Posted on December 15, 2008

Health insurance proposal: Medicare for all


By Saul Friedman
Gray Matters
December 13, 2008

Here’s a question for Medicare beneficiaries and those who will soon become eligible: Why should you care about the estimated 47 million American men, women and children who have too little or no health coverage?

The answer: Because there is some danger that Medicare and the 45 million older and disabled people it serves could become caught in a generational conflict in the coming campaign to extend health coverage to the uninsured - a conflict between those who have and those who have not. What part, if any, will Medicare play in the health care reforms? Medicare’s needs may simply get lost in the smoke of battle. But there is another way, which we’ll get to presently.

Medicare’s costs are $450 billion a year and growing rapidly. Its Part D drug benefit is confusing and more expensive than expected. Critics say Medicare’s growth may overwhelm the federal budget, and its friends acknowledge its shaky finances need to be fixed. As a result of these fears, a new coalition of Medicare defenders has formed the Alliance to Restore Medicare, to roll back the weakening of the public portions of the program during Republican rule.

In addition, Medicaid, the federal-state program for the poor and the elderly, costs around $200 billion a year and places an increasingly heavy budget burden on states, which are cutting benefits and restricting help for the elderly who need Medicaid for long-term care. And congressional Democrats intend next year to add millions to the State Children’s Health Insurance Program (SCHIP), which President George W. Bush opposed as a “step toward socialism.”

With such problems looming among many others facing the new administration, my experience covering Congress tells me that it will be difficult for members to focus on fixing Medicare while they are occupied with the popular cause of providing health insurance for younger workers and their families who have little or no protection.

Another conflict: Medicare is a mostly government-run program, while most of the proposals to cover the uninsured would depend largely on private insurance. That likely will rekindle the ideological struggle in Congress between Democrats who favor a wider government role and Republicans who favor reliance on the market.

In the coming battles, industry lobbyists will crowd the congressional corridors to follow up on contributions they have poured into Capitol Hill, and pay for advertising campaigns like those that killed the 1993 attempt by then-President Bill Clinton to provide universal health care. On the other side, health care and union lobbyists will fight for their views, but they won’t have the financial clout of industry.

In the 2008 elections, according to, the insurance industry contributed $38.2 million to presidential and congressional candidates, split between Republicans (54 percent) and Democrats (46 percent).

Senate Finance Committee chairman Max Baucus, (D-Mont.) who had an easy race (he won with 72 percent of the vote) will be a key player in the effort to extend coverage to all Americans. Baucus got $269,000 from the insurance industry. He was eighth among senators, behind John McCain ($2 million). Barack Obama ($1.5 million) and Hillary Clinton ($1.2 million), all of whom supported similar proposals.

Last month, Baucus introduced legislation to provide health care protection for the uninsured. It was widely praised, but Baucus based his proposal on the use of private insurance to be paid for by employers, individuals and/or the government.

At least a dozen other lawmakers, including Sen. Edward Kennedy (D-Mass.), have their own ideas. But all of them would use private insurance companies to provide the coverage, with all the problems consumers face with insurance coverage restrictions. Their administrative costs are nearly 20 percent, including stockholder dividends and executive salaries. Liberal economist Dean Baker said of the insurance industry: “The health care system’s waste is their profit.”

There is another possibility. Some call it single-payer, but more easily understood, is a proposal backed by the 5,000 Physicians for a National Plan (including mine) that would gradually provide Medicare for everyone who wants it and would pay a premium.

Medicare, all polls show, is the nation’s most popular health insurance plan - even among the young. But for me, the most compelling argument for “Medicare for All” is this: Unless the risk pool for Medicare grows and is strengthened to include millions of younger, healthier workers, their families and their kids, Medicare as we know it could die of old age. And with out-of-pocket costs soaring and people leaving Medicare for private, Medicare Advantage plans, the Congressional Budget Office has warned that original Medicare is in danger of becoming another private insurance plan.

Congress has before it a proposal for “Medicare for All,” which I have written about, introduced in February 2007 by Rep. John Conyers Jr., (D-Mich.). He’s been in Congress since 1965, the second- longest-serving House member. I mention this because Conyers, chairman of the House Judiciary Committee, is a liberal of substance and influence.

His proposal, which you may read at or 00676: has 94 co-sponsors, including some House veterans. Called the U.S. National Health Insurance Act or The Expanded and Improved Medicare for All Act, it also has the endorsement of most labor unions, thousands of doctors, nurses and health care professionals.

The bill does not call for socialized medicine, but rather an extension of the Medicare model to include all Americans. It would absorb such programs as Medicaid, SCHIP and be paid for by taxes and premiums. It could relieve auto manufacturers and other businesses of paying for health insurance for employees and retirees. Its sponsors say it would save $300 billion a year in administrative costs, for it would deny insurance companies a role.

Getting over that hurdle may be why HR 676 has gotten so little publicity, even from alleged friends of older people. There is no mention of it on the Web site of AARP, which earns $700 million a year in royalties on the sale of private health insurance it sponsors. Even the Kaiser Family Foundation, which has the most complete Web site for health care information, has virtually ignored HR 676. It may not pass, but it should have a place in the coming discussion.

WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY 11747-4250, or by e-mail at,0,6902079.column