POINT AND COUNTERPOINT: Medicare for All

The Journal of the American Medical Association published a troubling study last month.

Its authors found that life expectancy in the United States has been declining for several years. Of particular concern, the mortality rate for people ages 25-64 is on the rise. The causes of these trends are grim: Alcohol abuse, drug overdoses, suicide and diseases like diabetes and hypertension are killing Americans in their prime.

Despite these terrible health outcomes, we continue to pay more for our health care per capita than any other developed country. Something is wrong with this picture. Why are Americans paying more, but dying younger?

To answer this question, let’s first examine the problems with the American health care system and then turn to a discussion of the solution (spoiler alert: it’s Medicare for All).

In a podcast called “America Dissected,” Dr. Abdul El-Sayed succinctly breaks America’s health care woes into five parts. First, he explains that health care in the United States is a business; the bottom line is all that matters, and healthy patients don’t generate profits.

The second problem he identifies is the illusion of choice. If you are having a medical emergency you can’t shop around for the best deal, like you would a new car. That means you can get stuck with thousands of dollars in medical bills if the EMTs take you to an out-of-network hospital when you have a heart attack. Hey, you should have said something while they were defibrillating you.

Third, in the American system, doctors diagnose health problems and provide the cure. In other words, they tell us what we need to buy and then sell it to us. Inevitably, this leads to up-selling, which costs patients more money.

Fourth, our third-party payer system leaves patients at risk. You pay your deductibles, you pay your premiums, you pay your co-pays (notice a pattern here?), but your insurance company can still deny your claim. Getting it to pay up could require hours on the phone and added layers of stress. What a fun activity when you or a family member are experiencing a medical issue.

Finally, health care costs are too high. Insurance companies have no incentive to control them, since they can be passed on to patients.

We deserve a lot better than this debacle of a health care system. This brings me to the actual topic of the column, Medicare for All. Since Sen. Bernie Sanders, as he so forcefully put it, “wrote the damn bill,” I decided to read it.

Formally known as “S. 1129, To Establish a Medicare-For-All National Health Insurance Program,” this bill addresses each of the problems I just listed. First and foremost, the new “bottom line” of the health care system would be the health of patients, rather than corporate profits.

The bill charges the secretary of Health and Human Services with establishing a national health budget to identify total expenditures for covered health care services. To control costs, the HHS secretary would have the power to establish fee schedules consistent with the Social Security Act, which governs the Medicare program. That brings up an important point: This bill does not reinvent the health care wheel. Rather, it expands the existing Medicare system to cover everyone in the country. The federal government already knows how to do this.

However, the bill also affords the federal government the authority to negotiate prescription drug prices, which it cannot do under current Medicare regulations. No one would have to forgo or ration a life-saving medication, like insulin, because he or she couldn’t afford to pay for it. Administrative and other overhead costs would decrease for doctor offices and hospitals, which would no longer spend money and staff time negotiating prices and filing paperwork with insurance providers.

Under this system Americans would have choices about where they go for care. Any health care provider can apply to operate within the national health insurance program. Also, it doesn’t prevent anyone who can afford it from purchasing supplemental health care for benefits not covered under the plan.

As good as this all sounds, many people oppose Medicare for All. To argue their point, some individuals use scare tactics about exorbitant costs or tax increases on the middle class.

The next time you hear this kind of argument, ask yourself why the speaker is trying to frighten you. Are they really offering an accurate picture? As Dr. Donald M. Berwick, a pediatrician and former Administrator of the Centers for Medicare and Medicaid Services, wrote in a recent USA Today article, “Framing this debate by fear mongering over ‘higher taxes’ ignores that this money is already coming out of American families’ pockets.” He goes on to say, “It is deeply misleading to pretend that this shift is an increase in family health care costs. It is not.” My advice to you is don’t be mislead; read the bill for yourself.

Remember that depressing JAMA study I mentioned? Among the solutions the authors cite to solve America’s mortality crisis is expanded access to health care for all. Specifically, they argue for “strengthening of behavioral health services and the capacity of health systems to manage chronic diseases.”

The Medicare for All Act of 2019 would do exactly this.

Jessica Wells is a Southern Pines resident and vice president of the Democratic Women of Moore County.

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Finances Are Unworkable on Medicare for All

BY JOHN ROWERDINK

Democratic presidential candidates Bernie Sanders and Elizabeth Warren have both proposed converting our health care system to a “Medicare for All” program.

Several other Democrat candidates have expressed support. This is such a breathtakingly bad idea it’s hard to know where to begin.

Let’s start with the cost. Bernie has sponsored a Medicare for All bill in Congress. He’s a little fuzzy on the specifics, but experts say it will cost more than $30 trillion over 10 years. Elizabeth Warren says her plan will cost $52 trillion over 10 years, of which $20 trillion is new government spending.

The Urban Institute estimates it will cost $59 trillion, of which $34 trillion is new government spending.

So it will cost somewhere between $20 and $59 trillion over 10 years. Total federal government spending annually is $4.1 trillion. This increase will be somewhere between 50 and 83 percent. And federal spending is already $1 trillion a year in the red.

Furthermore, the federal track record of estimating costs isn’t good. When the current Medicare program was approved in 1965, Congress estimated the cost in 1990 would be $9 billion. Actual 1990 cost was $67 billion, more than seven times as much. Last year, it cost $582 billion. Apply these misses to the Sanders and Warren projections.

Next, how would we pay for it? Sanders at least admits that taxes will go up for everyone (no kidding!). Warren says that “if the rich and the giant corporations pay just a little more,” she can cover the cost. She may be a college professor, but her field certainly isn’t math. Even fellow Democratic opponent Joe Biden calls this “mathematical gymnastics.”

Let’s take the rich first. The second richest man in America is Jeff Bezos, with a net worth of $114 billion. If the government confiscated his entire fortune which he accumulated over his lifetime, it would cover a little more than 2 percent of the first year’s cost. So find 49 others as rich as Bezos and confiscate their fortunes, and you can cover the balance of the first year.

Of course, we don’t have 50 Jeff Bezoses. And then, how do we cover the second, third and ensuing years? And do you suppose rich people might find ways to avoid having their fortunes confiscated?

Remember, they didn’t get rich by being stupid. By the way, Warren’s proposed “wealth tax” on billionaires has already doubled, from 3 percent to 6 percent, and she’s not even started yet.

Then there are the “giant corporations.” Warren says she’ll raise taxes on them by $9 trillion. She calls this an “Employer Medicare Contribution.” Do you suppose there might be negative consequences to the economy if she does that? Fewer jobs? Businesses moved offshore? Higher prices for the products they sell?

Surveys show the vast majority of people with private insurance like it. Do you suppose they’ll like government-run insurance just as well? Make a visit to the DMV and ask yourself if you really want the government to run your health care. Kathy and I were there recently — nightmare.

Then there’s the issue of eliminating all the private health insurance companies. Warren says those 650,000 employees can just go to work for the car insurance companies or some other type of insurance company. Good luck with that.

Both Sanders and Warren suggest that Medicare for All will cover all your medical costs. Is that really true? I’m going to give you my actual personal costs here, having been on Medicare for the last 10 years.

During my 35-year working career, my employer and I each paid a Medicare tax of 1.45 percent (2.9 percent total). During my last year of employment before I retired in 2001, this amounted to a tax of $4,000. We paid this tax for 35 years. Sanders and Warren want to give Medicare to everyone even if they’ve paid no tax.

Now that I’m retired, I pay a Medicare premium of $270 per month. This is taken out of my Social Security check before I see it. I also pay a monthly premium of $226 for Medicare supplement insurance and $3,810 annually for long term care insurance, since long term care is not covered by Medicare. Then there are medical costs that neither Medicare nor supplemental insurance pays. Last year, that totaled $7,867. Is “Medicare for All” free? I don’t think so.

There are many other problems, including lower payments to medical service providers, health care rationing, etc. Kathy and I lived in England for four years and saw these things firsthand.

And as crazy as Medicare for All is, when you add all the other “free stuff” Democrats are proposing, it gets even worse. I’m talking about free college, student loan forgiveness, the Green New Deal, etc. Think carefully before you vote in 2020.

John Rowerdink, a Pinehurst resident, is the former chairman of the Moore County Republican Party and president of the Moore County Republican Men’s Club.