What is Medicare for All, and Medicare for More?

August 20, 2018     About this blog:  click here

What is Medicare for All, and Medicare for More?

If you listen to or read the news much, you’ve probably heard the term “Medicare for All.” If you read the news closely, you may also have heard of “Medicare for More.”

What do those terms mean?   They are both ideas – policy proposals – for possible future changes to Medicare.  Neither have been enacted by Congress, yet.

Let’s take a closer look.

#1:  Medicare for All

On the face of it, it seems straightforward:  The title implies that everyone in America who is not already on Medicare, would become enrolled in it as well.   The actuality would be more complex than that.

A big question is whether everyone would simply become part of the existing Medicare program, or whether there would be some changes to it.   Another question is whether the payments for it would stay the same, or change.

#2:  Medicare for More

This obviously means that more people than those currently eligible (65 and up, or under 65 with disabilities) would get on Medicare, but not everyone.  That leaves a lot of options.

The simplest way is to add more ages besides 65 and up.  Some proposals that have been floated are:  55 and up; 50 and up; or 50-55 and up plus people below age 18 or 21.

Once some additional ages are added, in theory more could be added over time, until perhaps everyone is on Medicare.   That would be a gradual way of getting to Medicare for All, over a period of years.

First question:  How would this work for different situations?

Whether you’re talking Medicare for More or Medicare for All, there are a few different situations to consider.

People who have no insurance now would simply start getting covered by Medicare.

People who choose and buy their own insurance policies would switch from that to Medicare.  This already happens for many people when the hit their 65th birthday.

For people who get health coverage from their employer, it means that they would switch off that coverage to Medicare instead.  The employers would no longer be arranging health insurance for their employees.

A huge benefit of that is people would not have to depend on a certain job in order to get health care.  They would get the same health care coverage no matter where they worked, or whether they worked at all.

For everyone who goes onto Medicare – if the way Medicare works does not get changed – there  are two choices:  Go on Medicare Parts A and B, and buy a Medicare Supplement insurance policy; or

Go on Medicare Advantage, which is actually Medicare Part C – in the form of a policy from an insurance company.

People would also get on Medicare Part D, which is for drug coverage.

Most people would pay a premium of $134 per month to the government for their Medicare coverage, plus whatever premium they pay to an insurance company for either a Medicare Supplement or a Medicare Advantage policy, and for drug coverage.

Second Question: How would this get paid for?

Medicare’s revenue currently comes from:  Monthly Medicare premiums paid by enrollees (19%); payroll taxes from employees and employers (36%); and federal tax money appropriated by Congress (45%).

With Medicare for More or Medicare for All, employers would no longer be paying part of their employees’ health insurance premiums.  Therefore, it could make sense for them to pay a higher payroll tax than before, and pay about the same in total as before.

An additional idea is to put the Medicare tax not just on wages, but on unearned income – that means investments like stocks and bonds.

And, since a portion comes out of federal revenues, more Medicare funds could be generated by making the federal income tax more progressive – that is, have the richest top 1% or 2% pay more of their fair share of the overall tax burden.

Third Question: Should there be changes to Medicare?

If we end up going to Medicare for More or Medicare for All, that would be a good time to make some improvements in how Medicare works.  Here are some ideas:

Have Medicare A and B pay a much higher portion of medical costs, instead of the roughly 80% that it pays now.  The coverage could be good enough for people not to have to buy Medicare Supplement insurance policies.   That would be much, much simpler.

Medicare Advantage (Part C) could be eliminated, since it costs the government more per person than does Parts A and B.

If it isn’t eliminated, then at least it would be a good idea for the government to start tracking and regulating the insurance companies’ profits off of it.  That would save money.

Medicare could also stop its experiments on “pay for performance” and “accountable care organizations” which were hoped to save money, but have failed to do so.

If Medicare is changed so it does not use insurance middlemen anymore, we would not only save money spent on corporate profits, but also greatly reduce spending on administration, ads, and mountains of paperwork.

The overall cost of health care would be reduced, by eliminating expense which is not actual health care.

You could call it:  Improved Medicare for More, or Improved Medicare for All.

Have a comment or question?  Go to the top of this column and write it in.

Like this blog?  Share it with your friends: