Health Care/Joan Retsinas

How to Slay the Medicare Beast: A Handy Guide

Medicare for All, or Medicare Awful. The cognoscenti recognize the dangers of this scourge. It threatens to gobble up insurers, drive up taxes, cement us under humongous debt, and rob us of those freedoms we elected President Trump to safeguard. Before it sweeps all ordinary law-abiding gun-toting citizens under its mammoth umbrella, Run! Fight! Resist!

As Medicare-Awful menaces the land, here is a step-by-step guide to slay the beast before it slays us.

First, recognize — and discount — the allure of Medicare for All. A bit like the fabled Trojan horse, the scourge arrives as a benevolent package. Consider: Medicare accepts everybody, even people who are sick. It imposes no treatment exclusions for “pre-existing” conditions: if you enroll needing chemotherapy, you get chemotherapy. If offers a wider range of benefits than private insurers. It tags premiums to income (the poorest receive total subsidies). Its “formularies” are broader than private insurers. Its administrative costs are lower.

Second, recognize — and discount — the legions of elderly and disabled enrollees who — even if they grumble — would never ever return to their pre-Medicare insurers. Whatever the tab, whatever the ideological bluster, no politician threatens to take Medicare from the people who have been entitled to it for 50-plus years. Of course, that allegiance doesn’t extend to the legions of Americans not yet disabled, not yet elderly. They can wait.

Before Congress blankets the country with Medicare, use this nifty guide to thwart the beast.

First, gather up allies. Enlist all those insurance brokers who negotiate mega-fees as consultants, steering private employers to “good deals” to insure their employees. In a Medicare-for-all world, they will lose their commissions, their salaries.

Enlist too all the private-sector insurers — very much for-profit ones — whose executives stand to lose their million-dollar-plus salaries, whose shareholders stand to lose their profits. They present a benevolent face in their communities: they sponsor walkathons, youth basketball leagues, cancer screening sessions. Remind everybody that these very profitable companies have their Mother Teresa sides … and that in a Medicare-for-All world, all those walkathons, cancer screenings, and basketball leagues will disappear.

Yell: Freedom. We have it; the rest of the world, particularly those Western European countries that have universal health insurance, don’t. Rope in the true-blue ideologues … the ones who hate Western Europe, even though they have rarely traveled beyond the USA. Raise the specter of the United States’ health care system morphing into that of France? Or Germany? Or the Netherlands? We have a system that is close to that of South Africa, and we don’t want to lose its distinctive features: limited enrollment, skimpy policies, high premiums.

Yell: Costs. Medicare-for-all will cost too much, bankrupting future generations. The not-fake-fact is that it won’t: Western European countries have not floundered on their universal health care systems. In fact, economists predict savings: not-for-profit Medicare will cover everybody, will pare those costly emergency room visits, will institute some rationality in spending decisions. But keep yelling the fake-fact.

Throw in the “complexity” argument: it is just too hard to remake the “system.” Forget that 50 years ago under President Johnson the country ushered in Medicare. We have gotten dumber, slower. Befuddle Congress with an assortment of models: a public option? A German-based option of sickness funds? A Canadian option? Then nit-pick each option, zeroing in on what is amiss, what could go amiss. The search for the “perfect” insurance will devolve into piles of studies.

Shade the strategy with subtle racism, classism, whateverism. Universal health coverage means covering everybody: do true-blue Americans, the ones yelling Freedom, who elected this President, really want to cover everybody? And do they want everybody to have the same Cadillac polices: shouldn’t poor people have poor insurance, poor health care? Poor people have poor housing, poor schools, live in poor neighborhoods. Let’s be consistent. Maybe a crummy life will spur poor people to work hard, to move up, à la Horatio Alger, or à la the Trumps.

With this guide in hand, we can trounce Medicare-for-All … until the next “crisis” reminds us of our cruelty.

Joan Retsinas is a sociologist who writes (occasionally tongue-in-cheek) about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, April 1, 2019

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