Don’t Confuse Medicare with Single-Payer

Whether intentional or not, the liberal “single-payer” promoters have greatly confused the public by equating single-payer, universal health care coverage with “Medicare For All.”  Ironically, it looks like they will get what they have called for; again, unintentionally.

With the long predicted demise of any “public option” or government sponsored program that would compete with the private sector, plain vanilla Medicare-for-all is targeted to become the gold standard for coverage under the basic private policies to be offered to all Americans (whether you like what you have now or not).  Take a good look at what that means in practice.

As I have attempted to explain in previous articles (“The Myth of Medicare for All “, (see counterpunch.org/cramer08052009.html)Medicare, by itself, does not cover annual physical exams, dental care, routine eye exams or eyeglasses. There is no coverage for hearing aids, annual physical exams, or foot care. Medicare participants must pay 50 per cent of an outpatient therapist’s charge for mental health services.  Other services and supplies not provided by Medicare include acupuncture, chiropractic services, several laboratory tests, long-term care, orthopedic shoes, prescription drugs, shots to prevent illness, and some surgical procedures given in ambulatory surgical centers. (You can see the entire list of “What’s NOT Covered by Part A and Part B” in the US Department of Health and Human Services booklet entitled “Medicare & You.”)  For those items that are covered, there is a charge of at least 20 per cent of the medical provider’s costs, and a deductible that must be met.

This new bottom line for benefits, much lower than anything I ever had with my “employer-provided” insurance plans, will be this basic Medicare plan offered to all, served up with blarney that now all Americans have access to the same excellent Medicare that the elderly are so “happy” with. If that isn’t good enough for you, anyone who can afford it will be able to purchase additional coverage, at a much higher price than seniors now pay for the government-subsidized supplemental programs (sometimes called Medicare “Advantage”).  According to repeated pronouncements by the President and Congress, these government-subsidized, supplemental programs (that seniors have depended upon to expand their Medicare benefits and make basic medical services affordable) will be eliminated. They constitute the “waste” in the system that the President and Congress repeatedly refer to. They also represent “chicken feed,” compared to the enormous profits the private sector is going to accumulate when we all have to purchase private health insurance policies.

This is what Grampy meant, when he protested that he did not want the government messing around with his Medicare.  In spite of the chortling and demeaning commentary by noted liberals on NPR talk shows, Democracy Now, The DR show, and others, Grampy does know that the deduction he agreed the government should take directly from his monthly Social Security check is his premium payment for the government-run Medicare plan.  He also knows he could never afford decent medical coverage if he did not make an additional monthly premium payment for the private supplemental  (“Advantage”) program.  Grampy knows that these supplemental programs that give him the “advantage” of being able to afford the basics of medical care, are on the chopping block and that their elimination (as Obama brags repeatedly) will play a major part in the cost-cutting needed to pay for the new health reform program.
Another cost-cutter Obama often cites is reduction in funding to those hospitals that provide services to the uninsured and poorest citizens.

Of the 165 seniors living in my elderly housing project, I know no senior who has been asked by any pollster how they like Medicare.  However, I am sure that no senior who was actually polled ever responded “Do you mean am I happy with my Medicare parts A & B, or do you mean am I happy with my Medicare plus the medicare supplemental plan provided by my private insurer?”  Seniors know the difference.  Unfortunately, pollsters, as well as most activists and journalists do not.  Recently, on a local FM radio program (“Sounds of Dissent, WZBC), a nurse from California, who has been organizing for single-payer health insurance for over 30 years, was asked why she did not explain to the public the difference between Medicare and the “expanded/enhanced Medicare-For-All” she actually wanted to see realized.  She responded that it took “too long to say all those words.”  She and the rest of the politicians continue to deal in sound bites, often making fun of Grampy’s ignorance and plans to “kill Grammy.”

The blitz and propaganda on both the left and right leave little room for a clear picture of what an alternative health care plan would look like.  The worse contribution to the BS I have heard to date came from the President himself.  He told the citizens at a New Hampshire town meeting that he wants “all Americans to have the same insurance programs that members of Congress have!”  Just how ignorant does he think we are? (If you don’t know what isn’t covered by Medicare, I bet you don’t know what is covered by congressional insurance programs.)

Obama’s healthcare reform is no more a response to the needs and wants of citizen supporters who worked to get him elected, than was his increasing the military spending and expanding the wars in Afghanistan and Pakistan. It is, however, a response to an economic crisis that has been growing in the “real economy” for decades. The remedies and options open to Obama are the same as those of his predecessors in similar situations: transfer as much as possible of the wealth, income, labor and resources away from the “consumer” (a/k/a workers, low income and middleclass citizens, elderly, disabled, children, the poor, et. al.) over to the private sector through wage and benefits cuts, through inflation, through outright “bailouts,” through government spending in industrial sectors that could not survive without that intervention (e.g. military weapons, aircraft, corporate agricultural industry, etc.)—all with the great “hope” of returning profitability to real (not bubbles reflecting inflated worthless paper)economic/industrial production. (For more details on this process, please see some of my previous articles in Counterpunch, e.g. “The Multi-Trillion Dollar Question” and  “Greenspan’s Higher Power.”)

The point being, that within the context of the “worse depression since the Great Depression,” we are not going to see a health reform plan designed to meet the needs of citizens for affordable, comprehensive medical services.  We will see a plan designed to increase profits in the private sector at the expense of the health and welfare of the majority of Americans, with particularly disgusting consequences for the poor and elderly.

Look at what happened with Massachusetts, the “model” for the national healthcare program.  As Ellen Murphy Meehan, Director of the Massachusetts Alliance of Safety Net Hospitals, points out in her Boston Globe/NYT article (The State’s Fraying Health Safety Net” 8/10/09) “…hospitals that serve the largest proportion of those newly covered and low-income populations have seen their state-funded payments diminish or be eliminated. By receiving lower rates, they have helped to subsidize health reform.  But the consequence of their diminished rates is financial losses and the prospect of the loss of critical services for poor and disadvantaged populations.”  She stresses that “as health reform has been implemented, rates have declined for many hospital, and special payments for hospitals that serve a disproportionate share of low-income patients have been eliminated…hospitals located in the state’s poorest urban communities [have been left] with no compensation from Medicaid for the vast amount of care they deliver at rates that are still well below cost.”

Meehan’s focus here is the increased number of poor on Medicaid in Massachusetts.  Obama also plans to expand the numbers of poor uninsured on Medicaid, while he cuts “waste” in services for the insured elderly on Medicare.  Although these are two very different and separate programs, Meehan’s advise to the Obama Administration in considering Massachusetts as a model is true for both of the Medicare and Medicaid: “Policy makers looking to Massachusetts as a model…[should] reconsider the wisdom of redirecting scarce Medicare and Medicaid disproportionate-share dollars away from hospitals that serve the poor.  Expanded coverage must go hand in had with financially stable providers.  In the worst-case scenario, coverage that’s financed by eliminating the payments that underpin healthcare services to the disadvantage is a roadmap to rationing of care…healthcare reform will fail in its objectives if it serves to dismantle healthcare services for the disadvantaged that it was designed to serve.” Well, as I said, we disagree on whom healthcare reform is designed to serve, but her warning about rationing is still valid.

No one I know in my elderly HUD housing project is worried about euthanasia, plans to “kill Granny,” or socialized medicine.  We do see rationing in the future with the cuts in Medicare “waste” and no proposed replacement for our private supplemental plans.  It is frustrating to listen to talk by well-meaning but ignorant “experts” about providing Medicare to everyone, with no discussion of the outrageous inadequacies of Medicare, and no apparent understanding of the pain and suffering caused by the draconian limits placed on coverage in the current Medicare program.

Recently, I graduated from “low income” to “extremely low income” according to the management of my elderly housing project.  The change in status was due to expensive dental procedures I needed (root canal and crown) that are among the many essentials not covered by Medicare or by the so-called Medicare Advantage programs.  I’ve been around too long to believe as do some, that if we increased the misery of all Americans by putting them on Medicare as it exists, we would suddenly have mass rebellion against it.  Without going into what’s wrong with that theory, or a lengthy commentary on American’s growing passivity in contrast with displeased citizens of Europe or Canada, or a reminder of the millions in US and around the world who have protested other policies supported by the Obama administration, or the newer militarized methods planned to keep unruly citizens in their place; the fact is, that is not on Obama’s table of options, yet (stay tuned).

What is actually on the table is not going to be disclosed by the media that have created a real carnival covering hecklers at health care reform town meetings.  I do not know who put those protesters up to it, whether organized or not, but Obama is clearly enjoying telling them how misled they are. He seems to savor a real donnybrook rather than disclose what his plan consists of (other than “consumer protections,” “no single-payer,” and “cuts to waste in medicare and hospitals programs” dependent on government funding). Nevertheless, I believe that Obama will get the kind of profitable health care reform he and insurance related business interests want, based solely on what is NOT in his plan.

Barak Obama may be able to get away with that blarney.  But, for us, this is no time for sound bites and dismissive putdowns. We need to know what we are talking about, and articulate that vision truthfully, clearly and respectfully to others.  When you mess with Grampy and Granny, you cut off your nose to spite your face. Yes, we need single-payer, universal health care coverage for all Americans, as they have in the other leading developed countries.  Just don’t confuse that with “Medicare (as it exists) For All.” Or, you are going to get what you ask for, not what we need.

MARY LYNN CRAMER, MA, MSW, LICSW, Senior Citizen, has a background in economics and clinical social work, and considerable personal experience with Medicare. She can be reached at mllynn2@yahoo.com










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Mary Lynn Cramer, MA, MSW, LICSW has degrees in the history of economic thought and clinical social work , as well as over two decades of experience as a bilingual child and family psychotherapist. For the past five years, she has been deeply involved in “economic field research” among elderly women and men dependent upon social security, Medicare, and food stamps, living in subsidized housing projects. She can be reached at: mllynn2@yahoo.com

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