Connect The Dots USA
To truly fix the cost challenges in Medicare and Medicaid requires fixing U.S. healthcare generally. Walter Cronkite aptly pointed out back in 1993, “America’s health care system is neither healthy, caring, nor a system.” For lack of a plan, we have allowed a crazy, inefficient patchwork to evolve in which for-profit insurance companies cherry-pick out the youngest and healthiest customers; and then government is left scrambling to cover the most expensive risk pools and plug in the holes.
All other industrialized democracies when faced with challenges in their healthcare systems have found different ways to cover everybody while spending far less than we do and getting better overall results. In many ways, foreign healthcare models are not really “foreign” to America — we’ve actually blended versions of all the systems together into a costly, confusing, inefficient, bureaucratic “crazy quilt.”
For half the U.S. population — roughly 150 million Americans — who get their insurance through their jobs, we’re like Germany or Japan: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals.
For seniors over 65 and the disabled in original Medicare, we’re like Canada or Taiwan: Everyone pays taxes and/or premiums for an insurance plan run by the federal government, and the public insurance plan pays private doctors and hospitals according to a set fee schedule (also known as a single-payer system). Medicare Advantage (Part C) introduced a useless private insurance middleman into this system.
Similarly, for Medicaid and CHIP (the low-income children’s health program) where federal and state governments share the costs of insuring folks living below the poverty line. Contrary to right-wing mythology, the vast majority of people on Medicaid are children, have jobs, or are seniors in nursing homes who have "spent down" their assets to qualify for Medicaid (remember, Medicare does not cover long-term care).
For the 8 million military veterans getting care at the Veterans’ Administration (VA), we’re like Britain. It’s actually our VA system for the American troops that is one of the world’s purest examples of “socialized medicine”: VA hospitals are run by and VA doctors are employed by the federal government; funding is through general taxes.
For the approx 14 million buying individual private insurance (like me), we’re like pre-1994 Switzerland without any leverage or protections from the greedy sharks at Big Insurance who cherry-pick healthy customers and
routinely deny claims to make huge profits off basic healthcare.
And finally, for the 50 million without any insurance coverage (three-quarters of whom come from working families, by the way), we’re like Burundi or Burma: Your options are pay out of pocket and possibly go bankrupt, pray, stay sick, or die.