Medicare or Who Cares for All?

“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.