Why does Medicare matter in the 2020 election?

The November election will make Medicare much, much better, or—for seniors like us—much much worse.  Unless you don’t care about spending lots more on your health, pay attention to Medicare.

Contributor: Buddy Robinson

If this wasn’t such a chaotic time in America’s politics, you’d be hearing more in the news about an important struggle that is still going on quietly, in the background: The future of Medicare.

 What is the problem, exactly?

You may already know that medical costs in general keep rising faster than the overall inflation rate. And even though those rises have slowed down in recent years, it’s still faster than inflation.

So, over time, health care costs continue to take a bigger share of the economy.

Add to that all the Baby Boomers who are getting older, which brings medical problems and a LOT of expense. That will continue for decades, until the Boomers die off.

And what’s going to pay for most of the Boomers’ medical costs? Medicare, of course.

About 45% of all of Medicare’s cost is paid by federal tax dollars approved by Congress. The rest is paid by enrollees’ monthly Medicare premiums, and the Medicare payroll taxes from workers and employers.

So, naturally Congress is concerned about the growth of Medicare expenses eating up a lot of tax dollars. Plus, conservatives want public programs in general to be as small as possible.

The obvious questions are:

How to slow the growth in the cost of Medicare, and how to pay for it?

Here’s where the real debate kicks in. There are different “prescriptions” of how to fix it, and these are based on different ”diagnoses” -- descriptions of what is causing the problem.

Here are the two main competing views, each with a Diagnosis and a Prescription:

View #1: “It’s the patients’ and doctors’ fault”

You don’t often hear this said outright, but what is said frequently is that “too many medical procedures, doctor visits, tests, and treatments are being done. These are unnecessary and add a lot of expense.”

Diagnosis: “Patients are asking for more medical care than they really need; and/or doctors and hospitals are giving more care than is needed, to make more money.”

Prescription: The answer, according to this view, is to force patients to pay -- out of their own pockets -- a much bigger share of their medical expenses.

The main proposals to accomplish this for Medicare are:

(1) Switch it to a voucher (also called “premium support”) system, which will cause people to pay much more themselves for the cost of their care. The amount the government pays into Medicare will be held steady, while medical costs continue to rise. You would use your government voucher to help pay for a health policy, at whatever price the insurance companies charge.

(2) Change the benefits of Medicare, by reducing how much care it covers, and/or to raise the age of when people can get on it.

View #2: “Too much money is wasted on NON-MEDICAL things”

Diagnosis: “The big unnecessary expense is not too many procedures and treatments, but rather, too much money being spent on things which are NOT actual medical care.”

Prescription: A third or more of all heath care money is spent on non-medical items such as inflated bureaucracy, unneeded administrative work, ads, excessively high profits (especially for drug, insurance, and medical equipment companies), and excessively high personal compensation for some people. Much of this is abetted by unnecessary complexity.

The answer according to this view is to simplify, and to remove unnecessary non-medical costs.

The main proposals to do this are:

(1) Remove the insurance company middlemen – especially the Medicare Advantage companies -- who take a large amount of Medicare money for themselves for profits, ads, unneeded bureaucracy, and excess executive pay.

(2) Change to one unified payment system in order to eliminate huge amounts of administrative expense for hospitals and clinics, and keep their prices in check.

(3) Negotiate with drug and medical equipment companies, to get much lower prices for Medicare.

These savings would also allow an improvement to original Medicare, by removing the 20% Part B copay. It would also improve the Medicare drug benefit by removing insurance middlemen and eliminating the dreaded “donut hole.”

The pressure on taxpayer dollars to fund Medicare can also be alleviated by changing the federal tax system so that corporations and billionaires, who have enjoyed huge tax cuts, bear more of the tax burden, like they used to.

Going even further, it would make sense to change the entire health care system for everyone -- whether on Medicare or not -- into one unified, simple and cost-effective system. That is what all other industrial countries concluded, long ago. Their per-person cost is half of ours!

This is what is known as “Medicare for All.” It would not weaken Medicare, but rather strengthen it by removing the unnecessary expense noted above.

So the question for the coming election is: Will the candidates hurt Medicare by cutting benefits, increasing your cost, and further enriching private companies? Or will they strengthen Medicare by removing unneeded, excess costs and profits, to hold down the expense and enable everyone to enjoy an improved and affordable Medicare for all?

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