Which do you Favor and Why: Medicare for All or ACA expansion?

[Pantagruel]

7. Good ideas posted 9/14

McCamy Taylor posted on 9/14
Talking Points for Medicare 4 All from a Public Health Physician

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.


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.