Medicare For All Who Lose their Employer-provided Insurance
George Bohmfalk, MD
As a result of the coronavirus pandemic, millions of U.S. workers who were satisfied with and didn’t want to give up their employer-provided health insurance are losing both their jobs and the associated insurance. While most public option plans have glaring deficiencies, this crisis may be the perfect moment for a new public option plan, Medicare For All Who Lose their Employer-provided Insurance.
The principal defect in previous public option plans is that they pit private insurance companies against a government-sponsored plan. Private insurers claim that they cannot compete against the government and that this would lead to their demise and Medicare for All. A more likely scenario is that private insurers would use every trick in their playbook to game the system and nudge older and sicker enrollees onto the public plan, raising its costs and premiums to unaffordability, predictably dooming the plan to fail.
Now, however, insurers are out of the game for the newly unemployed. They anticipate raising premiums next year in the neighborhood of 40% to make up for this year’s losses. How many employers will be able to pay that, when insurance premiums have already become unaffordable for so many?
These millions of laid off workers and their families desperately need insurance, for both Covid-19 related illness and unrelated health issues. Hospitals and physicians cannot care for them for free. Since state budgets are extremely limited, Medicaid cannot handle this new burden. Only the federal government has the resources to provide coverage quickly to millions of newly uninsured.
Fortunately, the infrastructure is already in place: Medicare is up and running, with over fifty years of efficient experience. All workers who lose their employer-provided health insurance should immediately be enrolled in a new public option plan, Medicare For All Who Lose their Employer-provided Insurance. We could call it Part E, for Employees.
This new program would not be Medicare as we know it. It would be the improved Medicare that everyone ultimately should have. There would be no deductibles, copays, or 20% coverage gaps, because people suddenly without jobs simply do not have money to pay them. Prescription drugs should be covered for the same reason, as healthcare without medication is not healthcare. All physicians and hospitals that participate in Medicare now would be included, so that desperate people who just lost their jobs would not also have to navigate confusing and restrictive provider networks. The rollout would be incremental, as more and more lose their jobs and insurance over the next several months. It would not overwhelm the system, nor would it be disruptive. On the other hand, doing nothing for these American workers would severely overwhelm and further disrupt them.
How would we pay for it? How will we pay for the multi-trillion-dollar relief and stimulus packages already passed? How do we pay for endless wars? The answer is in federal borrowing, at zero interest rate, the cheapest money ever available for such a necessary and beneficial investment in the country. Once people are back at work, they’ll pay for this through payroll taxes that will be less than before. The math really does work.
A more pressing question is, how will we otherwise pay for unavoidable healthcare required by millions of newly uninsured? We can squabble, overwhelm each state’s Medicaid and other limited funding sources, bankrupt and close many hospitals, and provide inadequate care. Or we can do something logical, through another essential relief bill providing Medicare to everyone that is uninsured, which will cost the nation less than doing nothing. We can easily pay for this. We must pay for this.
Millions of our fellow Americans are suddenly without jobs through no fault of their own. They need and deserve the relief and protection of healthcare insurance. As the first to experience improved Medicare for All, they can demonstrate its many merits and efficiencies. These desperate millions can enlighten the rest of the country to the superiority and dependability of a government-sponsored insurance program over an unreliable job-based one. They can pave the way to Medicare for All.
Dr. Bohmfalk, a retired neurosurgeon, chairs the Education Committee of Health Care Justice North Carolina, the Charlotte chapter of Physicians for a National Health Program.