John NIchols
According to John Nichols, writing in The Nation, the answer is, “Yes, It’s Called ‘Medicare for All.’”
He starts with some recent news:
The essential vote on the 11th Circuit Court of Appeals panel that ruled that the individual-coverage mandate in President Obama’s healthcare reform is unconstitutional did not come from a reactionary Republican appointed by Ronald Reagan or George W. Bush.
Rather, it came from a respected jurist whose two appointments to the federal bench—first as a judge for the Northern District of Georgia in 1994 and then to the 11th Circuit in 1997—were made by then-President Bill Clinton. No, Judge Frank Mays Hull is not a raging lefty, but nor is she a right-wing judicial activist. A former law clerk for Judge Elbert Parr Tuttle, who as the chief justice of the US Court of Appeals for the Fifth Circuit from 1960 to 1967 led the court in issuing a series of epic decisions on behalf of civil rights, Judge Hull has a reputation as a moderate defender of the rule of law who has earned reasonable marks for her pragmatic and decidely mainstream interpretations of the Constitution.
So why did Hull join with another member of the appeals court panel (Chief Judge Joel Dubina, an appointee of George H.W. Bush) to form the 2-1 majority that rejected the individual mandate while affirming the rest of the law? Perhaps it was because one can favor sweeping healthcare reforms—including an expansion of Medicare—while still believing that it is wrong to require Americans to buy insurance from for-profit insurance companies.
After pointing out that candidate Obama made the case against a mandate back in 2008, he declares:
The individual mandate was always a bad idea. Instead of recognizing that healthcare is a right, the members of Congress and the Obama administration who cobbled together the healthcare reform plan created a mandate that maintains the abuses and the expenses of for-profit insurance companies—and actually rewards those insurance companies with a guarantee of federal money.
Instead, he proposes:
… those of us who have no desire to perpetuate the insurance industry can and should recognize that the proper—and entirely constitutional—reform is an expansion of Medicare to cover all Americans.
And concludes:
As former Labor Secretary Robert Reich notes: “[No] federal judge has struck down Social Security or Medicare as being an unconstitutional requirement that Americans buy something. Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.”
“So if the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress,“ says Reich, “I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all, financed by payroll taxes.”
The insurance companies would, of course, scream.
But let them complain.
Americans don’t need mandates. They need healthcare.
And they have every right to ask, as activists with Physicians for a National Health Program have, that Medicare be expanded to cover all Americans —affordably, efficiently, capably and constitutionally.
Of course, if we are to expand Medicare to cover everyone – or even pay for our aging baby boomers – we’ll need to dramatically lower health care costs. And we’d probably need to limit the expanded Medicare benefit to cover only essential health services.
What do you think? Leave your comment below.
Read the whole post at The Nation.
Couple of things to point out – first, there is a presumption that if we all have Medicare that there will be providers to see this influx of patients without other significant changes being made to the system of care and financing, which are also significant parts of health reform. Today, it is increasingly difficult for a person on Medicare to find a new primary care physician, as an example.
The second presumption, that I’m not sure I agree with, is that insurers are not a part of Medicare today. The average person on Medicare does not have Medicare fee-for-service alone. They have Medicare HMOs, Medicare supplements, Medicare Advantage – all of which are insurance in some form or other. Until we begin to talk about Medicare in real terms, not the mythology of Medicare, we leave a lot of problems unstated, under the rug.
I do not disagree with the notion of creating a new way to get everyone under the tent, and to do so in a way that results in better coverage, lower cost and a better care experience. I just wonder whether we need a new name for the new concept. When we use “Medicare” we use a term that tells a story, whether that story is in fact true or not. Medicare is not self-sustaining, covers some things that might not be needed and doesn’t cover other things that might be more important. Its co-pays and deductibles are not affordable for everyone, and that’s why people purchase supplemental coverage, etc. The Medicare for All conversation sometimes focuses on what its supporters don’t want – private insurance – and not as often on what is desired in its place.
Will be interested in follow-up comments.
Medicare for All seems like a slogan to me. I also believe in Education for All. In the same way that Public Education should happen early so its benefits can be enjoyed throughout life, proper health care involves early treatment to be most beneficial. Better health, established early, is the best care we can offer.