“Medicare for All (will cost) 35-30-40 trillion dollars”
-Joe Biden, 2-18-20

  I will vote for Biden because he is head and shoulders better than Trump, who is currently attempting to totally do away with the ACA, leaving 20 million without insurance and permitting the greedy insurance companies to, once again, use “pre-existing conditions” to screen out sick people.

  However, Biden’s stated Medicare for All figures were wildly inaccurate because: (a) they don’t account for what people/ companies are currently spending for healthcare insurance via VA, Medicare, Medicaid, and private insurance; and (b) they are his projected (incorrect) costs for 10 years, not one year.

  According to a recent Amherst study (Pollin et al), Medicare for All would actually save money overall, primarily because Medi-care has an overhead rate of 2% versus 12% with private insurance. We are already spending $3.24 trillion annually on healthcare. Plus, 26% of Americans are underinsured while another 9% have no insurance. Single payer covers everyone while lowering expenditures to $2.93 trillion annually.

  As the Congressional Budget Office’s report on single-payer healthcare indicates, there is no universally accepted one-size-fits-all plan, complicating analysis. Most single-payer supporters desire expansion of our existing Medicare program, but with modifications. Where there are differences, they relate to:

• How quickly should the new program be implemented (example: should it be phased in by age groups)?
• Should it cover noncitizens?
• Should all physical and mental health services be covered, including long-term care?
• Should vision, dental and hearing be covered?
• How rapidly should Medicare Advantage be phased out?
• How quickly do we move to 100% Medicare coverage of costs (from 80% now, with private insurance covering the 20%)?
• How do we smoothly move current private expenditures by citizens and corporations into the public sector to defray the cost of the new system (i.e. which taxes and how much)?

  Bernie Sanders’s plan is very aggressive, covering things like vision, dental and hearing that are not now covered by Medicare. Having run the gauntlet on these items, paying for them myself, I know that they can be very expensive. But if there are strict enough guidelines, covering them may still be feasible. After all, Medicare covers PET scans and they’re not cheap. The key is in the restrictions as to who gets reimbursed and why.

  Some others want to retain the Medicare Advantage program. The plan is an easier sell politically, but the adverse selection problem would still exist. In less wonky insurance terms, that means that less ill people will go into Advantage and the sicker people into traditional Medicare. As stated above, this situation would drive up costs for traditional Medicare resulting either in budget deficits or higher premiums paid for by either the government or patients themselves.

  Some moderate Democrats take the politically easy way out (voluntary Medicare buy-in), which just creates more system cost via “adverse selection”. If you’re sick, you would opt for Medicare, even if premiums are higher. If you’re well, you stay with private insurance with lower premiums. By having more expensive, sicker folks in Medicare, premiums go up and program deficits rise.

  Trump brainwashes his followers into believing that our health financing crisis is another hoax. Things would be fine if we just defund Obamacare … even though he has never presented an alternative plan. In that aspect, it’s much like the GOP position on the climate crisis.

  Personally, I favor a phased-in, comprehensive Medicare program covering 100% of expenditures with the elimination of Medicare Advantage (a private PPO system). The basic problem with Medicare Advantage is that it “cherry picks” its enrollees, pushing excess cost onto other Medicare enrollees.

  Medi-gap programs via private carriers would also be unnecessary if Medicare covered 100% (rather than 80%) of expenses. However, if it’s necessary short term to involve the insurance companies (i.e. to dull their self-interested, big money political lobbying), then we could have them bid nationally for the 20%. But Medicare should eventually pay 100%, cutting out unnecessary middlemen.

  Because our current inefficient healthcare reimbursement system is draining resources from education, research, infrastructure and other vital areas, simply going on as we have been is not an option. Our per capita spending is more than double other developed nations. Medicare for All will help, not hurt, our competitiveness. And, I hope that future President Kamala Harris understands that fact.