Road to single-payer could go through Medicare Part C
Rep. Todd Akin was wrong, wrong, wrong when he said that “America is threatened with a stage 3 cancer of socialism, and Obamacare is Exhibit 1.”
Actually, Medicare is Exhibit 1. Far more socialistic than the Affordable Care Act, Medicare requires a major transfer of wealth from taxpayers to older people. Medicare is also wildly popular, and I dare Akin to call it a “cancer” in front of his electorate.
That’s why I can barely contain my anger at a Trump-voting neighbor, an otherwise lovely older woman who’s undergone years of kidney dialysis and serial hospitalizations. She must have consumed a quarter-million taxpayer dollars by now, yet would deny guaranteed health coverage to the younger workhorses paying to keep her alive.
(No, Medicare is not self-funding. The payroll taxes, premiums and deductibles the beneficiaries have paid don’t cover it all. General revenues currently fund 40 percent of the program’s costs, and that percentage is rising.)
Stories like these are why many of the town hall attendees currently hollering at Republicans who voted to dismantle Obamacare are also yelling, “Single-payer ‘Medicare for all.'” Well, what of it?
Let’s talk policy, and that requires defining things.
Medicare is not single-payer like the Canadian system. In Canada, the government picks up all the medical bills. Medicare is multi-payer, combining public and private coverage. France’s superb health care system, rated the best by the World Health Organization, is also multi-payer. Canada ranks 30th on the WHO list, and the United States is 37th.
So in developing a health care system that is universal, provides high-quality care and is affordable, we need not make a fetish out of copying the Canadian model.
There’s now some bipartisan interest in what’s being called — and it’s a mouthful — “Medicare Advantage Premium Support for All.” Billy Wynne, a health care consultant, champions this idea in the Health Affairs blog. He’s taken some raw numbers and figures and determined that Medicare Part C could cover everyone and save businesses more than $600 billion. And no new taxes.
To understand Medicare, one must take apart the parts. Part A covers hospital and post-acute care. Beneficiaries don’t pay extra for that. Part B covers outpatient services and Part D the drug benefit. To get one or both, one must pay extra.
Part C is Medicare Advantage. These are private plans that offer Part A and Part B benefits plus some added perks, which may include vision, dental and drug coverage. Enrollees pay a premium depending on how fancy the plan is. Despite recent reports of their bilking Medicare (all billers need to be monitored), Medicare Advantage plans have a good record of controlling costs.
On quality of care, Medicare Advantage plans often do better than traditional fee-for-service Medicare. They are especially good at follow-up, making sure people take their medications and show for doctors’ appointments. After all, sick enrollees are not good for their bottom lines.
Medicare Advantage Premium Support for All could be deemed single-payer, in that the government would pay the insurance companies. It could also be deemed market-based, in that people would choose their preferred plan.
How the medical-industrial complex would take to this remains to be seen. Insurers would see their benefits regulated and funding capped. They could use the clout of a national market to get good prices from providers, but providers might not like that.
Obamacare has accomplished much but needs work. And the Republicans’ American Health Care Act is a political and social disaster. America seems headed to some kind of single-payer system. Medicare Advantage Premium Support for All could be one of the roads that lead there.