The Path Toward Medicare for All (2024)

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Photo by Jose Quezada

Mad River Community Hospital

Recently Mad River Community Hospital faced the prospect of selling out to a corporate group from Texas. Is Mad River Hospital now an endangered species like so many of our rural hospitals? Recently, Blue Shield and Providence (the conglomerate owner of St. Joseph's Hospital) struggled with a contract dispute that could have banished many people from the Providence system. In Humboldt County, it's nearly impossible to find even primary care while affordable dentistry and specialty care are even more daunting. The dispute was finally settled — for now — with no guarantees for the future.

Some 100 million in the U.S. struggle with medical debt, totaling $140 billion, according to a New York Times report, a crippling financial burden and the greatest cause of bankruptcy in our nation. Not to mention inability to access health care that causes the loss of life and health of millions of residents. What can be done to repair our disintegrating healthcare system?

Sixty years ago President Lyndon Johnson ushered in the revered and necessary program of Medicare. Conservative forces almost immediately compromised that program by demanding a "skin-in-the-game" 20-percent co-pay on Medicare's Part B, a move that set the scene for increased weakening of Medicare as a safety net for elders and the disabled.

The "Balanced Budget Act of 1997" created "Medicare + Choice," a forerunner of Medicare Advantage (MA), an assault on traditional Medicare that consummated a 30-year project of the ultra-conservative Heritage Foundation. As Dr. Robyn Stone, assistant director of health and human services under President Clinton, observed, Medicare Advantage was the "beginning of the end of entitlements for the Medicare Program."

The flaws of MA are legion and now well-publicized. Despite offering programs with little or no premiums and sweetened by promises of tasty perks like "help" (marginal and often not widely available) with dental and vision bills plus other pseudo-enticements in the form of gym membership and even groceries, MA enrollees feel initially satisfied. As long as they stay relatively healthy, those perks and low premiums are almost impossible to pass up, especially for poorer folks. But later on, prior authorization requirements produce delays and denials of care, while need for specialized care puts people out of network with unknown and often perilous cost. Returning to traditional Medicare becomes nearly impossible.

The Center for Medicare and Medicaid Services (CMS) keeps warning that "Medicare is going broke." Here's why: the largely unchecked MA runaway train is also a big player in feeding at the public trough, as it gulps down billions of dollars every year from overpayments gouged out of the Medicare Trust fund by making its enrollees look sicker than they are and keeping funds intended for medical treatment as profits. An October 2023 exhaustive study from Physicians for a National Health Program (PNHP.org), "Our Payments, Their Profits," shows overpayments to MA programs from $88 to $140 billion per year.

What then is to be done? MA, for example, now enrolls a majority of seniors eligible for Medicare. MA's tentacles reach deeply into the financial and social structure of the nation. As such, it is unlikely any mechanism exists where it can be decreed, "Medicare Advantage now is outlawed."

We can, however, talk about a concept of "leveling the playing field." Where would that start? Forget trying to eliminate the programs that put huge profit over patients. Instead, why not claw back the illegally gained funds to level the playing field between traditional Medicare and MA?

If we recouped those lost billions of dollars and gave them instead to traditional Medicare to offer (but fully paid for) the same benefits as MA — dental, vision, hearing, long-term care and eliminate Part B's 20-percent premiums, who would then choose a Medicare Advantage program of narrow networks, pre-authorizations, delays and denials of care and squandering of tax dollars? Traditional Medicare would become a top, one-stop choice for all seniors while the MA blood supply would shrivel. And then, finally, we could begin to expand real, improved Medicare to everyone from cradle to grave, a program that would save some 40,000 lives and $350 billion per year for individuals, families, businesses and government agencies.

It all depends on political will that is not turned by financial quid pro quo. Our goal is to elect representatives who will hear us, and they will if we speak loudly enough — as the late Everett Dirksen once observed, "When I feel the heat I see the light!" It's time to call, email, write, heat them up and insist on passage in the House of Representatives of HR 3421 (Jayapal), the Health Care for All Bill.

FYI: To find an estimate of what a universal, single-payer healthcare program would cost you, personally, check out this calculator developed by PNHP and compare it to your current cost of premiums, co-pays and out-of-pocket fees:

healthyca.org/medicare-for-all-savings-calculator. And consider joining us working for this healthcare goal: [emailprotected]. Meeting every fourth Wednesday of the month At 5 p.m. at The Sanctuary in Arcata.

Patty Harvey (she/her) is the co-chair of the Humboldt County chapters of Healthcare for All and Physicians for a National Health Program. She lives in Willow Creek.