“What if I die?” My question landed on her face.
The USF Diploma on the wall behind her backed up her authority on the topic, so I anticipated a clinical answer, “We all die,” she said and smiled.
Doctors should not tease, but she and I had exchanged joking comments from time to time and her answer did not shock so much as what was to follow. She explained that the day for me was not that day, but she did want to run some tests to be sure we were on the right track. When she had suggested some tests, she explained, “Sonogram of your carotid arteries to be sure that brain of yours is getting enough blood.”
She gave some comfort explaining how the tests are done, and then added, “First step is to be sure your insurance will pay for it.”
“How long may that take?”
“Most times in a couple of weeks, could be a month at the most.”
“A month,” led to that question, “What if I die before the insurance approves my reason to continue to live?”
This story goes on all the time for those ripe enough to be on Medicare. Several problems with the fanciful idea of ‘Medicare for All’ comes to mind.
First, Medicare is not free. We pay every payday all our working lives into that fund that is rightfully our money.
Medicare payroll tax on earned income
The Medicare payroll tax is 2.9%. It applies only to earned income, which is wages you are paid by an employer, plus tips. You’re responsible for 1.45% of the tax, and it’s deducted automatically from your paycheck. Your employer pays the other 1.45%. If you are self-employed, you pay the full 2.9%.
The Additional Medicare Tax
The Additional Medicare Tax was added by the Affordable Care Act in November 2013. The ACA increased Medicare by an additional 0.9 percent, but only for individuals whose incomes are over a certain threshold. Those affected pay a total of 3.8 percent in Medicare tax.
Once we get to the age when we qualify for Medicare Insurance and can begin to use all that money taken from our payday, we continue to pay. The cost for the insurance is deducted from the monthly Social Security check. If you do not have supplemental insurance you are on the hook for twenty percent of the cost of actual care. A recent operation for a shoulder injury requiring a hospital stay racked up over $150,000. That twenty percent means $30,000 out of pocket. Therefore, Medicare is not free.
Next, the doctor you get may not be the one you want. Several years ago we enjoyed a family practitioner that really knew her stuff. We were not alone. She gained the trust of many and decided she no longer needed to work for someone else, a practice that did accept Medicare. She opened her own office and discovered she would have to hire someone to fill out all the paperwork and take on the liability of getting insurance companies to pay. That education so nicely framed in her office had left her with over a half million in college debt, so forget hiring someone to fill out government forms. Instead, like so many doctors, she instituted the DIY system of file your own insurance in the hope to get back some of the $200 appointment fee. With too much out of pocket, we had to find another doctor with a practice that accepts Medicare.
The problems associated with ‘Medicare for All’ includes:
Approval or denial of life saving tests delaying potential treatment.
Doctors in debt that refuse to accept Medicare. With a single payer system this could create a number of doctors that choose not to run their business on discounted prices and high overhead.
In 2018 there were about sixty million people on Medicare. Nearly twenty million were on Medicare Advantage that covers some of the gap or out of pocket costs. What happens if we expand that pool of those insured by ‘Medicare for All’ to include all three hundred twenty some million Americans?
The answer is you will not get health care, but instead you will get an insurance policy. An insurance policy is not health care. This would be as if the government gives everyone in America a car, but no gas.
When you hear anyone who says, ‘Medicare for All,’ the truth is, ‘Who Cares for All’.
Your government will not care if you lose your doctor. The politicians do not care if your life saving tests are delayed or outright denied. No one in Washington, D.C. cares about the trillions in national debt that you will pay for every April 15th for the rest of your life.
Old McDonald’s farm had grown over two centuries to become a formidable cattle enterprise.
Truth be told, he wasn’t that old, just enough years to remember the Beatles being called the British Invasion long before the word invasion offended half the country. W. Robert McDonald, or affectionately referred to as Billy Bob; short for William Robert McDonald was in charge of the five thousand acre ranch tucked between two large breasts of mountains somewhere in the Midwest.
Billy Bob ran the place successfully enough to make his grandfather’s grandfather proud. A big operation like this is huge with multiple buildings and large equipment to harvest hay to feed thousands of cows. Each of these animals takes nearly three years of feed to fatten them up for tasty hamburgers at the other McDonalds under the golden arches.
Life was good. Then, he received a letter from a new government agency serving an eminent domain notice. This gave him concern, so he called and discovered the government did not want some of his vast acreage for a new highway, the notice was for his cattle. They offered what the government called a fair price which was no where near the two thousand dollar going rate for a beef cow.
When Billy Bob asked for an explanation, the young official stated, “All scientists have agreed the emissions of methane from cows are destroying the atmosphere leading us all to extinction in just twelve years.”
“Is that so?” Billy Bob inquired.
“Absolutely. The ozone is disappearing as we speak.”
“What do you plan to do with my stock?”
“They will be set free to live out a peaceful life on the plains. It would be inhuman to just kill them for no reason.”
Billy Bob thought and offered, “Well that is thoughtful of you to consider a better life for our bovine friends. However,” he said and paused.
He whipped out his trusty Excel Spreadsheet.
“Hello, Mr. McDonald?”
“Just a minute,” then he offered “There may be something to consider.”
“You do know a fair number of our stock is slaughtered currently to feed the masses. Out of the ninety four million cows currently grazing just over thirty two million end up slaughtered every year. That keeps the net population just about the same as it has been for years; right around that ninety million mark.”
The young clerk intimidates, “So?”
“You may not know this but a good healthy cow rarely dies of natural causes. Most make it between eighteen and twenty two years of age on their own. Barring any mad cow disease or pack of wolves, they will do just fine. However,” he pauses.
“Left without our consumption, and the fact that the birth rate for cows is around forty three percent, in twelve years just over six point nine billion cows will be grazing the plains right here in the good ole U S A and farting away the ozone you are so concerned about. Again let me be clear, that is billion with a ‘b’ and that’s a lot of cows.”
“Look,” says the clerk, “Do you want the government to pay a fair price or just take them?”
“You make that sound like I have no choice in the matter.”
“That’s one way you can take it.”
“What am I supposed to do?” says W. Robert. “This ranch is all my family has done for several centuries.”
“You are missing the silver lining.”
“What silver lining could that be?”
“Now, with all your free time you can do art, invent something, go to a museum, learn something, take a vegan cooking class, move to Florida, whatever you want. Isn’t that great?”