Market Mad House

In individuals, insanity is rare; but in groups, parties, nations and epochs, it is the rule. Friedrich Nietzsche


How Medicare for All Might Work

Since 60% of Americans; including President Donald J. Trump, think national single-payer healthcare or Medicare for All is a good idea, we need to ask how such a system might work.

Here are my suggestions for a United States Single payer health insurance system:

  1. Use the existing infrastructure of the Centers for Medicare and Medicaid as the basis for the system. Since most pharmacies and medical clinics already accept Medicare, simply expand that system. The Medicare brand is also well known and widely respected.


  1. Allow all citizens and legal residents of the United States to register for and participate in Medicare, regardless of age or income.

  1. Restore freedom to the American people and businesses by repealing the Obamacare insurance requirement and the employer mandate. This means nobody would be coerced into buying health insurance, and no employer would be forced to provide health insurance.


  1. Give all Americans the choice of whether to participate in Medicare; go without insurance, or buy private health insurance.


  1. Abolish all government health insurance programs except Medicare. That means get rid of Medicaid, the health insurance program for federal employees, S-chip for poor children, the Indian Health Service, Veteran’s Administration benefits (VA hospitals and clinics would remain to provide specialized services to veterans), etc. This would save vast amounts of money by eliminating bureaucracy.

  1. Open enrollment would be abolished. Americans would be able to sign up for Medicare at any time online or via phone; by a system like that GEICO uses for car insurance registrations. All a person would need to do to sign up is to provide a Social Security number and some other information. Blockchain technology can be used to keep it secure. Persons would also be able to sign up when they file their income tax returns.


  1. The uninsured would be dealt with in this way. If a person received healthcare; and did not pay, the provider would send the bill to Medicare. Medicare would then contact the individual and offer the choice of either signing up or paying the bill. If the bill was not paid; it would be added to the person’s income tax or deducted from their income tax return.


  1. To reach the uninsured; healthcare providers, nonprofit organizations, charities, local governments, insurance, tax preparers and others would be paid $50 or $100 every time they signed somebody up for Medicare.

  1. Medicare would be required to pay all claims that meet the legal criteria within five business days.


  1. Sampling and artificial intelligence would be used to detect fraud. Suspected fraudulent claims would be turned over to the Medicare Fraud Detection Division of the FBI for investigation. No claim would be delayed or denied simply because a bureaucrat suspected fraud.


  1. The Centers for Medicare would have the ability to expel healthcare providers from the system for violation of its rules.


  1. The Centers for Medicare would set the reimbursement prices for all healthcare procedures.

  1. Nursing home, assisted living, and hospice services would be covered by Medicare.


  1. All non-cosmetic dental procedures would be covered by Medicare.


  1. The Centers for Medicare would have the ability to negotiate drug and medical device prices with manufacturers, retailers and wholesalers.


  1. To pay for Medicare there will be a 5% national income tax on all Americans that make more than $20,000 a year and a 5% corporate income tax. This will be augmented by a 1% national sales tax on tobacco, marijuana, alcoholic beverages, deserts, smoking paraphernalia, candy, soft drinks, ice cream, pastries, cookies, manufactured snacks, fast food, retail sales of syrups and sugars and sugary breakfast cereals.


  1. Individual Medicare participants that make less than $20,000 a year will pay no premium.

  1. Children under 18 will pay no Medicare premium.


  1. Honorably discharged veterans will be able to participate in Medicare without paying a premium.


  1. All other Medicare participants will pay the following premiums: persons that make more than $20,000 a year will pay a $20 a month premium. The premium will increase by $10 a month for every $10,000 in taxable income an individual makes over $20,000. That means a person who made $100,000 a year would pay a $100 premium.


  1. Medicare eligibility will be assessed by individual taxable income. That means a person that does not work will be eligible for Medicare regardless of his or spouse’s salary.


  1. Mental health services and drug treatment will be covered by Medicare.

  1. All copays on services, treatments, devices and prescriptions funded by Medicare will be set by the Centers for Medicare.


  1. The Centers for Medicare will establish a National Center for Healthcare Technology will fund research into information technology, artificial intelligence, information security, payment technology and communications for the improvement of healthcare.


  1. The Obamacare health insurance marketplaces and tax credits shall be abolished.


  1. All services provided through the state Medicaid and similar programs will be administered by the Centers for Medicare through Medicare.

  1. Every Medicare participant will carry a Medicare card similar to a credit card with a chip that will provide access to all healthcare records. Those records will be kept in a central data base and shall be encrypted by blockchain technology. Healthcare providers would be able to access records via the internet and blockchain encryption.


  1. The Centers for Medicare will develop and administer a Medicare app similar to Apple Pay that will function as an alternative to the Medicare card.


  1. Basic eyeglasses would be paid for through Medicare.


These are just a few suggestions but the United States currently has the technology to create the world’s most advanced single-payer healthcare system if it wants. Were it properly administered such a system would be far cheaper, more efficient, more effective and more humane than the mess we now call a “health insurance system.”