If I Were Running: Medicare 4 All
May 2, 2019, Part 1
The most redeeming social value of the ACA today is that it has engendered a deep discussion of health insurance in America. It was never a carefully crafted plan to cover all Americans. It was conceived by the Obama campaign to position the candidate to defeat Hillary Clinton in 2008, suffered from President Obama’s efforts to find bipartisan consensus in the face of obdurate Republican opposition, and was birthed as a hodgepodge of popular ideas band-aided together to have some semblance of fiscal viability.
The key takeaway from the decade of debate is that any health insurance system has to cover everyone for two reasons: (1) so that healthy, primarily younger, people pay premiums to pay for the care of older people who need and use the vast majority medical services and (2) to eliminate the fear and actuality of random medical crises that the many of Americans cannot afford without adequate insurance.
The only logical conclusion is that we need Medicare for All.
The current insurance system has two primary payors, Medicare and employer-based insurance. The employer-based system is so complicated and irrational that it cannot be justified.
Let me use my own experience as a parable. As the former Executive Director of a nonprofit employing up to 85 people, I had the annual task of determining what insurance coverage we would offer to our employees. In my first year in that position, I was faced with a renewal notice from our incumbent carrier with a 20% premium increase. I objected and asked our agent to seek competitive bids. This simple request threw me into the crazy-quilt world of trying to make sense of and balance premiums; coverage plans; hospital, doctor and prescription co-pays; provider networks and dozens of other buzzwords that were seemingly designed to confuse, and manipulate, employer decision-makers.
And we always received our renewal notice about 30 days before we had to decide on a carrier for the following year. Luckily, we had an excellent agent who listened to my concerns, which I was learning as we went along, and helped simplify the options. That year we changed carriers, providing significant cost savings with little changes in networks and coverage for our employees. But it got worse.
As premiums continued to escalate, we faced an annual crisis to get and compare competitive bids, trying to remain fiscally responsible while providing our employees with a reasonable health care plan. A couple years later, with premiums rising at 500% to 2,000% of the rate of inflation, our agent suggested a “high deductible” plan paired with individual Health Savings Accounts funded by the company and our staff. These new plans helped keep premium increases down (although still at multiples of the inflation rate) but presented new concerns. I chose plans that were competitive, perhaps even generous, in our marketplace for employees, but the deductibles were still $2,000 for an individual and $4,000 for a family. As many people discovered, even these modest (compared to what many other employers offered) deductibles kept many of our staff from getting medical services and prescriptions that they needed. A simple prescription that used to come with a co-pay and out of pocket cost of $20 to $40 now cost our staff many hundreds of dollars if they had not met their deductible. Of course, early each year, no one had met their deductible and even later in the year, many employees never had expenses to reach those numbers.
Essentially, for many employees, we paid premiums for zero coverage from the carrier.
One year I called our agent in the late summer and said that, anticipating the annual crisis meeting in early November, I wanted him to start early to “shop” our company to different carriers. He told me that was impossible because carriers were forbidden by law from giving quotes until they saw the renewal notice from the incumbent carrier! After a five-minute rant about antitrust laws, I resigned myself to the annual crisis.
If all of this sounds confusing and intimidating, it was. I began to realize that I was making decisions for our employees that significantly impacted their health, their family’s health and their financial well-being with only minimal, on-the-job training and consistently under the threat of imminent deadlines.
And multiply my situation by the hundreds of thousands of other employers across the country in the same no-win situation. For no rational reason, our employees got a particular deducible, shared an ever-increasing premium, had a particular network of care providers, and had to pay particular co-pays that varied from service to service and prescription to prescription. And the people who worked next door had a completely different set of premiums, deductibles, co-pays and network. And so on and on and on across the area, state and country.
In what alternative universal would any of this make any sense as a way to determine the health insurance for a most Americans? It is unambiguous insanity. This method for determining health coverage for millions of Americans does not benefit employers, it does not benefit hospitals, it does not benefit doctors, and it sure as hell does not benefit people who need health care.
I suspect that most employers simply threw up their hands and accepted the first renewal notice, much to the detriment of their bottom line and their employees’ well-being.
Let me be clear. When politicians say they do not want to take away health insurance that people like, they are disingenuous if not dishonest. Employees’ health insurance is not what they choose, it is what their employers choose and can afford. If an employee changes jobs, health insurance is very likely to be very different. Even year to year with the the same employer, carriers, coverages and provider networks are likely to change. As premiums have skyrocketed over the past decades, both employees and employers have fewer choices, increased costs and ever-diminishing coverage.
In Part 2, I will discuss how Medicare 4 All will reduce the cost of providing health insurance for employees, employers and the nation’s economy.