Medicare for all

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Theodore Roszak's new book, "The Making of an Elder Culture: Reflections on the Future of America's Most Audacious Generation," a sequel to his "The Making of a Counter Culture" (1969) will be published this month.

At last count, the bills I racked up for two years of heavy-duty medical care (hospitalization, surgery, nursing, drugs) came to $2 million. If it weren’t for Medicare, my life would only have been saved at the cost of bankrupting my family. As it turned out, Medicare, with a reasonably priced supplementary insurance policy, has paid all the costs except for a modest co-pay for pharmaceuticals.

What a relief that I didn’t have to worry about the financial side of my illness or fear that my coverage would max out or that my deductibles would be overwhelming.

I’m sure the healthcare providers involved in my case would have liked Medicare to pay them more; the system cuts back on some bills severely -- and in some cases, I think, unfairly. (Those who save our lives ought to be paid more than mediocre basketball players.)


But I never heard a gripe from anybody along the way. I’m sure they knew that without Medicare they’d be collecting practically nothing from me. Either that or I’d have to perish without paying anyone a cent. That was the situation before Medicare was established in 1965. No insurance company would sell a policy to anyone over 65. Seniors simply weren’t part of the healthcare marketplace.

Liberal defenders of President Obama’s campaign for healthcare reform have tried to allay the fear that the “public option” is a scary government “takeover” of the health insurance industry by citing Medicare as a benign example of a government-funded and administered program.

One might have hoped that was common knowledge, but apparently even among those on Medicare, there are many who have no idea who’s paying for their healthcare. Do they think there is a company called Medicare Inc. that has bestowed affordable healthcare on them as an act of charity?

Angry seniors rail against the government, but they cling to their Medicare with no fear that it will hire “death panels” to kill them off. Even when it is called to their attention that Medicare is a socialistic program, that fact fails to tar it as a nefarious liberal plot.

So why has it not occurred to the champions of reform that instead of telling people that the public option is “like Medicare,” we might simply let the public option be Medicare? That would reduce all the complexities to one clear-cut public-option solution: Amend Medicare so that it will be available to everyone regardless of age.

Since 1951, the self-employed have been able to buy into Social Security; currently about 9 million of them are in the system. Why not remove the age restriction on Medicare and let everybody buy in who wants to buy in? Medicare provides a very elusive target for right-wing vilification or for those who seek to make reform look so complex that we must wait an additional 20 years to change the system. It is a time-tested program that people know and trust. It has an exemplary track record for low-overhead administration. Medicare is already the most successful cost-control program we have, and it can be made more effective still. (There are estimates that fraud in the system costs over $60 billion a year -- a serious but fixable flaw that accounts for enough money to keep the system solvent.)


Above all, it’s here. Its administrative procedures and personnel are in place. Unlike health co-ops -- which remain a mystery to most of us -- Medicare needs only to be expanded, which has to be cheaper than starting from square one.

Neither the president nor Congress has done a good job of defining a public option. How exactly will it be financed? What will it cost? What coverage will it offer? Who will run it? With Medicare, we already have answers to these questions.

If you’re under 65 and want the Medicare option, you would have to pay a designated premium, which would have to be high enough to cover the costs of the expanded coverage. But it is bound to be lower than any private plan. (Seniors would still be covered, without paying a premium, as they are now.)

Those who join up would find that, unlike the convoluted policies that private insurance companies offer, Medicare literature clearly states what it does and doesn’t pay for -- and what you pay (if anything) beyond what the program covers. In my experience, a phone call to Medicare produces reliable and courteous information. Or for you novices, you might simply ask your parents or grandparents what the deal is.

Medicare excludes no one for prior conditions; it is portable and stays with you for a lifetime. Worried seniors may actually like seeing Medicare get bigger and take in more money. That would produce a more durable program that’s better able to bargain with providers and pharmaceutical companies. Even Republicans and Blue Dog Democrats may find it more acceptable to vote for an enlarged Medicare than for another public option. And as a bone to the insurance industry, those covered by expanded Medicare, like those covered by classic Medicare, could buy private supplementary insurance plans to pay for whatever remains uncovered.

As for the uninsured who cannot afford even reasonable premiums, this is a problem with every reform proposal. Obama has identified several convincing ways in which subsidies for the truly needy could be provided. Besides, if we are going to have any reform at all, Congress will have to come up with some combination of savings and revenues to pay for a comprehensive program.


Despite noisy opposition and malicious misinformation, a majority of the public still wants healthcare reform, but legislation running to 1,000 erudite pages looks formidable. Why not start with something as familiar and popular as the program that paid for your mother’s hip replacement or your grandfather’s bypass surgery? It is easier to promote something tested and trusted than something strange and new. It is easier to enlarge a proven, existing program than to start from scratch. It is easier to win people over to something simple than to wade through endless complexities about how a new system will work. “Medicare for Everybody” is practically self-explanatory -- and very nearly bulletproof.