Her Medicare bandage won’t stop the bleeding
Is Hillary Clinton's floated proposal to expand Medicare with a buy-in option for people in their 50s a step toward single-payer health care?thinks not.
"A STEP to the left" is how the New York Times described Hillary Clinton's talk about allowing people aged 50 and over--or maybe 55 and over--to buy in to Medicare, the federal program that covers health care for seniors 65 and over as well as people with disabilities.
Clinton was responding to the pressure she's under from Democratic primary opponent Bernie Sanders, whose widely popular left-wing message is based in part on his willingness to criticize the disastrous system of for-profit health care in the U.S.--and to make the case for a single-payer system that would provide health care to everyone.
Just a couple months ago, the Clinton campaign, led by the candidate's daughter Chelsea, was on the attack against Sanders, insisting that his willingness to still talk about single-payer--often described as the improvement and expansion of "Medicare for all"--was pie in the sky, and that he wanted to dismantle Obama's Affordable Care Act (ACA).
Now, she's publicly contemplating a "Medicare for more" plan that she claims is more reasonable and achievable than single-payer.
That might sound like a "step to the left," as the Times put it. But how much of a step? Just how "left" is Clinton's proposal? And while we're at it, would it be any more achievable?
For those who support a single-payer system that would guarantee access to quality health care to each and every person in the U.S, the answers are: not enough, not very, and no.
"IF YOU were able to move people 55 or 50 and up, who are the biggest users of health care, into the Medicare program--they would have to buy in, but they would be buying into such a big program that the costs would be more distributed," Clinton told a group of parents in Virginia when one of them asked what Clinton would do about the high price of health insurance. "There's a lot of things I'm looking at to try to figure out how to deal with exactly the problem you're talking about."
For people who don't qualify for health coverage through the government's Medicare or Medicaid programs, finding affordable insurance is a huge burden--especially as they get closer to 65 because older people have more health issues than younger people.
While the Obama health care law barred companies from refusing to provide insurance on the basis of "pre-existing conditions," the ACA allows insurers to charge different levels of premiums--so older people end up being charged as much as three times more than young adults.
Lack of affordable insurance is a burden on many working-class families, and so a lot of them simply do without. As the Kaiser Family Foundation reported:
Even under the ACA, many uninsured people cite the high cost of insurance as the main reason they lack coverage. In 2014, 48 percent of uninsured adults said the main reason they were uninsured was because the cost was too high. Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for public coverage.
The idea that Clinton is talking about isn't a new one. During congressional bargaining over what to include in the Obama health care law in 2009, a so-called "public option" was part of the House proposal--a government-subsidized plan would have been one of the choices offered in the ACA's marketplace for purchasing insurance, alongside many private plans.
By the time the proposal for a "public option" got to this point, it was already full of holes--it lacked the scope of coverage and affordability of Medicare. But in the end, the public option was jettisoned completely from the Senate version of the ACA--thanks to opposition from Republicans but also Democratic senators, as well as independent Joe Lieberman.
It later emerged that the Obama administration had made a deal with health care industry lobbyists that the public option would never make it into the ACA.
So in the end, the voice of the for-profit health care industry was much more influential than any discussion of affordable health care.
NOW, WITH passage of the ACA six years in the past, the idea that a plan for expanded Medicare or a public option could be revived is pretty remote in the current political climate.
This gives Clinton some political insurance of her own. She can float proposals for "Medicare for more" and sound like she's searching for an answer to the health care crisis--while knowing full well that any concrete proposal she made would be crushed in Congress.
But Clinton knows something else--what she's talking about isn't nearly as revolutionary as the New York Times says it is.
First of all, it's a Medicare buy-in, which raises all sorts of questions. How would the premium paid by 50-year-olds-and-up be calculated? Would it be based on the higher costs of health care for older people who are much more likely to suffer from chronic conditions or long-term disability? According to the Congressional Budget Office estimate in 2008, a Medicare buy-in program for 62- to 64-year-olds could cost about $7,600 a person.
Furthermore, Medicare at it exists today isn't perfect--far from it. For instance, there is no ceiling on out-of-pocket spending for basic Medicare coverage, so patients who use Medicare could see huge bills that they are responsible for. The risk is so great that as of 2012, some 90 percent of people with Medicare had another form of coverage as a supplement.
Medicare needs many improvements, but instead Congress continues to nurture the private Medicare Advantage (MA) plans while neglecting the traditional Medicare program...It is difficult to see Congress enacting a Medicare public option that has better benefits and lower costs than the private MA plans--certainly not as long as the private insurance industry holds sway over Congress."
The passage of Obama's ACA itself meant billions dollars in cuts to Medicare. The ACA got rid of annual increases in Medicare reimbursements for hospital costs, home health services, hospices and skilled nursing services, which decreased Medicare spending by $716 billion over 10 years, according to a Congressional Budget Office estimate.
IN MANY ways, any expansion of Medicare, a government program with the stated aim of providing health care to people who couldn't afford it otherwise, is fundamentally incompatible with the ACA, a plan dedicated to preserving the monopoly of private insurers.
And that's why any plan--even if it were proposed in earnest, which has to be debatable if it's coming from Hillary Clinton--to add in an affordable nonprofit option to a system dedicated to profit is doomed to fail. Clinton thinks she can score political points if she acknowledges that millions can't afford coverage under the ACA--but she has no intention of threatening the health care industry's control.
The main aim of a single-payer system would be to do away with for-profit health care, with its competing corporate interests and wasteful administrative costs, and replace them with "everybody in, nobody out" access to the health care.
Clinton's changing position on health care is an attempt to counter popular sentiment in favor of a single-payer that became apparent through the Sanders campaign. One recent Gallup Poll survey showed that a majority of all U.S. adults favor replacing the ACA with a federally funded health care program.
Sanders, who initially said he would refuse to vote for the ACA unless it included at least a public option, eventually voted for the legislation in the interest of getting something passed.
Now, he's calling Clinton's "Medicare for some" proposal "a step in the right direction, but just like her support for a $12 minimum wage, it is not good enough." But Clinton's plan is worse than that.
Sanders' position makes it seem like Clinton has a more incremental way of getting to the same goal. But Clinton's goal isn't single-payer, now or ever. And her Medicare buy-in proposal isn't a step in the right direction; it's no step all. As the PNHP's McCanne concludes:
No, a Medicare buy-in or public option is not a step toward single-payer. It would be merely another player in our dysfunctional system. Worse, it would further postpone enactment of the reform that we really need merely because we would be thinking that we've done something when we really haven't.
Sorry, but we have to change that chant from "Public Option" to "Medicare for All, not just some."