A few thoughts on "Medicare For All"

There are 3 main parts to Medicare currently: A, B, and D. Part A covers hospital inpatient stays, and if you've been working and paying into Medicare long enough (through payroll deductions) you don't have to pay a premium for Part A. If you don't qualify for free Part A, (usually because you or your spouse paid in for less than 10 years - 40 quarters) then the premium is between $240 and $437 per month. Part B covers medically necessary doctor visits, outpatient care, durable medical equipment, home health, and mental health services. Part B premiums start at $135.5/month if you earned less than $85K in the tax year 2 years prior to the plan year and increases in 5 tiers to a top premium of $460/month Part B also has a $185 deductible, after which you pay 20% of the Medicare approved amount for any procedures you have. Part D covers prescription drugs. Most Part D plans have a premium, but nothing is listed on the Medicare site, other than the 5 tier add-on which starts at $12.40/month for incomes over $85K in the tax year 2 years prior to the plan year. The Part D deductible is also variable, but not more than $415 in 2019 and $435 in 2020. You can check all this, and details of what's covered here; https://www.medicare.gov/your-medicare-costs ________________ Some of the things Medicare doesn't cover are:

• Long-term care (also called custodial care )
• Most dental care
• Eye exams related to prescribing glasses
• Dentures
• Cosmetic surgery
• Acupuncture
• Hearing aids and exams for fitting them
• Routine foot care

----------------------- Most Medicare Advantage plans don't charge a premium and provide some services at no cost. Some also include vision, hearing, and dental care -- but it's limited and carries a copay. ____________ So right from the get-go, let's dispense with the idea that Medicare is "free". It's not and for some people, paying the premiums and deductible is a real hardship. Medicare also has a massive amount of bureaucracy, and if it was expanded to cover the whole country, that bureaucracy would also be expanded. And bureaucrats aren't cheap. If you're working, you'd still be paying the Medicare payroll taxes, as well as premiums and deductibles. ----------------------- If either Bernie Sanders or Elizabeth Warren's plans are adopted and private insurance goes away, everyone on Medicare who has a Medicare Advantage or Medigap plan would be kicked back onto basic Medicare and lose the benefit of the low or no copays they currently have. For example, the Medicare Advantage HMO I have has a $0 copay for PCP and Urgent Care visits, $20 specialist, vision, dental, and hearing, and $120 ER visits. This is actually cheaper than my last health insurance! --------------------------------------------------- Then there are a few other issues.

1. Medicare pays less than commercial insurance to both doctors and hospitals. This will be a problem. Operating costs (rent, utilities, equipment maintenance, insurance -- both facility and malpractice) aren't getting cheaper. Staff have to be paid. Doctors, nurses, techs, janitors, and all the other people who make hospitals, clinics and doctors offices run don't work for free. As things stand, smaller hospitals and clinics -- especially in rural areas are having a hard time making ends meet.
2. Medicare doesn't cover everything. If you need a drug that isn't on the approved list, or a procedure that's not covered, you're S.O.L.
3. Medicare was designed for senior care and end of life care. Most people spend 60 years give or take before they need a lot of the care Medicare is designed to provide. This means that before it can be implemented, there's going to have to be a whole lot of revision undertaken.
4. Dumping the private insurance system, cumbersome, expensive and inefficient as it is will put a whole load of people out of work. Between 6 and 10 million people are employed in health insurance and related areas. I think Warren's estimate of 2 million jobs lost is an understatement, but even that is a lot of people to suddenly find themselves out of work. -------------------------------------- Yes, we need health care reform, but "Medicare for All" isn't it. In fact, "Medicare for All" isn't a plan or a policy -- it's a slogan. The Devil, as they say, is in the details. And there are A LOT of details.