The difficult things about reading about the Democratic debates is one reaches a realization that too many members of the press are generally ignorant - not as ignorant as the public, but too ignorant to rely upon for information.
The problem lies in the appropriation of phrases. In the blog post here Has Democratic Socialist Alexandria Ocasio-Cortez cost us decades of progress on the Green New Deal? it was noted that "The Green New Deal" was coined when Ocasio-Cortez was 14 years old by serious environmentalists who have been a systematic part of California's success in Climate Change policy.
The term "Medicare for all" was coined in 1970 by The New York Times in an article about "a national health insurance program that would extend Medicare benefits to people of all ages by 1973" which was proposed by Republican Senator Jacob K. Javits. That is what most folks think "Medicare for all" means - a program that would extend Medicare benefits to people of all ages. As a Democrat, I have supported that approach since 1970.
That is not what the "Medicare for All Act of 2019" is regardless of what you think Bernie and the others are saying. (If they were honest, they would call it "Medicaid for All.")
Generally speaking, only those who have Medicare coverage and their caregivers have any idea what Medicare health insurance is and what it costs those insured taking into account deductibles, co-pays, and monthly premiums (yes there are premiums). It only affects those who have reached age 65 or who are disabled. But most who are affected know that Medicare involves private insurance companies.
In 2019 if you were covered by Medicare you would be paying to Medicare $135.50 per month or more, depending upon your modified adjusted gross income from your 2017 tax return, for Part B.
Medicare Part B is the medical insurance component of the Medicare program. It pays for costs like doctor's office visits, medical equipment, and outpatient procedures. The annual deductible for all Medicare Part B beneficiaries is $185 in 2019. After you meet your deductible you will pay 20% of each medical bill - that's right, a 20% co-pay.
Medicare Part A, which mainly covers hospital stays, remains premium-free for most, but not all, American seniors. The Part A annual deductible is $1,364 in 2019. There are co-insurance amounts for hospital care. There is what is called "Lifetime Reserve Days" which are additional days that Medicare Part A will pay for if you are in a hospital for more than 90 days during a benefit period. Beneficiaries are limited to a total of 60 reserve days that Medicare will cover over the course of a beneficiaries life.
It is possible with Medicare to not engage with private insurers. But you will not have any drug coverage, vision coverage, dental coverage, and some other coverages as you understand such coverages. And, of course, you will be subject to all Parts A & B deductibles, co-pays, co-insurance, etc.
In rural California a person can pay a private insurance company $113 per month for the best Medicare prescription coverage (Part D), but it still means co-pays and the infamous doughnut hole.
For a supplement called Plan F, in 2019 a 73-year-old in rural California can pay a private insurance company a premium of $232 a month (which would be $282 a month if that person were 78). It covers all of the following:
- Part A deductible
- Part B deductible
- Part B excess charges
- Preventative care Part B co-insurance
- Part A hospital and co-insurance costs up to an additional 356 days after Medicare benefits are exhausted
- Part B co-insurance or co-payment
- First three pints of blood used in an approved medical procedure (annually)
- Part A hospice care co-payment or co-insurance
- Skilled Nursing Facility (SNF) co-insurance
- Foreign travel emergency
That leaves dental and vision. A plan for that is available for $56 a month. But it is a very limited plan.
For a "family-of-2-coverage-package" as described above, a retired couple would pay $1,122 a month to both Medicare and a Medicare authorize private insurer. That gets about as close to the "Medicare-for-All" complete coverage that is being implied or promised by the various Democratic candidates.
It should be noted that another private insurer option known as a Medicare Advantage Plan (also known as Part C) is available to some.
Medicare pays a fixed amount for your care each month to the private insurance companies offering Medicare Advantage Plans. Some Advantage Plans charge the insured no premium. Some Advantage Plans pay all or part of your Part B premium. These companies must follow rules set by Medicare. But each Medicare Advantage Plan can charge different out-of-pocket costs. They can also have different rules for how you get services, usually requiring the use of in-network medical care providers. Parts A and B services are included in these plans but with varying deductibles, co-pays and co-insurance. Usually some prescription coverage (Part D) is offered. Some Medicare Advantage Plans also offer extra coverage, like vision, hearing and dental coverage.
About 35% of Medicare patients opt for this plan. In urban areas usually there are a number of private insurers to choose from who offer Advantage Plans. In some rural California areas, there is one insurer and many local providers are out-of-network. In some rural California areas there are no Advantage Plan providers. Effectively, it is a situation this writer calls "The American Way Plan" as it assures that choices depend upon what area or ghetto you live in.
The cost to the government for the existing Medicare system which covers 16%± of the U.S. population is not cheap.
If you receive a paycheck, you may have noticed that you pay a 1.45% payroll tax on your wages to fund Medicare. It is matched by your employer. There is an 0.9% additional Medicare tax on an individual's wages paid in excess of $200,000 in a calendar year. There is no annual wage maximum at which level Medicare taxes are no longer deducted. If you are self-employed, you pay both the employee and employer share.
Regarding investment, capital gains, and other non-wage income, rich folks don't avoid the tax completely as there is 3.8% Medicare tax the amount of your modified adjusted gross income that exceeds $200,000 for individuals, $250,000 for couples filing jointly, or $125,000 for spouses filing separately.
All of which brings us to the issue of cost if "Medicare for All" were simply an action to add the other 84% of the population to the Medicare system plus add costs such as maternity coverage.
In this writer's opinion all kinds of lowball cost numbers are being used. Few even try to relate the costs to the existing Medicare tax system which does not completely cover the cost of the existing Medicare program after the Part B premiums collected from those insured by Medicare are deducted.
How about we use some honesty? We have no idea what adding everyone to Medicare will cost 10 years after everyone is added. We have no idea who will pay for it. Is that really something Democrats want to gamble on as a winning issue?
If it weren't for the fact that the courts might overturn Obamacare before the election, that gamble might assure Donald Trump's reelection. As it is, the healthcare system might just become a political chaos issue....
No comments:
Post a Comment