Healthcare for All: Harry and Louise Revisited

Fifteen years ago, the Clinton health plan was rejected, in part because of the success of ads sponsored by the health insurance industry. These ads featured a couple--Harry and Louise--talking at their breakfast table and sowing fear about any change in the delivery of healthcare. One can only imagine what Harry and Louise would be saying today.

Louise: Harry, I've been thinking. I think we were really fooled last time. The insurance companies told us a government sponsored health care program similar to Medicare would be bad for us and bad for the Country. They were wrong though, don't you think.
Harry: I sure do, we've been on Medicare now for over five years--and it's been wonderful. We've been able to select our own doctors and our own hospitals. We've have had wonderful care--and peace of mind.
Louise: And we have also been very happy with the Medicare supplement we bought through an insurance company. That's the role I think the insurance companies SHOULD be playing. Extra supplemental insurance for those of us who want more than the basic Medicare. But the basic program should be government sponsored, just like Social Security. I wish our children and grandchildren could have a program like Medicare so we didn't have to worry so whenever one of them gets sick or loses a job.
Harry: That would be great. In fact why not Medicare for everyone. If the Government started out by making Medicare available to children under a certain age and then moved the age up at the bottom and down at the top every few years, pretty soon the whole country could be enjoying better medical care--and cheaper too. I wish that that had been our message 15 years ago. We were fooled then. Never again. We should have Medicare FOR EVERYONE.
Louise: Harry, I love you.

England, France, Canada and Switzerland all developed their national health programs based on the unique experience of each of their countries. None tried to develop a program from scratch.

In the U.S. there are two potential bases on which we might build. One is the highly successful Medicare program. This program has very low administrative costs, permits patients to select their own doctors and hospitals or an HMO and has few if any barriers to services such as requiring mandatory second opinions or third party gateways. The other potential base is the employer-based system many through their employers. This system has high administrative costs, more limited lists of doctors, hospitals and HMOs and substantial barriers to treatment. Lawsuits concerning denial of care are common and the expenses are high.

Given these two choices, the policy decision would appear to be obvious. Medicare has proven itself highly successful. Almost everyone in America today is either participating in the Medicare program, the son or daughter of someone who is or was a Medicare participant or the grandchild or great grandchild of someone on Medicare. Those of us who are on Medicare know its benefits. We chose our own doctors and hospitals. We chose our own insurance company to carry our supplemental or medigap insurance. We can choose a fee for service plan or an HMO plan. And if we chose an HMO plan we can select the HMO of our choice.

Any proposal to support the extension of Medicare should find a ready source of truth-tellers. Those of us on Medicare know that we have as much or more choice than we had with the employer-sponsored program in which we were enrolled prior to Medicare. We get our medical care, and bills paid, without the need for pre-approvals or other restrictions placed upon our doctors and hospitals. We also know that it is the ability to retain our own doctors and chose our own hospitals which is most important, not the ability to retain our old plan. Many, if not most, of us switched to Medicare from a private, employer-based plan, a virtually seamless switch which in no way impaired our choice of doctors or hospitals. All that was lost was the higher cost of the insurance program from which we switched.

Those of us on Medicare also know that insurance companies are not excluded from Medicare. Their role, however, is more constructive. Insurance companies participate in at least two respects. One insurance company does all of the administration and takes care of the payments to the doctors and hospitals. Another, in my case, provides my supplemental or medigap policy. This public private-partnership has well served me and the other millions of seniors on Medicare. It could just as well serve our children and grandchildren.

Medicare for all could readily be phased in. As suggested above, Medicare could first be made available to children under a certain age and to those over some age such as sixty or sixty two. Then every few years, the age for eligible children could be moved up and the age for eligible adults moved down. Very shortly, the entire country could be enjoying better--and cheaper--medical care.

Alternatively, a Medicare-like option could be provided. Such an option would give all consumers the choice that most over 65 have now. Insuring that there is a public option is essential, however, not only to insure that there is a real choice but also to insure that real savings can be secured through an option with low administrative expenses. After all, if the doctors are going to be the same, and they will, and the hospitals are going to be the same, and they will, cost savings can most easily be realized by reducing administrative costs, and the administrative costs of the public-private partnership that is Medicare are much lower than the costs of plans based solely on insurance.

So if not Medicare for all, we should at least have Medicare (or a program like it) for all who want and need it.

Comments

[allpeopleunite]

«So if not Medicare for all, we should at least have Medicare (or a program like it) for all who want and need it.»

Absolutely, and it should be free!