Leon Lederman, a brilliant physicist, recently passed away at the age of 96. Lederman won a Nobel Prize in 1988, but he was unable to leave his Nobel Prize medal to his children and grandchildren for them to cherish. In 2015, Lederman and his wife reluctantly sold the medal for $765,000. Why part with such a rare and distinguished honor? In his nineties, Lederman required long-term care. He and his family needed the money to pay the cost of that care.
The cost of a semi-private room, food and housecleaning in a nursing home averages $225 a day, $82,125 each and every year. And the current Medicare program does not cover long-term care — neither care at home nor in nursing homes.
Most families cannot pay that bill by selling a Nobel Prize medal or anything else worth over half a million dollars. Instead, seniors are generally forced to impoverish themselves so that they can qualify for Medicaid.
Once poor enough to qualify, they are restricted to facilities that accept Medicaid patients and can be subjected to other difficult and painful limitations, as Medicaid rules vary significantly state to state. Even if their families want to care for them at home, Medicaid may make that choice impossible. Depending on the state rules, Medicaid may pay for institutional care, but not the costs of what families need to keep their loved ones at home.
It doesn’t have to be this way. This week, over one hundred members of the House of Representatives are introducing the Medicare for All Act of 2019. The legislation expands Medicare to include comprehensive long-term care coverage, including at-home services and supports, as well as nursing home care. This would be life-changing for tens of millions of seniors and their families, who would no longer be forced to become destitute to get the care they need.
The Medicare for All Act significantly expands Medicare in other extremely important ways, as well. It adds hearing, dental and vision coverage. The inability to see is tremendously limiting and can result in falls and other accidents requiring medical treatment. Inability to hear is even worse.
Helen Keller, who lost her sight and hearing as an infant, explained, "The problems of deafness are deeper and more complex…than those of blindness. Deafness is a much worse misfortune.” Inability to hear can result in walking problems and greater risk of falling. It is also extremely isolating, resulting in serious depression and other mental challenges. Perhaps most seriously, recent research has revealed that hearing loss results in the atrophy of the brain, substantially increasing the likelihood of developing dementia.
Unavailable during Keller’s life, surgery today can restore hearing, and hearing aids are becoming increasingly sophisticated and effective. But treatment is expensive. Around one in three seniors aged 65 to 74 suffer from hearing loss. The number is nearly one in two for those aged 75 or older. Three out of five of those over age 65, however, are untreated for their hearing loss. That would change overnight if the Medicare for All Act of 2019 were enacted.
As serious as untreated vision and hearing loss is to health and well-being, those losses pale before the seriousness of untreated dental problems, which can lead to malnutrition. Before that even happens, untreated gum disease can result in heart and lung disease, as harmful bacteria enter the blood stream.
All of these crucial medical treatments — vision, hearing and dental — are provided under the Medicare for All Act of 2019. And the legislation eliminates every penny in premiums, co-pays and deductibles. If Medicare for All were the law of the land, healthcare costs would no longer consume over 40% of the average Social Security benefit.
Despite the fact that current Medicare beneficiaries have so much to gain from Medicare for All, they are being subjected to a cynical propaganda campaign to turn them against it. Just prior to the midterm election, as Democratic candidates embraced the wisdom of improving Medicare and expanding it to everyone, USA Today gave Donald Trump column space to publish an op-ed filled with lie after lie, claiming that Medicare for All would hurt seniors. Sadly, that is only the beginning.
For-profit insurance corporations, big pharma and the other industries that profit off our current wasteful health care system are terrified of Medicare for All. They will do everything they can to defeat it, including scaring those who are most dependent on health care and therefore have among the most to gain from Medicare for All — older Americans. We are just beginning to see their campaign of fear.
In addition to trying to scare seniors, the fearmongers seek to convince all of us that adding important services to Medicare and expanding the program to cover everyone is unaffordable. Nothing could be further from the truth. What is unaffordable is what we have now. Even conservative analyses show that Medicare for All will reduce what seniors and the rest of us pay currently.
The reason is obvious. Insurance is most efficient, secure and reliable when the risks can be spread across as broad a population as possible and when no one can purchase the insurance only when personal risk factors increase — a practice known as adverse selection. Only the federal government has the power to establish a nationwide, universal risk pool, with mandatory participation, making adverse selection impossible. And when the federal government administers the insurance, overhead is minimized. Instead of high-paid CEOs, hardworking civil servants are in charge. And other costs, like advertising and marketing, are unnecessary.
Today’s Medicare covers seniors and people with disabilities. These are people who have, on average, the most expensive and chronic medical conditions and therefore require the largest numbers of doctor and hospital visits. Accordingly, they have the largest number of health care claims. Yet, Medicare is significantly more efficient than commercial health insurance.
According to the most recent Trustees Report, Medicare spends just 1.1 penny of every dollar collected and spent on administrative costs. The other nearly 99 cents are spent on health care. In contrast, the administrative costs of private health insurance are generally more than 12%. Indeed, it took the Affordable Care Act to limit insurance companies to spending no more than 20% of patient premiums on administrative costs.
As a stark illustration of the greater efficiency and effectiveness of Medicare, a proposal floated a few years ago to raise Medicare’s initial age of eligibility from 65 to 67 would have resulted in increased health care costs for the nation as a whole of $11.4 billion a year and increased premium costs for both Medicare and all other health insurance by about 3%. Just as shrinking Medicare’s coverage increases costs, expanding coverage would reduce our nation’s overall costs.
Adding everyone to Medicare would not only increase the size of the risk pool. It would reduce costs even more by adding healthier, younger beneficiaries to that risk pool, driving the per capita costs even lower.
Opponents of Medicare for All are seeking to scare those younger Americans into opposition. The fearmongers tell working families that they will lose the insurance that they have. The reality is that those younger people who have those fears should, along with seniors, be the strongest supporters of Medicare for All. Today, one’s health insurance is lost when employment ends or when one’s employer simply decides to change policies or provide no insurance at all. If you want to make sure you won’t lose your health insurance, you should be pushing hard for Medicare for All.
That is also true if you want more choice. Today, Americans have sharply restricted choice of doctors and hospitals, because they are limited to who is in their insurance plan’s network. Under Medicare for All, there will be no networks. Americans will be able to choose whatever doctors and hospitals they prefer. They will be able to afford their medications. They will be able to get early treatment when medical problems arise.
All of us together will be able to afford all of this by cutting out all of the waste. Currently, there are about 16 non-doctors for every doctor working in the nation’s health care system. Only six of those 16 are involved with patient care; the other ten are doing paperwork so our medical providers can be paid. That is not making anyone healthier. If we get rid of the waste and are more in line with what other countries pay, we can increase reimbursement for doctors, hospitals and other health care providers, pay less out of pocket, cover everyone and have balanced federal budgets for the foreseeable future. Let’s not let the fearmongers scare us from this better world.
The enactment of Medicare for seniors in 1965 was intended as just the first step to Medicare for All. Improving Medicare’s benefits and expanding it to cover everyone will make the program stronger, more successful and more popular. Moreover, with all of us covered by the same group insurance plan, we will have enormous leverage. And, since that insurance plan — Medicare — is sponsored by the federal government, we will have direct recourse at the ballot box if our collective interests are not well served.
We can make Medicare for All a reality, but only if millions of us mobilize to defeat the power of big money. Seniors, who have an immense amount to gain from Medicare for All, must be at the forefront of that mobilization. That means calling your members of Congress and telling them that you are a current Medicare beneficiary who strongly supports expanded and improved Medicare for All. It means talking to your friends and family about why the corporate-funded propaganda is false. And it means working to elect political leaders who will listen to voters instead of donors. Together, we will make high quality health care a human right for everyone in America.
