiple claims against them is necessary for single-payer to keep prices down. There's absolutely no impetus in the current system to address malpractice, malpractice insurance costs, or reducing malpractice.


Doctoring is among the noble professions, and shouldn't be a pathway to extreme wealth. Just ask a teacher!


That's true. My Mom worked at a Doctor's office, then for a vitamin company and was way ahead of the rest of the country on nutrition and had us taking supplements all along. We used to shop at a health food supermarket in Glendale called "Foods For Life.". She believed ( and I still do ) that the American Medical Assn. deliberately put the kibbosh on nutritional efficacy to keep doctors' earnings up.