Blog #129 – Medicare and Beyond — For a Secure Health System


Beyond Medicare. How about a Secure Health System, analogous to the existing Social Security System?

We are a better country than we often want to acknowledge. We have a Social Security system, out of concern that old age should be secure and free of financial worry. We have an Unemployment Insurance system, out of concern that workers unable to find work in the open market should not be left in poverty or indigence. And we have Medicare, which can be seen as a fumbling step towards a health security system. We recognize, though we don’t often say so, that the Declaration of Independence’s call for government to provide for the security of life, liberty and the pursuit of happiness as inalienable rights is an appropriate, indeed indispensable function of government, that that means measures guaranteeing all members of society security in having at least minimum access to what it takes to make those rights meaningful.

Wouldn’t a Secure Health Care system fit right into that pattern? Isn’t ill health, like old age, like joblessness, like physical vulnerability, a cause of painful insecurity that  we would like no one to have to suffer from – need we doubt the parallel appropriateness of police protection for all, or environmental protection for all?

Doesn’t every civilized country care, both practically and legally, for the health and welfare of its citizens, and directly implement minimum standards for what that entails?

What, then, would a “Secure Health System” in the United States mean? – a system in which every person can count on the fact that , if  they become ill, they will be taken care of, will receive the  treatment and the care that  they need??  

It would mean the setting of minimum standard of health care to which all are entitled, without regard to incomes or health problems, the treatment, the medications, the comforts, that their condition requires. If individuals are able to provide that for themselves without government assistance, good and fine, let them; do so, but whether or not they can do so on their own,  all are entitled to security in having the minimums, no questions asked. We don’t deny the rich police protection because the can afford private security, nor deny the children of the rich public education because they can afford private schools. Beyond that, if they want and can afford more, more power to them. We don’t ask social security recipients it they have better pensions, children if their parent can afford better schools, home owners if they have private security systems. All members of society are entitled to security in obtaining the benefits of civilization, period.                                                                 

Why should health care be any different? It shouldn’t. Yet it involves one of the few necessities of life in which direct provision by government is now very limited, in which major provision is by private entities and personnel, by and large, by the private sector, with  an interest in high  prices for their  own benefit.

Health care in the U.S. needs fundamental change today.  

What might a system providing Secure Health in the United States look like? It would not deal with insurance companies or facilitators. Doctors and hospitals and drug companies would submit their bills to it, and be paid, verifying only that the services billed for were actually rendered. The plan would be financed by a small tax akin to a payroll tax, levied on all adults. If proceeds were insufficient to cover all claims, the national government would keep it solvent, just like social security.

If necessary, some of Elizabeth Warren’s revenue proposals might be adopted as needed. The savings from eliminating paper-work and enhanced bargaining-power with providers, i.e. pharmaceutical companies, private hospitals, should produce major savings in cost – and annoyances..

              For more limited improvements in the current Medicare system,               see, Blog #128, Solving the Fake Medicare Opt-out problem:    

Blog 128 – Solving the fake Medicare opt-out problem

Solving the fake Medicare opt-out problem,   with a fair health care system.

The debate about letting the healthy and the wealthy opt-out of Medicare is a fake debate. Each component has a pretty simple and feasible answer. The real debate is only as to the profits of insurance companies.

All the issues raised by the question of whether patients should be allowed to opt out of paying the Medicare tax if they buy their own private insurance can be fairly handled, with a little effort. Raising the issue is a booby-trap laid by insurance companies wanting to sell their policies and maximize their profits.

The response requires respecting the basic principle is that it is both morally and socially just and economically sound that the healthy share in covering the health care needs of the ill, that the wealthy share in helping with the needs of the less-well off– principles that are well accepted in core governmental policies, from social security to unemploment insurance public housing to the setting of progressive tax rates and our ddalyl-[too-day relations with each other. .

The basic answer is that in a fundamentally fair economy all should share in the ability to have good quality health care, regardless of their wealth or health. And all should have the same options. Further, the obscene level of paper work and rules and regulations about coverage should be eliminated. The need to worry about coverage, co-pays, prior conditions, time limits, source of coverage, overlapping policies is unnecessary, produces nothing, and is not cost-effective. Having a single payer or Medicare for All, or Universal Coverage, system (beware— “Medicare” means different things to different people) is not hard to structure. . Economically Medicare for all can simply give greater strength to taxpayers as against medical suppliers, when users can bargain collectively in setting rates with providers, preventing pharmaceutical companies and medical providers from taking advantage of their near monopoly position to fix rates. morally, simply requires adjusting tax and reimbursement rates to reflect the extent of need and the availavblity of the parties’ resources to met them. resources to meet them. A class system of medical care, in which the rich get better and faster care at the expense of the less-well-off A system of medical care in which the rich get better and faster care at the expense of the less-well-off is generally accepted as socially undesirable. Helth cares should be considered a necesity of lilfe, not a commondity to be auctioned off to the highest bidder.

Such a class system can be avoided by not permitting providers to refuse treatment to patients on the basis of the source patients use for covering their bills, Medicare vs. private insurance. The medical profession as a whole should join in fixing fair reimbursement rates for all providers, bearing in mind a good faith obligation of fairness both to providers and patients. Care can be provided by providers of the user’s choice, not only to the healthy and the wealthy, who are likely to get unfairly favorable treatment from insurance companies and providers if they can pay more for treatment than the less well-off. Options should be equal for all. This is a democracy, and fairness is a core value.

(Elizabeth Warren’s plan recognizes all of the above. On the cost side, see:

For an even better, but probably today not yet politically feasible solution, see Blog #129, Medicare and Beyond: for a Secure Health Care System.