As the health care circus swings through town after town, and the inner sanctum of President Obama’s West Wing wrings its hands, fearing that a failure to win a “public option” will undercut their efforts to run –read, ruin – the American political economy , worst of all putting their post-2012 job prospects in jeopardy, although I suppose Rahm Emanuel can always hock energy futures at the Chicago Exchange, again, and Lawrence Summers can recede into a nice fat hedge fund, shop for Nantucket real estate and continue his research on how women can’t do research, it is of some value to some to be reminded of what could have been. Here is an RX for the health system:
Rather than inject new terms into the debate, such as public option and single payer, go with what’s familiar and proven: Medicare. Start by extending the age of eligibility, first to 60, then to 55, for now. Medicare pays less than commercial insurance for services, by about 20%. There’s some savings.
Add to those savings the elimination of fee-for-service, or MD as entrepreneur. Give patients what they need, not what helps pay the country club dues for surgeons and health tech company owners. Start hiring, directly onto the federal payroll, medical professionals to care for the Medicare eligible. Doctors grumbled about taking Medicare fees back in 1965 when it was first introduced; today few turn it down. Many would go further and welcome a job. Let’s start to do away with the private medical cadre once and for all and get some docs in need of work, even pay for medical school for those (millions) interested, and build a Medicare workforce. Add administrators too, as commercial insurance recedes, and soak up some of those unemployed.
Don’t we need to good jobs in America? Leave that to private enterprise and this ship will sink. Count on it.
Of course, somebody would have to pay for the expansion of Medicare. First, keep in mind that the so-called “public option” is another plan you have to pay for. It comes out of your pocket and rest assured even the public option rates will be substantial. In the new and improved Medicare, charge those under 65, some co-pay, based upon their income. Whatever shortfall exists make up for with some real new taxes on the Upper Class. Call it a national duty duty.
As for children, like the hundreds of thousands kicked off the Medicaid rolls in California recently, expand eligibility for CHIP – government subsidized health insurance for the care of children – to four times poverty, as was introduced in New York State and viciously attacked during the Bush years. That is already a sliding-scale system, and even at the high end much cheaper than commercial insurance rates. Again, start hiring pediatricians and the like onto the program’s payroll. There is plenty to do.
For medicines, stop the US Senate immediately from another grotesque collaboration with the owners of drug companies and start negotiating bargain basement prices for pharmaceuticals for Medicare without delay. Imagine the wonder: the US coos with glory at the freeing of two young Nobelist Gore-paid freedom-loving journalists from the prisons of North Korea; why not send our best negotiators to suburban New Jersey, and Switzerland, to free medicines from the vice of rip-off profits?
Hound the defrauders of Medicare; don’t leave the policing to private lawyers with their own get-rich schemes but to an expanded corps of anti-fraud attorneys, also on the federal payroll. There are many, many unemployed lawyers out of work. Get the young ones involved before they get hooked on golf. Even some Harvard Law grads, top-of-the-class law review editors, future presidents, might learn to live without the millions they are sure to come by.
That leaves middle class families making more than about $80,000 a year with adults under 55—or until the eligibility age comes down again. Some of this group has commercial insurance though the workplace and it should be left in place, for now. Keep the write off in place for insurance costs to induce companies to maintain policies. By all means, tax the premiums of elite policies of the ubermensch corporate chiefs, whose worries about longevity seem to inform economic policies affecting every inch of the globe.
Watch the cost of health care go down as the newly-expanded Medicare, free of fee-for-service gouging, pays reasonable costs for needed care. On the CHIP side, step up medical services in schools, make preventive care a reality. You might even improve the quality of school lunches– there’s an awful lot of slop out there, and start putting a dent in the diabetes disaster sweeping the country, 24 million Americans, and counting.
These ideas are not new. They have been circulating for years, even inside the Beltway, where Medicare founders and their students have had to deal with the double-cross of Jimmy Carter, the terribly defeating self-interest of some key unions, and the domination of commercial health insurance through GOP and Democrat administrations alike.
What should resonate in the West Wing, where success is everything, is that by utilizing the vernacular you don’t send shock waves through the populace, and by expanding affordable coverage you put the gouging status quo on the defensive. The absurd protests of Medicare recipients fearing induced death would be drowned out, forever.
Let the profiteers and their spokesmen in the US Congress say: No to more Medicare! And see how the public reacts.
CARL GINSBURG is a NYC-based lawyer serving Medicare clients. Reach him at firstname.lastname@example.org