How to Make Medicare for All Work in Practical Terms

I did a twitter thread awhile back to let people know how to make medicare for all work. There is a way to make universal healthcare work using our current system. One of the barriers to Medicare for All is the fact that health insurance companies (who often also own hospitals and other services) will essentially be out of business or severely reduced in size laying off millions and throwing the medical system into a manufactured crisis the implications of which we probably don’t yet fully understand. There would obviously an implementation period and a full government plan to figure out how to make the switch. Implementation periods range from 4-10 years depending on whose healthcare plan you read. Then there are those who want to keep private insurance. However, I think all of these ideas are good and what I’ve done is tried to combine them together in one unified system. I’ve had some experience with public health as a patience and I’ve gotten to experience a couple different system as an end-user and I used that experience to craft what I think is a viable plan for Medicare for all that solves some problems while providng the universal care that we need.

What to do with Health Insurance Companies?

I propose that the government contract with insurance companies to serve as basic health providers. The health insurance companies often own or are in partnership with hospitals and providers. They can offer supplemental insurance to the basic plan. These plans could include a monthly plan to reduce fee costs (like a membership) or Prescription memberships. This plan does include fees at time of care and we’ll get to those in a moment. There is no way to reform 1/6 of America’s economy without doing something with the large companies that currently control the healthcare conversation. That’s just the fact of the matter. If we can change their business model from health insurance to health providers than this will involve them, save jobs, and give Medicare a chance to work in a familiar way.

What Will It Be Life for Average Americans?

One of the biggest concerns that Americans have with medicare for all is what their next doctor’s appointment will be like. Rather than walking into an office and presenting a health insurance card, Americans can be universally registered using the social security system into one universal healthcare database with access from all health providers through online systems. Providers can look them up and access medical records as well. One of the big projects in healthcare that should have long happened is the integration of all medical records into one central system for a simple unity of care. This is the chance to make that system a reality. Going to a doctor or hospital should be simple, straight forward, and easy.

Tiered Costs

One of the best ways to raise money to pay for this new system and attack the idea that people won’t have “skin the game” is to create a system of tiered, income-based, fee structure for people. These tiers will be income-based on previous years taxes. People can apply to get reduced rates in case of job loss or a change of employment. The process should take place online and be quick and easy. The system would look something like this:

8 tiers

Each income level corresponds to a cost level that the end user would pay.

Income levels:	Doctor, medical device and prescription costs:
0-30,000	0
30,001-45000	1
45,001-55,000	5
55001-62,000	10
62001-74,000	15
74001-85000	20
85001-90000	30
90001+	45

There are some items that would no longer have any cost associated with them:
Ambulances
Medical transportation (the government could even contract with Uber and Lyft for certain medical transportation, eliminating the medicab system)
Medical tests
Hospice
Physical rehabilitation
Addiction rehabilitation

Reforming Care

Getting rid of pain points is important. Under the new system we can add online doctor’s visit and streamlined systems for refills where the refill system is entirely automated without having a patient call a doctor’s office. If a test is needed that should be ordered and done without ever having to talk to a doctor or even go to a particular office.

There are also ways to make the medical system more efficient and help doctors do what they do best: heal. We can reduce the amount of paperwork involved by eliminating billing and coding and we can expand the time doctors can spend with their patients and make sure that everyone sees the specialist that they need and gets the care that they need. We can reduce wait-times by spending money on expanding facilities and offering special loans for those going into the medical field to encourage people to enter and stay in the field. The new system can also be open to helping people through their whole journey and can include some alternative treatments that wouldn’t just give them a pill but actually heal their bodies. Rather than hoping insurance companies will pay for physical rehabilitation or other such services, people could take advantage of those things for as long as they need. We can include chiropractic and massage as apart of the new system so allow people to get and stay well. Regular visits with a nutritionists and other services can allow people to solve problems with their health through food. All of these things are well-known treatments but only to those who can pay for it. Under this system, we can expand this healing to everyone. Keeping people sick is profitable but under this system, profit will not be the goal: people will be.

How to Pay for It

The biggest debate is how to pay for the tremendous expense of Medicare for All. The US spends more for worse outcomes than other developed countries. Much of this money currently flows into the pockets of insurance companies but much of the money is also in inflated medical costs. One of the goals of the plan is to cut out those costs and keep the expense of care no more than 10-25% of the cost (including administration). Americans are used to paying premiums through their employer and then also paying up to their deductible amount which can be thousands of dollars. In the current system, the average person might pay $50-$100 a month in premiums and then $2,000-$5,000 a year in deductible. That means the average person is currently paying $600-$1,200 in premiums plus the deductible so most people are paying $2,600-$6,200 in out of pocket costs per year just to access healthcare. This doesn’t even count prescriptions or co-pays at time of service. Co-pays can be as much as $40 and prescription costs can vary by drug but can range up to thousands of dollars. This means someone can be spending almost $10,000 a year on healthcare costs.

My plan is simple:
6% payroll tax for employers (per employee, all work types greater than 50)
2% payroll tax for employers (per employee, all work types, less than 50)
6% paycheck tax (per pay period)
Example: Mark makes $600 a week (pre-tax) at his construction job. His tax share for healthcare would be $36 (plus his other taxes). His yearly spending on healthcare from taxes would be $432. Mark makes about $28,000 a year so under the tiered fee structure his visits, medical devices, and services would be free to him. The average American would pay $68.12 per week in healthcare expenses. This would add up to $5-$10 Billion per year in taxes for healthcare. Keep in mind, this on the math of averages, considering that make more would pay more, the revenue could be far higher. This would be matched by the employer tax which would match the revenue from the employee’s checks. This would generate annual revenue of $10-$25 Billion.

The other way to pay for this would be to eliminate Medicaid (currently block grants to the states), veterans healthcare, and state plans and use those funds to fund the national system.

Also funding this system would the revenue from the tiered fee structure. If every American saw a doctor at least once and had to take at least one prescription at an average fee price of $10 each, that alone would raise 7.1 billion in fees alone. Taken together, the number could be far higher.

In addition to the above revenue streams new general fund revenue can be achieved through raising top end corporate income tax rates to 70% and by taxing overseas holdings that are on the books of a corporation and all their subsidiaries and assigns. Corporate deductions can also be reduced to make that any business over $1 million in revenue in a single year is paying the proper taxes to the federal government. To keep up enforcement, the IRS should empowered to perform audits on all corporations over $50 million in revenue every 5 years. For individuals, anyone who is taking in more than $5 million in any single year should be subject to audit once every 5 years and no more than twice in any 10 year period unless fraud has been found.

Doctor’s Don’t Work for Free

One of the complaints is that doctors, nurses, CNAs and others don’t work for free. Under this system, they won’t. Instead, they will be paid on the government pay schedule and all the health provider companies will abide by that pay schedule. Doctors, nurses, and others within the medical field will be well compensated for their time. Doctors and others can be promoted with experience and increase in education and ascend the pay scale as needed.

Standards for Medical Providers

It is important to make sure that the new medical provider companies provide all the care needed to people. It is also important that these companies operate efficiently and don’t unnecessarily cost the taxpayer.

The new medical provider companies must offer:
Dental
Vision
Primary care
Preventative care
Appointments within 90 days

It is also important to enforce minimum facility requirements throughout the nation. No one should be farther than 25 miles to a medical facility and can easily get to that medical facility by ambulance, if in an emergency, by their own transportation, or by a medicab service (see above). Everyone will be able to go to any office and be able to seek out medical care without unnecessary referrals and in urban and poor areas, unifying as much of this care under one roof would be crucial to the success of the new healthcare system.

Rebuilding American Healthcare

Medicare for all is an opportunity to give people the chance to improve their health. Healthy people will be more productive and more prosperous. This means that they will often make more money. We can eliminate the sad system of people begging for medical bills online through GoFundMe and we can eliminate the shameful system of causing people to go bankrupt because they had the unfortunate experience of being sick. This is also our chance to reduce inefficiencies, improve care, and get people what they need quickly and easily. Imagine a country where people have decent care for all parts of their health and where they can afford to take all their medication and are able to begin living life and not having to live in fear of medical bills or staying in a bad job because the healthcare is good. The potential businesses that aren’t being started because of this could hide the next great innovation or the next local employer. America can and should do better and hopefully this plan has given everyone some ideas on how we can re-make American healthcare to serve people, not profits.