Medicare for All?

The current mantra amongst the left is "Medicare for All". (See Sanders Plan S 1804). They have no idea what they mean but that has never stopped the left before. I recall Thomas Paine and his analysis of social services and he felt compelled to say what it was and how it would be paid for. Not with the left, just shout out the mantra.

Medicare as it now stands has two components:

1. Recipients have paid into the system, 3.5% of one's gross, not net or limited, income for a lifetime, say from 18 years old to 65. That is 47 years of paying insurance premiums. Then you still pay for Parts B and D, and for that you get 80% coverage from a provider willing to accept Medicare. You also may end up paying for an additional coverage plan. One should recall that if you were in the top 35% income bracket you will never get back what you put in, on average!

2. Coverage is for medical and hospital care and some medications. No dental.

Thus Medicare today means you have paid and continue to pay and that your coverage is limited.

Now what is "Medicare for ALL"? As the NY Times notes:

“Medicare for all” has become a rallying cry for progressive Democrats, though it means different things to different people. Supporters generally agree that it is a way to achieve universal coverage with a system of national health insurance in which a single public program would pay most of the bills, but care would still be delivered by private doctors and hospitals. One-third of Senate Democrats and more than half of House Democrats who will serve in the new Congress have endorsed proposals to open Medicare to all Americans, regardless of age. A Medicare-for-all bill drafted by Senator Bernie Sanders, independent of Vermont, has been endorsed by 15 Democratic senators, including several potential presidential candidates: Cory Booker of New Jersey, Kirsten Gillibrand of New York, Kamala Harris of California and Elizabeth Warren of Massachusetts.

What they mean is that anyone who has never paid a penny will get what those of us who have paid all their lives. Social Justice be damned, any justice be damned. In addition it would be, if Sanders and the left have their way, "free", yes, totally free, unless of course you have any money, which they will take to pay for it.

I keep thinking of the TSA. They are generally brutes with a badge. Now they will be the ones managing this system. So if you like full body pat downs, insulting and man-handling characters, this is just what you want. So ten years ago I fought Obamacare, thirty six years ago Hillary Care, and now thank God I have that Irish passport! At least I can find a nice pub.

Just think of a Government run anything, except the military. Think Post Office, TSA, IRS, NJ Transit, Amtrak, and keep going. None work! What I wonder do these people really have in mind?

The un or under employed millennials think "free" everything. But for me and the 35% like me, we get near nothing but pay the carry. Who pays? As they say, you no longer live with mommy!

Yet then along comes a left wing Presidential candidate. She states after bemoaning the situation with her mother (I went through the same two decades earlier so I have first hand knowldge, it is always difficult):

I believe that health care should be a right, but the reality is that it is still a privilege in this country. We need that to change. When someone gets sick, there is already so much else to deal with: the physical pain for the patient, the emotional pain for the family. There is often a sense of desperation — of helplessness — as we grapple with the fear of the unknown. Medical procedures already have risks. Prescription drugs already have side effects. Financial anxiety should not be one of them.

Logistics, alone, can be overwhelming. I remember that as my mother’s condition worsened, she needed more care than we could provide. I wanted to hire a home health care aide for her. But my mother didn’t want help.

One agrees, financial difficulty should not be a problem. But equity and a form of justice should be considered. Although we do have Matthew 20:1-16 wherein it states about the Laborers in the field:

⁸ “When evening came, the owner of the vineyard said to his foreman, ‘Call the workers and pay them their wages, beginning with the last ones hired and going on to the first.’
⁹ “The workers who were hired about five in the afternoon came and each received a denarius.  So when those came who were hired first, they expected to receive more. But each one of them also received a denarius. When they received it, they began to grumble against the landowner. ‘These who were hired last worked only one hour,’ they said, ‘and you have made them equal to us who have borne the burden of the work and the heat of the day.’
¹³ “But he answered one of them, ‘I am not being unfair to you, friend. Didn’t you agree to work for a denarius?  Take your pay and go. I want to give the one who was hired last the same as I gave you. ¹⁵ Don’t I have the right to do what I want with my own money? Or are you envious because I am generous?’
¹⁶ “So the last will be first, and the first will be last.”

But one can ask; did not these workers enter into a contract? And was not the contract honored, albeit differently for groups but equitably for each as agreed. Yet one then must ask based upon contract law, where the conclusion at the end comes from? Is this the basis for Medicare for All? Why not Marx, namely "according to one's need" Is there a moral requirement to make some contribution. By someone at some point. Or are we establishing the "free rider" principle.

As a digression, the piece from Matthew above has various interpretations. One is that which I noted, namely a Master can decide what to pay workers irrespective of their individual contributions. The more classic interpretation was that one who came to the Lord late in life would receive the same redemption as one who had been faithful all their life. This was to act as an incentive for Gentile conversions. Needless to say there can be multiple interpretations. But the operative phrase is "generous". That means that the person paying may pay whatever they so think. However with Medicare for All it raises the question as to who is paying. Clearly it is the taxpayer, and as structured now the taxpayer pays proportional to their total income, similar to the above. But if the Master were forced to pay for those who have done no work in the field, would that not change the parable?

 Having an equitable yet exceptional health care system is complicated. Medicare is somewhat akin to the above parable, we all agree to participate, wait till we are 65, hopefully, then continue to pay whether we are ever ill or not. That is the essence of insurance and that is Medicare. If we want a plan for all others, hopefully not eliminating choice as is the case with the New York Plan we discussed, then any new plan must at the very least not be a Medicare plan or any adjunct to it, but a stand alone plan with clear financial monitoring. What that is I do not know nor does it appear do any of the sycophants proposing it. This whole movement may make Obamacare look rational! Perhaps they will eliminate the need for Medical School, allow only the use of an aspirin, and focus on infrastructure by building bigger graveyards!

Welcome to the never ending debate on health care. But remember the "back of the envelope" calculation. Health care costs are about $3.5 trillion, there are about 330 million citizens and thus per citizen it is $11,000 pa. Sick or not. Young or old. So where is that money coming from. Current Medicare participants are paying between $1,500 to $4,500 pa for 80% coverage. They are left with 20% of the $11,000. But, and this is critical, Medicare starts at 65 but one contributes from day one of employment, for many that is 18. So do we give a 25 year old the same benefit but at what cost! This issue is; who pays. The second issue is: since cost is critical, will the Government control this "plan" like it does all others? An "iron fist".