This piece was published in the Pasadena Star News on March 22, 2020.
When I hear Bernie Sanders say we need “Medicare for all,” I don’t understand his reasoning. Medicare wasn’t designed for “all.” It was designed for a particular group of Americans who paid into the system first, and then collected benefits later. Loading the system with millions more Americans who have not paid into the system distorts the model.
Medicare has worked as it was designed to work for fifty-four years. It is an earned benefit, meaning that the people who paid into it during their working years were able to get a return on their investment after they retired and began receiving benefits. From the beginning, it had cost-sharing: a first day deductible for the hospital insurance (Part A) and a 20% co-pay for Medical insurance (Part B). There is a monthly premium for Part B that is deducted from beneficiaries’ Social Security check.
From my first job at the Ohio Bell telephone company in Findlay, Ohio as a telephone operator in 1968, money was withheld from my paycheck to pay for Social Security and Medicare. It was called a payroll tax. Money was taken from my paycheck for the next 49 years until I retired and started receiving Social Security and Medicare benefits.
In 1996 I became Manager of the Health Insurance Counseling and Advocacy Program (HICAP), a program of the California Department of Aging, and worked for the next six years with Medicare. I helped people figure out their medical bills, helped them determine how much Medicare paid, explained how HMO’s worked with Medicare, and educated beneficiaries on the constant changes and adjustments in Medicare law. Overall, the system worked.
Politicians who imply that government bureaucrats sit in the basement of the White House and deny claims are wrong. Medicare claims are processed by insurance companies who contract with Medicare to pay claims. Coverage issues are decided by Congress. Fellow HICAP advocates and I met with now-retired Congressman Henry Waxman to discuss doctors who charged Medicare beneficiaries to process claims. We didn’t think that was right and neither did the Congressman. About eighteen months later, it was prohibited by law.
When Bernie says: “No copays, no deductibles, no premiums!” I cringe. That’s not Medicare! He wants to take an idea with a proven track record, a strong foundation and clear goals and squeeze it into a one-size-fits-all. It won’t work.
What he doesn’t say is that taxes will go up to pay for all this largess. President Obama proposed and Congress passed a health insurance bill that was designed for people who are working but don’t have insurance from their employer. The Republicans have been trying to repeal it and attack it in any way they can since it passed.
If you think Bernie can put together Medicare for All, I have a bridge to sell you.
During the Democratic debates I got very frustrated and bored with the extended discussions of the candidates about their respective Medicare for All or Medicare for Those Who Want It or Medicare on a Post-It Note. Joe Biden was the only one who stood up for the Affordable Care Act (ACA). Nobody else came to the defense of a law that has been defending itself from the onslaught of Republicans who want it gone, and Trump, who wants it gone out of spite.
The ACA has insured millions of working Americans who do not have insurance through their employers. Despite continuing efforts by the Republicans to kill it, the ACA has survived. Let’s elect politicians who will build on that and leave Medicare to do what it does best.
Kathleen Vallee Stein