Medicare works great!
I get Medicare. I love it.
Young activists may not understand how possessive people my age can be. We don't want to lose something good.
I had an UpClose political experience. I needed health care in America. I had a hernia. It got worse quickly. I got it diagnosed, had surgery, and am now recovering.
Medicare is easy and convenient.
Cost. Medicare isn't free. It isn't even cheap, at $13,000 a year. But it is available, which is the important thing. My wife and I each get $550/a month deducted from our bank account to pay for it.
I still pay Medicare taxes, too. My wife and I pay 1.45% of our earned income in Medicare taxes, matched by our employers. Both of us are over 65 and still have earned income. Our employer-match is part of employment cost, so it, too, is part of our pay. In addition, those married couples who earn more than $250,000 a year pay more Medicare taxes, another 0.9% on all earned income.
Still, from a senior's point of view, Medicare is a good deal. Issuance is guaranteed. A person can plan retirement understanding that they don't stand to lose everything if they get cancer or some other illness with a long treatment cycle.
Easy. Fast. Seamless. I felt abdominal pain, and went to Urgent Care. I showed them a photo ID and my two Medicare cards. They scanned them. I saw a provider promptly. They scheduled a Sonogram. Yup, a double hernia. They sent me to my normal provider, who said I needed surgery and he contacted a surgery provider group. Two days later I had surgery.
From the patient's point of view, the process is simple. Everyone knows where the money comes from. Medicare works. Does it pay enough to the doctor, the surgeon, and the anesthesiologist, and the hospital with its million dollar robot machines? Apparently not quite.
Medicare is a low-payer, covering most of the overhead for the various providers, but not quite enough generally to support the system. Private pay people (i.e. people with employer insurance) pay a higher rate than Medicare, so they are an essential part of the mix that keeps the physicians working and the hospital solvent. Medicare-for-All would require Medicare to pay more. That could be worked out.
But all that is invisible to the patient. What we see is a small part of the cost.
I got little bills from the doctors who did the early urgent care visits, about $20. I will get more substantial bills from the surgery (surgeon, anesthesiologist, hospital) and it might be a couple of thousand dollars. Expensive, but not catastrophic.
Politics. If it is so good, don't I want everyone to get it? Personally, yes. I want everyone--including me--to get the good situation I got.
But, here is the political vulnerability for Democrats: I don't want Medicare to be screwed up by becoming overbooked and slow and unavailable. I am loss-averse.
I feel ownership in Medicare. I paid my dues into the system from 1965 to 2015--fifty years--paying for Medicare for others, so I could get my good service in my time of need. I don't want that taken away or watered down.
Is that selfish? Well, I would call it cautious and defensive.
I am happy to share Medicare, but I don't want to lose what Medicare means, by having it changed for the worse. I suspect a lot of people my age feel that way.
People fear losing what they have more than they desire to take risks to get more. That is a reality I observed continually in my work as an investment advisor.
Trump and the GOP will run ads telling people my age that the crazy liberals' Medicare for All will mean that Medicare will be destroyed, with endless wait-times and deteriorating service. They will liken it to the DMV, or people squeezing into coach on airplanes, hogging the overhead compartments and putting you in the middle seat. Articles like this, too.
People hate losses. Medicare for All can be framed as a loss for seniors. They are already doing it. Democratic framing needs to anticipate this and assure seniors they can keep Medicare as they know it.
It will be a heavy lift.
Still, from a senior's point of view, Medicare is a good deal. Issuance is guaranteed. A person can plan retirement understanding that they don't stand to lose everything if they get cancer or some other illness with a long treatment cycle.
Easy. Fast. Seamless. I felt abdominal pain, and went to Urgent Care. I showed them a photo ID and my two Medicare cards. They scanned them. I saw a provider promptly. They scheduled a Sonogram. Yup, a double hernia. They sent me to my normal provider, who said I needed surgery and he contacted a surgery provider group. Two days later I had surgery.
From the patient's point of view, the process is simple. Everyone knows where the money comes from. Medicare works. Does it pay enough to the doctor, the surgeon, and the anesthesiologist, and the hospital with its million dollar robot machines? Apparently not quite.
Medicare is a low-payer, covering most of the overhead for the various providers, but not quite enough generally to support the system. Private pay people (i.e. people with employer insurance) pay a higher rate than Medicare, so they are an essential part of the mix that keeps the physicians working and the hospital solvent. Medicare-for-All would require Medicare to pay more. That could be worked out.
But all that is invisible to the patient. What we see is a small part of the cost.
I got little bills from the doctors who did the early urgent care visits, about $20. I will get more substantial bills from the surgery (surgeon, anesthesiologist, hospital) and it might be a couple of thousand dollars. Expensive, but not catastrophic.
 |
| Click: Expect ads like these. Seniors watch out!!!!! |
Politics. If it is so good, don't I want everyone to get it? Personally, yes. I want everyone--including me--to get the good situation I got.
But, here is the political vulnerability for Democrats: I don't want Medicare to be screwed up by becoming overbooked and slow and unavailable. I am loss-averse.
I feel ownership in Medicare. I paid my dues into the system from 1965 to 2015--fifty years--paying for Medicare for others, so I could get my good service in my time of need. I don't want that taken away or watered down.
Is that selfish? Well, I would call it cautious and defensive.
I am happy to share Medicare, but I don't want to lose what Medicare means, by having it changed for the worse. I suspect a lot of people my age feel that way.
 |
| Click. Articles like these. Seniors, watch out!!!!! |
People fear losing what they have more than they desire to take risks to get more. That is a reality I observed continually in my work as an investment advisor.
Trump and the GOP will run ads telling people my age that the crazy liberals' Medicare for All will mean that Medicare will be destroyed, with endless wait-times and deteriorating service. They will liken it to the DMV, or people squeezing into coach on airplanes, hogging the overhead compartments and putting you in the middle seat. Articles like this, too.
People hate losses. Medicare for All can be framed as a loss for seniors. They are already doing it. Democratic framing needs to anticipate this and assure seniors they can keep Medicare as they know it.
It will be a heavy lift.
8 comments:
The biggest knock they can come up with is that it MAY become cumbersome which is textbook Regressive. It's 2019, folks, by the time it gets implemented we will have incentives for more and better services. For one thing NPs will play a greater role in basic care, and the plan will also train more doctors, most of whom will be immigrants. The VA will be rolled in as well. Will it be big? Hell yes! That's how we do it in America!
There need not be an either/or solution. MCA could be introduced gradually, for example, dropping the qualifying age to age 60 in a first phase, then two years later to age 55 and so forth. This will also allow time to gauge any tax impacts and gradually wean the insurance companies from their cash cow, we the people. Requiring employers to fund employees insurance, IMHO, was a ridiculous idea from the start.
https://www.nytimes.com/interactive/2019/04/10/upshot/medicare-for-all-bernie-sanders-cost-estimates.html
Andy Seles
A few things that may help overcome the fear of loss:
1. Bernie’s Medicare for All would actually expand benefits for people who are already enrolled. It would eliminate all deductibles and co-pays (no money out of pocket to see a doctor).
2. It would also eliminate monthly payments/premiums for recipients. It would be funded by completely by a combination of taxes (mostly on the super-rich) and savings realized by eliminating huge operating costs (Private Insurance company profits). Any increase in taxes for middle income would be outweighed by the elimination of monthly premiums and out-of-pocket-expenses. This has been proven to be true by that fact that every country that currently has a Single payer System is operating with lower overall healthcare costs than the U.S.
3. Private Insurance (or the current Medicare system) does not guarantee short wait times. I often wait for months in order to see a specialist within the current system, and sometimes hours in a waiting room to see my primary or specialist. My waiting time in the DMV or Post Office are usually far less than those of my private-practice doctor. The fact is that Medicare for All is not public run medicine; it is merely public run insurance, which has little to do with wait times regardless.
It seems that we Democrats often worry more about what people might think than we need to. People are ready for change. Most polls show that around 70% of all Americans support Medicare for All. It seems to me that we shoot ourselves in the foot by communicating the message that people are scared of it, when the reality is, that most are not.
I'm not sure incrementalism will get us there soon enough. I do agree that getting employers out of the system is the first step, along with a subsidized public option and the mandate.
i dont agree with you.
Peter, you bring up an important point - Medicare is not free if you want full coverage. From the costs you cited, you likely have a Senior Advantage plan. My wife and I also have that, and while we are limited to Kaiser facilities for normal care, we are fully covered worldwide for urgent and emergency care when we travel.
Sure, $550/mo seems reasonable but I'd say many have the uninformed perception that Medicare is free.
Our Medicare Senior Advantage plan also has a very reasonable max on annual out of pocket expenses.
It's too bad that the Medicare and Medicaid for All policy discussions rarely discuss what it will still cost.
One other factor is that doctors, nurses, and healthcare providers will still want to be paid salaries commensurate with their skills, so Medicare will never be "free".
He probably has a Medicare Supplement.
Medicare "Advantage" is not Medicare. You trade your Medicare for an Advantage plan, which then manages & administers your benefits through a private insurance company. It is cheaper. It has trade-offs, such as restricted networks and prior authorization requirements.
As a service connected disabled veteran, I'm in the VA system, but I'm still required to have Medicare Parts A and B, for which I pay a relatively small premium of about $135, deducted from my Social Security check. In addition, any prescriptions I might need must come through the VA pharmacy and there is an $8 copay per prescription.
RePuglicans pushed through something called Veterans Choice, as part of their continuing efforts to privatize the VA, and by extension, kill Medicare. It's now May, and I've been waiting for an approval of a referral to my Urologist since February, and the same time lapse to see a Dermatologist regarding a worrisome skin cancer. These delays are caused by the incompetence encountered in the Company selected to administer the Choice Program, which just happens to be a Major Contributor to RePuglicans in both Houses of Congress, including our very own weasel, Greg Walden.
I might be more supportive of Sanders if he were to provide real numbers as costs, benefits and drawbacks to his "plan", other than "We'll tax the rich"
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