Talking Points for Medicare 4 All from a Public Health Physician

[McCamy Taylor]

Hi. You may or may not remember that in addition to being a primary care physician working in a not for profit publicly funded health care system (not saying which one), I also have a Master's Public Health. So, here are some talking points to help sell Medicare 4 All.

Talking Points for the General Public:

1. Number one--it will save money in the long run. How? Because once Americans have cradle to grave coverage with the same insurer, that insurer (Medicare) will have a tremendous financial incentive to invest in disease prevention. Current Medicare, which only covers you once you are old and sick, gains nothing by investing in disease prevention. Medicare is too busy scrambling like crazy to pay for the consequences of decades of health neglect to take time to invest in disease prevention. And your private insurance, which only covers you until you are old/sick (and get on Medicare), also gains nothing from disease prevention.

2. All this investment in disease prevention to save money down the road (and we are not talking next century here, we are talking in the next two to three decades) will also make Americans healthier. And healthier means less pain, more happiness, longer lives, better quality of life.

Right now the only "cradle to grave" single payer in this country is the VHA--the Veterans Health Administration. And it is not really cradle to grave. It is honorable discharge to grave. But that is close enough for the purposes of this essay. Because the VA promises to take care of veterans health forever, it invests in disease prevention. The VA studied aspirin's effects in preventing heart attack. No Big Pharm would have done that--aspirin is a cheap generic. The VA developed the shingles vaccine. It developed the new injectable alternative to statins for those who can not take statins. It supplies diabetic socks because it would rather prevent the diabetic foot ulcer than amputate your foot. It pays for vitamins and nutritional supplements, because it would rather keep you well nourished than try to put you back together once malnutrition wrecks your health. When the VA comes up with a cheap and easy way to prevent disease( and suffering), the VA reaps a direct economic benefit which allows it to stay solvent.

Ever wonder why West Europeans/Canadians pay half per year of what we do in this country for health care and yet are so much healthier? It is because their cradle to grave single payer health plans have an economic incentive to invest pennies in disease prevention now to avoid paying gazillions of dollars down the line to treat horrible disease like heart failure and cancer.

Ever wonder why the VA is under attack? Because the VA model, even more than Medicare is the winning health care model. The one that gives the greatest benefits for the least cost. But Big Pharm all over the world makes a killing in the US. The manufacturers of durable medical goods including artificial joints all over the world make a killing in the US. Hospitals make a killing in the US. Literally. They are killing us with preventable disease so they can make money.

This is the same reason that the UK's National Health is under attack. These are the world's two biggest single payer __to grave plans. Don't be fooled by Twitter trolls. People in the UK love their guaranteed health care. Veterans love their guaranteed health care. Why? If a veteran is told that he has heart disease and needs surgery or cancer and needs chemotherapy, the first words out of his mouth are not "Will I have to put a second mortgage on my house to pay for this?" For the veteran, sickness does not equal bankruptcy and poverty.

So, when talking M4A, remember these two key points 1) It will keep you healthier and 2) After an initial start up investment, it will save this country about 1-2 trillion dollars a year once it is up and running. (Based upon current annual US health care spending) And this is not even factoring in increase worker productivity.

Talking Points for Targeted Audiences:

For 20 somethings who think that they are immortal and invincible, selling disease prevention is not easy. However, there is actually an easy way to get their attention. Point out how overweight and unhealthy their parents and grandparents are. Ask them "Do you want to end up like them? Wouldn't you rather be better than your parents and grandparents?" (Young people always want to believe that they can change the world for the better) Sell the 20 somethings on better health.

For seniors who love their Medicare to death and who are afraid that if they have to share it with younger folks there will not be enough Medicare left over for them remind them that this will keep Medicare solvent. Everyone will pay (small compared to traditional insurance) premiums. People coming into the system will be healthier and stay healthier. More people in the system means that the system will be self sustaining. Old folks ought to be worried as hell that if something is not done now to increase Medicare enrollment, eventually Medicare will be so crowded with high utilizers that it will collapse. Sell the seniors on Medicare solvency.

For middle aged people who have fairly decent private insurance through their jobs or that they purchase for themselves, remind them that their out of pocket on Medicare will be lower than even the most platinum plated private insurance. Including the monthly premiums, the average Medicare patients pays around $7000 a year out of pocket (not counting medications that is a whole other issue). (For comparison, I have platinum plated federal health insurance and for two folks it averages to around $8000 per year per person out of pocket.) M4A means every American will have out of pocket that is actually less than Congressional Insurance! Yippee!

For middle aged people who do not have insurance, M4A sells itself. They are putting off their hysterectomy or mammogram or heart surgery because they cannot afford these things. They lost their jobs because they were too sick to work and now they run a cash register at 7-11 and are praying they live long enough to get Medicare.

[True Blue American]

1. Thanks for that!

Medicare Advantage Insurance Companies are now doing the Wellness thing.

Silver Sneakers, Visits to your home, computer sites.

But Medicare has a 3% over head and younger people need that too.

They also should pay Physicians College costs. That would give us more Doctors.

There is so much to be done that is fair to all. Doctors are forming groups with Nurse Practitioners.

I had to find a new Doctor couple of years ago, a Receptionist gave mea Care Finders card. Couple of phone calls I had a young Doctor.

Old Hospitals are closing, combining in one stop services in modern, condensed building.

[McCamy Taylor]

2. Two More Talking Points

1. In states that took the Medicaid expansion, small towns were able to open new clinics and hospitals (compare rural Colorado and New Mexico to rural Texas). Medicare 4A would have an even greater effect on small towns. And once there are doctors and hospitals then companies and jobs could relocate to small towns. So M4A is great for rural America!

2. M4A will mean more emphasis on disease prevention meaning a greater demand for primary care physicians. We can either continue to import them from other countries where the cost of going to medical school does not put you half a million dollars in debt. Or, we can do medical school debt forgiveness for docs who go into primary care. Primary care is much more fun than specialty care. But many medical students give up their dream of being an all around doctor (think Marcus Welby) because it would take them too long to pay back their loans on what a pediatrician or family doctor makes. So M4A means more primary care doctors. Meaning it will no longer be easier to find an orthopedist to replace your knee (next day) versus a primary care doctor to treat your diabetes (never in some areas where primary care is no longer accepting new diabetic patients)<--- this is an absolutely true story. As a nation we ought to be scared that it is easier to get a new knee than to get your blood sugar under control.

[questionseverything]

14. as it is now, private insurance companies charge big bucks for young healthy peops

and as they age and need care pass the costs on to the govt wether it is thru Medicaid,medicare, bankruptcy or just lost productivity

[McCamy Taylor]

15. Exactly! The government is expected to pick up the tab for sick people and allow pvt insurance

to cherry pick the healthy ones to collect premiums from. The federal government spends about a dollar for every dollar that is spent out of private funds on health care.

[crazytown]

3. It's what young people want.

The do not want to be keeping track of their/their parents' private health insurance while transition from home to college, jobs and locations, in and out of gigs etc. Young people swap jobs frequently. Private health insurance is an unwelcome complication.

[McCamy Taylor]

4. Great point!

For 20 something You can take whatever job you want without worrying about the health insurance.

[crazytown]

8. "without worrying about the health insurance"

Exactly - want to commit to a 6 month IT contract, or put some money aside by driving Uber ... done. Getting and keeping a good secure job, and with good health insurance to go with it, was the way the world worked, but it is not the ways things looks now.

[Uncle Joe]

5. Kicked and recommended.

Thanks for the thread McCamy Taylor.

[Kitchari]

6. K&R. n/t

[EveHammond13]

7. K&R

[Garrett78]

9. As I wrote in another thread, short-term investment for long-term gain is an almost impossible sell.

Neither the media nor the average voter tends to grasp or appreciate the fact that an initial large investment in health care (or drug rehabilitation or public education or alternative energy) would save lives and trillions of dollars more in the long run.

In a nation this populous and diverse where so many have been brainwashed for so long, to say we're fighting an uphill battle is an understatement.

I think we can one day do away with for-profit health care, but it'll happen in stages. The next stage should involve a public option.

[LiberalLovinLug]

10. What is also overlooked is the mass pschologically healing effect this will have on the nation

Maybe Marianne Williamson should address this.

But in all sincerity, simply having EVERYONE covered, from cradle to grave, no matter your employment status, moving to another job, how costly an operation is etc...can affect a lot of ills in society that stem from the stress of things like fretting about if something will be covered. or staying at a bad abusive job just for the medical benefits, living with pain because you don't think you can afford going to a doctor.

In Canada here, one thing that stands out to me reading American's terminology on the topic is that we do not even use the word "insurance" here. Certainly never the term "pre-existing conditions". Medical care is simply accepted as a right. When we get sick, we go to our GP, who then determines if we need specialists care etc...

I have enough to worry about in this fast life, I can't imagine what its like for ones medical care to be so draconian, and in the whims of private insurers whos goal it is is to deny you. And the access to medical services and doctors so separate from my everyday natural human experience, and human right.

[CaliforniaPeggy]

11. A big, fat K&R!

Excellent points and very well and clearly stated!

Thank you.

[mvd]

12. Big K&R

Sanders and Warren can use your points for arguments in the next debate.

[ChubbyStar]

13. Wonderful post!

Many thanks.

[Gothmog]

16. Speaker Pelosi-There's no need to reinvent health care -- just improve Obamacare

I agree with Speaker Pelosi https://www.cnbc.com/2019/09/17/nancy-pelosi-no-need-to-reinvent-health-care-improve-obamacare.html?__source=sharebar|twitter&par=sharebar

Democrats should focus on making improvements to Obamacare instead of trying to reinvent the wheel with “Medicare for All,” House Speaker Nancy Pelosi said Tuesday.

“God bless” 2020 Democratic presidential candidates putting forth Medicare for All proposals, Pelosi said in an interview with “Mad Money” host Jim Cramer. “But know what that entails.”

Pelosi’s thoughts on how to improve the nation’s health-care laws appear to align with those of former Vice President Joe Biden, who in his 2020 presidential bid is calling for building on provisions of Obamacare, formally known as the Affordable Care Act.

“I believe the path to ‘health care for all’ is a path following the lead of the Affordable Care Act,” Pelosi told Cramer. “Let’s use our energy to have health care for all Americans, and that involves over 150 million families that have it through the private sector.”

[Claritie Pixie]

17. This is wonderful, thank you!

You've managed to explain why MFA is better in concrete terms.

[Gothmog]

18. Societal savings are not tax revenues and cannot be used to pay for this plan

Such a plan in theory may generate societal savings but such savings would not pay for a program. Governments can only spend tax revenues and/or borrowings. This study does not say how one would pay for such a program in the real world. I note that Prof. Krugman like the concepts of such a plan in theory but notes that taxes will have to be raised a great deal to pay for such a plan
Back in 2016, here is his position Prof. Krugman compares Sanders hoped for health care savings to the GOP tax cuts. http://krugman.blogs.nytimes.com/2016/01/19/weakened-at-bernies/?_r=0

On health care: leave on one side the virtual impossibility of achieving single-payer. Beyond the politics, the Sanders “plan” isn’t just lacking in detail; as Ezra Klein notes, it both promises more comprehensive coverage than Medicare or for that matter single-payer systems in other countries, and assumes huge cost savings that are at best unlikely given that kind of generosity. This lets Sanders claim that he could make it work with much lower middle-class taxes than would probably be needed in practice.

To be harsh but accurate: the Sanders health plan looks a little bit like a standard Republican tax-cut plan, which relies on fantasies about huge supply-side effects to make the numbers supposedly add up. Only a little bit: after all, this is a plan seeking to provide health care, not lavish windfalls on the rich — and single-payer really does save money, whereas there’s no evidence that tax cuts deliver growth. Still, it’s not the kind of brave truth-telling the Sanders campaign pitch might have led you to expect.

Today, Prof. Krugman says that such a plan is feasible if you are willing to pay a great deal more in taxes
https://www.alternet.org/news-amp-politics/paul-krugman-explains-why-single-payer-health-care-entirely-achievable-us-and-how

If we went to government provision of all insurance, we’d pay more in taxes but less in premiums, and the overall burden of health spending would probably fall, because single-payer systems tend to be cheaper than market-based."

The amount of higher taxes are not quantified in this article by Krugman. To pay for any such plan will require massive tax hikes

Again sanders has utterly failed in his attempts to get Vermont to adopt his magical single payer plan because the state of Vermont cannot use hypothetical societal saving to pay for this plan. Even Krugman admits that much higher taxes are needed