Medicare/Medicaid Advocacy

“MEDICAID FOR ALL” MAKES FAR MORE SENSE THAN “MEDICARE FOR ALL”
By
Dave Kingsley, PhD

Transforming Medicare into a universal, single-payer program for all Americans makes no sense. It does make sense to end Medicaid as welfare-medicine and expand the program’s benefits to all U.S. residents.

Medicare is a program with a complex structure that has become increasingly financialized and enmeshed with corporations and professions comprising the medical-industrial complex.

[1] Historically, Medicaid has been lower-tier, stigmatized medical care for the poor with a rather simple structure. It is not complicated by a payroll tax funded Trust Fund and other components involving oligopolistic corporations, and trade associations with immense lobbying power.

Unfortunately, Medicare has become increasingly financialized (along with the U.S. economy in general) and thereby privatized. Monetization of elderly health care risk has resulted in a stream of premium revenue into United Health, Humana, and other third parties.

Beneficiaries pay for nearly 60% of all Medicare costs through payroll taxes, premiums, and out-of-pocket costs - only 42% of expenditures are transferred from general revenue (i.e. income tax from the U.S. Treasury).

This symbiosis between 60 million Medicare beneficiaries and the medical-industrial complex presents an asymmetrical power relationship between advocates for Medicare for All and a juggernaut comprised of major medical corporations, trade associations, and politicians.

It is difficult to see a path to Medicare for All that does not result in financial enslavement of U.S citizens. Perhaps, at some time in the far distant future the proponents could achieve a goal of unbelievable proportions by integrating all U.S. residents fairly into a program designed as a social insurance program funded by the beneficiaries themselves.

It is particularly interesting to me that the Democratic Socialists of America are vying to win a struggle in which the achievement would be a privatized, financialized program – not a socialistic, publicly-funded program in the public interest without an excess of the funding finding its way into Wall Street.

Medicaid is medicine for “the medically needy,”[2] which means that Americans who qualify for it must prove they are among the deserving poor, e.g., they are a parent of a child and have a very low income.

Conversely, they cannot be among the “undeserving poor,” e.g. an abled-body adult without children – that is, unless they live in a state that has expanded Medicaid benefits to very low income non-disabled adults without children.

The idea of a special category for poor people in government-funded medical care was the brain child of Southern Democrats Robert Kerr and Wilbur Mills in their attempt to head off Medicare, which they believed would eventually be expanded to cover all Americans and not just the elderly.

A few years later, Medicare passed but Mills was able to force President Johnson to include Medicaid as a maneuver to keep as much power at the states as possible and undermine future expansion of Medicare to the rest of the population.

Government funded medical care for some but not for all is immoral. It is a violation of human rights; it is not befitting of the wealthiest and most technologically advanced, industrial country; and it is not medically ethical (with the exception of Physicians for a National Health Plan or PNHP, the medical profession doesn’t seem to care much).

It is time to eliminate the “medically needy” category and move all responsibility for medical care to the federal government (“states-rights,” Southern Democrats insured, through their design of Medicaid, that states could humiliate and stigmatize citizens seeking medical assistance).

Medicaid beneficiaries are poor. They cannot purchase costly health insurance on some market concocted by lobbyists and legislators. Hence, monetization of poor peoples’ health risk and privatization of Medicaid hasn’t proceeded like it has with the Medicare program. The program is not weighed down by a payroll tax, trust fund, and complicated premium structure with large out-of-pocket expenses. Let’s expand it to everyone!

[1] During the half-century history of Medicare, it has fulfilled its mission of providing workers “earned” medical care in their old age. Employees pay 2.9% of their hourly wages or salary into the Part A Trust Fund (hospitalization benefits). Upon reaching age 65, beneficiaries can opt to buy physician services (Part B) and a drug benefit (Part D). The premium for Part B is deducted from Social Security benefits. A beneficiary can opt to buy Part C through a private insurer, which covers Parts A, B, & D. The door was opened to privatization from the beginning in 1965 but has been boosted throughout the program’s history through various legislative enactments. However the floodgates were opened in 2003 by the Medicare Modernization Act, which created Medicare Advantage.