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Health Insurance Reform: Single Payer, Improved Medicare for All

By Stan Gold
Sonoma County (Calif.) Gazette, Jan. 2, 2015

In the December issue of the Gazette, we pointed out that the U.S. is No. 1 in the world in health care costs (17.3 percent of our GDP), and that the U.S. health insurance industry is a barrier to the delivery of affordable, comprehensive, health care to the American people. We also noted that “Single Payer Health Care,” aka “Expanded, Improved, Medicare for All,” is a tried and tested solution to our health care problems. It has had many decades of successful performance in a large number of the world’s industrialized democracies. U.S. travelers to European countries, Australia, New Zealand, Canada, etc., can happily attest to this.

If Single Payer/ Expanded Medicare was currently available in the U.S., everyone could receive his/her lifetime health care I.D. card at birth (just like getting a Social Security card today). That card could be used to obtain medical care from ANY medical provider in the U.S. who is selected by the cardholder. The Cardholder is not subjected to any insurance company’s “approved list of physicians,” or “out-of-area” restrictions. Likewise, any physician or hospital could provide care for ANY patient and submit the medical bill to the government area-office for timely payment, without costly, time consuming hassles over what part of the medical treatment is not covered under a particular insurance policy.

Further, all Americans would have equal access for all their necessary health care needs, without any income distinctions. This is NOT the case, today. Under the Affordable Care Act (“Obamacare”), Covered California lists Bronze, Silver, Gold, and Platinum insurance plans! The more expensive the metal (Plan) one chooses, the higher is the premium, and the lower is the deductible.

Consider a person whose income is just above the point of receiving any government subsidy. If such a person purchases a Bronze Plan, because he/she cannot afford a more expensive plan, isn’t it likely that he/she may find it difficult to pay this highest deductible (thousands of dollars) of any of the plans? The deductible is the out-of-pocket medical costs that must be paid by a patient, BEFORE his/her insurance policy begins to pay anything. The prohibitively high deductible may cause this individual to delay getting timely medical attention.

In contrast, a person who can easily afford the higher premium for a Platinum Plan probably has no problem in paying the lowest deductible of any plan -- thus accessing timely medical attention without delays for financial considerations.

Single Payer/ Expanded Medicare assures the SAME level of access to health care for all people at all income levels. There is no fragmentation of the population into segments, with multiple policy types, in order to guaranty the profits of insurance corporations. Insurance companies are prohibited from selling coverage in basic health care, which is covered by the nation’s universal health care law. Insurance corporations are free to sell other “none basic health care” policies such as coverage for cosmetic surgery (e.g. non-medically indicated breast enhancement, liposuction, teeth whitening, etc.), private hospital-room coverage, etc.

Single Payer/ Expanded Medicare would have no deductibles, no co-payments, no pre-existing conditions restrictions, and no annual or lifetime caps. Some of these terms as well as an explanation of how Single Payer/ Expanded Medicare is financed are the subjects of future LTEs.

We now use “Single Payer Health Care” and “Expanded, Improved Medicare for All” interchangeably. Since these are new terms to some people, clarification may be helpful. Single Payer Health Care is fully comprehensive. It covers everything in basic health care, including in-patient (hospital), out-patient (office), pharmacy, lab tests, X-rays, blood transfusions, ambulances, dental care, eye glasses, hearing aids, physical therapy, hospice care, etc.

Medicare is somewhat limited. It excludes everyone under the age of 65, and does not cover important medical conditions above the neck. There is no coverage for dental care, eye glasses, or hearing aids.

Medicare is an effectively run 49-year-old national medical system with astonishingly low overhead costs (just over 2 percent). Since the Medicare infrastructure is already in place, it can be adapted to a national Single Payer Health Care system by expanding Medicare to commence at birth, and including Single Payer coverage. Thus we get “Expanded, Improved Medicare for All.”

Next we’ll focus on the advantages of Single Payer/ Expanded Medicare to businesses. Tell your business friends to read the Gazette in February. They will be pleasantly surprised.

Till then, check out www.pnhp.org, Physicians for a National Health Program.

Stan Gold is a member of the Sonoma County chapter of Physicians for a National Health Program. He resides in Petaluma. This article is part of a series titled “We’re #1 But We CAN Change That!”

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