By Patrick Svitek
The Texas Tribune, March 17, 2019
Beto O’Rourke has long advocated for “universal, guaranteed, high-quality health care for all.”
But O’Rourke has a less-than-straightforward history with Medicare for All, and he continued to keep it at arm’s length in Iowa, saying at one point that he is “no longer sure that thatās the fastest wayā to achieve universal health care. Instead, he arrived in the Hawkeye State ready to talk about a different health care proposal: Medicare for America.
Introduced in December by U.S. Reps. Rosa DeLauro of Connecticut and Jan Schakowsky of Illinois, the legislation would set up a government-run health care program ā like Medicare for All ā but aims to let people keep their employer-sponsored insurance if they have it and like it.
“It responds to the fact that so many Americans have said, āI like my employer-based insurance. I want to keep it. I like the network Iām in. I like the doctor that I see,'” O’Rourke said.
Comment:
By Don McCanne, M.D.
In my presentations in years past, I frequently asked audiences to think back to twenty years ago. Think about the insurance you had then. Now, how many here still have that same insurance? No hands go up. That is, except for people over 85 on Medicare, and except for a Kaiser Permanente physician who had worked for Kaiser for over twenty years.
The obvious point is that people do not have stable health care coverage throughout their lives. There are many reasons. To mention just a few: employment is not stable and individuals lose their coverage when they leave a job; moving to a new location usually results in loss of prior coverage, employers may change their employee benefits or change their insurers; frequent changes in insurer provider networks may cause individuals to lose their usual sources of care; low-income individuals may lose their Medicaid with a modest increase in income or a change in state eligibility policy; individuals with long term disabilities or end-stage renal disease may be shifted to Medicare; individuals on Medicaid have frequently been transferred into restrictive Medicaid managed care plans; states may have overly stringent eligibility requirements for Medicaid, such as the work requirements that are causing many to lose their coverage; patients in traditional Medicare may transfer to private Medicare Advantage plans with provider network restrictions; Medicare Advantage plans may withdraw from selected markets; unless grandfathered, as of 2020 individuals will no longer be able to enroll in more comprehensive Plan C and Plan F Medigap plans and may be subjected to underwriting requirements; plans in the individual market are quite unstable with frequent changes in benefits, in provider networks, and in the plans themselves since they are subject to cancellation; bankruptcies may impact retiree benefits including pension and health benefits; premiums may become truly unaffordable resulting in loss of coverage due to inability to pay; and, of course, at any given time tens of millions of people face being uninsured. There are endless other reasons for lack of continuity of coverage, but it is the norm.
And now many politicians besides Beto O’Rourke are telling us that we should not enact the single payer model of Medicare for All because it would not allow people to keep the insurance they have. Memory must be very short. Not too long ago President Obama received the Politifact Lie of the Year award for saying, “If you like your health care plan, you can keep it.”
So then they say, well, you can have your choice of plans. What choices? The most common coverage is through employer-sponsored plans, but you do not have the option of choosing one of the millions of plans offered by other employers, only that from your own employer, if one is even offered. You cannot choose Medicare or Medicaid plans if you have not met the eligibility requirement. Your only option may be to choose a plan in the individual market, but you may find that you have a very limited choice of highly restrictive plans that may not cover your physician or hospital. Some choice.
Besides, the choice you want is that of your health care professionals and hospitals, not a choice of your supposedly beloved health plans, even if mediocre. Under Single Payer Medicare for All you do have total free choice in your health care, choices that are being taken away by the private health insurers.
When you are told that you get to keep your health plan, you don’t have to respond by calling the person a liar (as was disrespectfully done with our president at the time). “Fallacy” is a less pejorative term than “lie” so you can emphatically respond with, “THAT IS A FALLACY; NOBODY GETS TO KEEP THEIR SAME INSURANCE THROUGHOUT LIFE; INSURANCE CHANGES ALL OF THE TIME!”
If you have the opening, you can go on with, “WHAT I WANT IS MY CHOICES IN HEALTH CARE. THE INSURERS ARE TAKING THAT AWAY FROM US WHILE WASTING OUR MONEY ON ADMINISTRATIVE EXCESSES.”
Anyway, we need to bring to an abrupt end the fallacy that you can keep the insurance you have, especially when it is being used to dismiss the great opportunity we have to bring health care to everyone in America by enacting and implementing SINGLE PAYER MEDICARE FOR ALL!
This is a time for PASSION. We have to get this message out there.
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