To fix what ails U.S. health care, expand Medicare — for all

By Chess Yellot, M.D.
Spirit of Jefferson (Charles Town, W.Va.), Aug. 5, 2015

Isn’t it time to have a serious conversation on the question: why aren't we all covered by Medicare, regardless of age? 

More than 50 people, young and old, from the Eastern Panhandle turned out to publicly celebrate Medicare’s 50th birthday. Medicare is a popular program. The local celebrators joined others throughout the country to show their gratitude and to spread the message: “Medicare: As American as Apple Pie - Protect, Improve, Expand!”

Let me start the conversation by describing my experiences at an area community health center where I practiced for 14 years, until my recent retirement. I saw many working people without insurance. Tragically, some died because they could not afford the specialists or procedures they needed. Others suffered needless pain, discomfort, and disability. 

The Affordable Care Act, or Obamacare, enabled many of my West Virginia patients to obtain Medicaid. I saw a lot of new patients who had delayed care for years. They had gone months and years feeling fatigued, short of breath, depressed, in pain. Many times their problems would have cost the system much less if their conditions had been treated when symptoms began. 

Now, some middle-class families can obtain health insurance under the Affordable Care Act, but many are finding the co-pays and high deductibles unaffordable. Out-of-pocket costs continue to be a barrier to getting care. Still other patients find that insurance companies limit their choice of physician. The preferred provider might not be in the insurance company’s network. 

If we had improved and expanded Medicare for all, I would not have had patients who died and suffered needlessly. My patients would never have gone without needed care because they could not afford the deductibles and co-pays, or because the best specialist for them was out of network. 

Let’s look at a solution: A bill in Congress, HR 676, “The Expanded and Improved Medicare for All Act.” Under the simple, 30-page bill, every person in the U.S. would receive prescription drugs, vision, dental, and hearing services, long-term care, and all other medically necessary care. There would be no co-payments, no deductibles, no premiums, and no insurance companies. Funding would come from current federal financing for health care, increasing personal income taxes on the top 5 percent, a modest tax on some unearned income, a modest payroll tax, and a small tax on stock and bond transactions.

The great thing is that for 95 percent of households, these taxes would be less than what they now pay for premiums and out-of-pocket medical expenses. 

HR 676 also would mandate that drug prices be negotiated, resulting in huge savings. Currently, federal law prohibits Medicare from negotiating lower prices.

All practitioners providing medically necessary care would be in this one system, and their fees would be negotiated. This would again save money and everyone could choose their own provider. There would be no networks. As is the case now, most providers would be in private practice. We would have private providers and public financing.

A significant study indicates that because of the simplicity of the system described by HR 676, the health care funds currently diverted from our insurance premiums to company profits, high executive compensation, stockholder dividends, advertising, lobbying, and campaign donations would be spent on health care. Medicare’s overhead is around 2 percent. Compare this to private insurance overhead which runs 15 to 20 percent. Add in the amount hospitals and medical practices spend on billing, and this comes to a total of 30 percent. The savings made possible by a simple, single payment system would now go toward Medicare for all. And patients won’t be wasting time trying to figure out their medical bills!

No system is perfect. But if HR 676 became law, no one would suffer or die or go bankrupt due to lack of money to pay for the health care they need. HR 676 is affordable and the savings it provides would protect, improve and expand Medicare for all of us.

Dr. Chess Yellott writes from Shepherdstown.