I have been working all week on a different article, but after many discussions and arguments and every attempt to appeal to the better part of human decency of some people, I just feel I need to address this first. Healthcare is an issue that will not go away. I’ve made no illusions as to my preference for a single payer system. After all, Medicare was designed and intended to be a medical system for all of our citizens, not just the elderly. And it would definitely work. I will get to that in a minute. First, I want to address why we should want to do this. Why is it important? How will it help our country? Why is it our responsibility?
Yes, you read that right. Responsibility. It isn’t just a nice, charitable thing that good people should try to help the sick. It is our responsibility as citizens of our country, states, counties and parishes, cities, towns and communities. Making sure everyone has access to healthcare is our responsibility as being part of this society. We all contribute how and what we can, within reason, to ensure everyone has the basic needs of life and human rights. In our nation, where there are doctors and hospitals and medical facilities and clinics from coast to coast, pharmacies in almost every town, how is it excusable that people are denied healthcare? How is it excusable that we choose to allow our fellow citizens to suffer in illness or die because they don’t have money?
I’m not an enormous fan of the ACA. I feel like it was too much of a give away to corporate insurance companies banking enormous profits off the extortion of money from people who fear getting sick without it. I worked in the medical management department of a PPO Network. I know first hand how crooked that system is. While perhaps not breaking (too many) laws -I did see laws broken meant to protect patients up to and including the company falsifying documents which led to the denial of medical services or the ability to appeal that denial- they did everything they could to deny coverage. They take your money and they cheat every way they can. The ACA curbed how much cheating they could do. So, the ACA is better than what we had before, but not by that much. Medical Insurance companies made themselves into an industry they hoped would be too large for the government to undermine and replace. Not only have they been holding the people hostage, they have been holding the government hostage as well with the threat of economic collapse should they fail. Nice plan. I mean, if you are a greedy insurance company who doesn’t care how many people die. So, no I’m not a huge fan of the ACA, but think it is better than insurance companies selling medical coverage a la carte and ripping people off at ten times the pace.
But here is the thing, it doesn’t actually have to be that way. We can afford Medicare for all. And we can do it in a way that won’t cause drastic hardship on the economy. We can phase out insurance, allowing those companies to divest and move into other markets over a set span of time.
We initiate it by moving the Medicare age back to 55 and include all veterans. Five years later, we move it back to 40. Five years after that we move it back to 25. Then, finally, in five years, we cover everyone. That is fifteen years, which is plenty of time for the market to slowly adjust. Alternately, We move it back to 50 immediately, plus all vets, then in five years to 30, and in five more year extend to everyone. That is still a full decade for market adjustment. By doing it this way, job losses will be much slower and more easily absorbed into the economy. Remember, many of the middle class and lower end jobs in health insurance will transition to Medicare, as they will need workers skilled in medical knowledge and coding to fill positions caused by higher demand in their department and increased claims to process. So all of these jobs are not just going to disappear. Just the top ones and I’m sure those people making millions a year will be just fine. I don’t know about you, but I am not really all that concerned about the future employment opportunities of multi-millionaire health insurance CEO’s. Pretty sure they can manage. But, hey, speaking of millions of dollars in salaries to just a handful of people, let’s look at that!
When Insurance Companies can afford to pay tens of millions to their top execs, they are banking some nifty profits. Think all those high premiums are because the actual cost of healthcare is so high? No. A big part of it is the salary they pay to the top execs and the fact that these are corporations with shareholders and they pay out big. Insurance companies are not hurting on profits, by any means. In fact, their whining about losses is a misnomer. They are whining because they may not make as much profit as they could, not because they are actually losing money. They are still making profit hand over fist. So think about this: if a for profit industry is making money even with paying its execs top dollar (those salaries count as expenses and aren’t part of the profit margin) and insuring people with preexisting conditions and having to cover things like maternity care and mammograms, based on the money they receive in premiums, isn’t it a no-brainer that we can afford that medical coverage without the insurance company? If we divert the money being paid in premiums to Medicare, then we can pay for those expansions. In fact, we don’t even have to pay as much, because we are no longer footing the bill for those top executives. Employers can pay a medicare tax per employee instead of insurance policy benefits. It would actually save them money. Employees can pay their premium on a sliding scale based on their earnings. that is how Medicare premiums work right now. Part A, B and D can all be rolled into just one plan for everyone and include both dental and optical. Yes, we want to include that. It is ridiculous that these parts of our body are excluded from healthcare and considered separate. Teeth and eyes are important, too, people. It is also shown that appropriate dental care helps the overall health of a person. And optical care in cheap and easy to provide. Seriously, we pay like $3 a month for our entire family and my husband’s employer chips in about $9. So, yeah. We can do that and it will make a serious difference to a lot of kids and lower income homes and the elderly.
So, as we lower the age for Medicare, we divert those employer and individual premiums. Instant funding. After all, that money is already doing the job in great excess. Some things we need to do: #1 The excess will fund people who do not have coverage. #2 We divert the subsidies for those buying insurance on the market to subsidize what would be the employer portion of their healthcare. Again, this is all money already being spent. #3 We put the excess into a fund to help secure the transition. #5 We bill out to Medicaid, payable to Medicare for the services provided to people who had been receiving those benefits, in the proportion that Medicaid paid. In this way, we begin the transition of moving funds from Medicaid to Medicare. Eventually the funds for Medicaid will exist primarily to provide offsets in Medicare premiums for low income adults and pay the premium on all children for so long as they are students and not employed full time. #6 Any excess Medicaid after the full transition will be moved, annually, to the Medicare general fund which covers all expenses in human resources, administration, and medical reimbursements. #7 All VA funding can be moved to Medicare with a portion set as the VA Fund. This fund pays the Medicare premium and any out of pocket expense for every veteran. Money may be set aside for specialty facilities which deal with illness, injury and afflictions unique to Veterans. However, the primary care for all veterans would be immediately moved to Medicare, meaning our veterans would instantly have both freedom of choice and ready access to healthcare. There is zero legitimate reason our veterans are forced to have a separate healthcare system which in many places is inaccessible and frequently substandard. Our veterans deserve the freedom they have fought to preserve for the rest of us and the dignity to receive medical treatment when and where they need it and by doctors and facilities they trust. #8 Once we have streamlined the transition, there should be a mandatory audit and assessment to determine how premiums can be lowered. This mandatory assessment should be required every seven years with specific focus on administrative efficiency, preventive medicine and education programs which can reduce expenses with a specific purpose to determine if premiums can be lowered. #9 Money can never be diverted from any Medicare surplus to the government’s general fund to be used for any other purpose. #10 changes to increase Medicare Premiums will be subject to a super majority vote in both the House and the Senate and that statute can only be changed by a super majority vote in both the House and the Senate. #11 Medicare for All cannot be repealed except by a super majority vote in the House, the Senate and be approved by a super majority of the States.
See, the thing is, we can fund this based on the money we are already spending. We just aren’t giving that money to Medicare at the moment. We are giving it to corporations who are making big profits, which means excess that we can utilize to expand coverage. The CEO for Centene, Michael Neidorff, made $22 million in 2016. That is just one person in their company. The VP’s for that corporation range between $3 to $4.6 million a year. Together, all five total over $40 million a year. And the company is still making billions. Centene Corp alone had $40.6 billion dollars in revenues for 2016 and 86.5% of that revenue came from their health insurance subsidiaries. Now that means they had $34,759,592,000.00 in health insurance revenue. One insurance company. They saw a gross profit of $5.4 billion. That’s after everything and everyone is paid. Profit. And, by the way, for those talking about how the ACA is too expensive for insurance companies to maintain, Centene’s gross profit of $5.4 billion in 2016 was up from $2.75 billion in 2015, $1.98 billion in 2014, $1.21 billion in 2013, and $705.51 million in 2012. (If you don’t like to do quick math in you head, their gross profits increased more than 765% in a four year span.) Doesn’t look like they have done so bad under the ACA, does it? Remember, this is after they have paid out medical claims. And this is just one company. You still have big boys like Humana, Aetna, Cigna, Anthem, UnitedHealth, and WellCare, and more.
What is the point of this? First, insurance companies don’t care about your health. They care about taking your money and keeping as much of it as possible. They are for profit businesses and that profit margin is their first priority. That is fine for some things, but healthcare? When people depend on medical treatment for their lives and health, should that be entrusted to corporations who only see dollar signs or should we develop a system which answers to the people and doesn’t hold our citizens hostage, extorting every penny it can from them by leveraging a person’s fear of death? Medicare works. It is a proven system. Is it perfect? Of course not. It never will be because no system is. But we are already spending the money to pay for a complete Medicare system. We are just paying it to the wrong people.
Yes, it would devastate the Medical Insurance market, basically shutting it down except for specialty policies, secondary policies and the like. It may also have a place for travelers, providing short term insurance policies for those visiting the US or traveling abroad or for immigrants who have not established residency and qualified for Medicare. They will no longer be the big, fat, and greedy conglomerates we see today. But face it; they haven’t been making these huge profits all that long and they are not a necessary market in our economy. In fact, they are a drag on our economy. They take huge sums out of the hands of the middle class (those who tend to push the economy in spending) and redistribute it to a wealthy few who do not use it to fuel the economy.
Now, what do the people gain from this, without actually paying anything more? Freedom. Every facility and provider will accept Medicare. You will have a choice. You won’t be locked into a network which may or may not have providers you trust. Sub standard providers will no longer be artificially enabled by PPO Networks, which means far less malpractice. Which reminds me, don’t feel too sorry for those insurance companies, they still sell life, auto, home, flood, earthquake, workers’ compensation and malpractice insurance. So they do have other areas they can concentrate on. They have business opportunities.
The point of it all is that the money being thrown into this industry along with what the government is already supporting will be more than ample enough to pay for the program. If we reduced the employer contribution to a flat, per employee rate that is 10% less than the current national average, we are still looking at roughly $300 billion dollars diverted into Medicare from the top ten insurance companies alone. Combine that with the VA budget, Medicaid budgets, subsidies budgets and current Medicare budget and, yeah, we got this.
Healthcare is such a basic need. It should not be afforded to charity. People should not be forced to beg to not die; to beg to save their children or their mother or father or friend or spouse. No one should be shamed or demeaned for needing healthcare and it is not a commodity to be entrusted to those who have taken no Hippocratic oath. this is a basic need of society. It is our responsibility as citizens of a community, of a civilization, to ensure the basic welfare of our fellows. Government isn’t just what it can do for you. it isn’t just to keep you safe, educate you, etc. You and I are part of society and we have a responsibility to provide the basic human rights which make our freedom possible. It is your duty to help. It is my duty to help. Community is all about working together so that we all have a better and safer life. We work together to build our economies, educate our children and workforce, provide protection, both from foreign threats and domestic, build our roads and transit systems, develop municipal necessities which provide things like water, sewage systems, waste management and firefighter services. We do not all use all of these services, but we understand the need for them and we understand why our part is necessary. Would we not put out a fire because someone didn’t have enough money to pay for a firetruck to come to their house? Think about it. Healthcare is every bit as essential because it affects every single citizen at some point in their life. It is just as much our responsibility to ensure healthcare as it is access to police, fire services or even roads.
We can do it. We have the money and resources and public support. It isn’t just a test of our moral compass, that life is more important than money, but a responsibility to ourselves and our fellow citizens and the nation we love. This is what patriotism actually looks like at the civilian level: people willing to sacrifice something small for the betterment of their country.
We are One Woman, One World.
Ann Lavendar Truong
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