CRASHING THE SYSTEM.

• Author: Held, Kristin S.
• Position: MEDICINE & HEALTH - Expanded and Improved Medicare for All Act - Law overview

FEW AMERICANS realize that a Medicare For All bill already exists--H.R. 676. The Expanded and Improved Medicare For All Act was introduced Jan. 24, 2017, by Rep. John Conyers, Jr. (D.-Mich.). Rep. Keith Ellison (D.-Minn.) assumed sponsorship when Conyers resigned after 52 years in Congress, amidst multiple allegations of sexual harassment.

What follows is a dissection of H.R. 676:

To begin, who is eligible to be registered in Medicare For All?

The bill states: Section 101. Eligibility and Registration, (a) In General--All individuals residing in the United States (including any territory of the United States) are covered under the Medicare For All Program entitling them to a universal, best quality standard of care. Each such individual shall receive a card with a unique number in the mail. An individual's Social Security number shall not be used for purposes of registration under this section.

Notice, the bill covers residents, not just citizens. The Secretary of Health and Human Services is given the power to define what constitutes residency. Clearly, the political ideology of the party in the White House will impact this definition. Do you become a resident when your caravan crosses the bridge at the U.S. border, or will there be something more to show, like a water or electricity bill?

Moreover, given the government's record on privacy breaches, what new possibilities for identity theft and other abuses would be unleashed by the issuing of a card "with a unique number in the mail"?

What entitlements will Medicare For All provide? As seen in the text that follows, theoretically, everyone will be entitled to everything. Again, the presiding political philosophy will play a huge role in determining what care will be provided and for which patients. (Remember ObamaCare architect Ezekiel Emanuel's Complete Lives System of rationing by age and return on society's investment.)

Provision of such procedures as abortion and euthanasia may be prohibited, allowed, or even required, and will depend on the political ideology du jour of the White House, Congress, and Supreme Court.

Section 102. Benefits and Portability.

(a) In General--The health care benefits under this Act cover all medically necessary services, including at least the following:

(1) Primary care and prevention.

(2) Approved dietary and nutritional therapies.

(3) Inpatient care.

(4) Outpatient care.

(5) Emergency care.

(6) Prescription drugs.

(7) Durable medical equipment.

(8) Long-term care.

(9) Palliative care.

(10) Mental health services.

11) The full scope of dental services, including periodontics, oral surgery, and endodontics, but not including cosmetic dentistry.

(12) Substance abuse treatment services.

(13) Chiropractic services, not including electrical stimulation.

(14) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).

(15) Hearing services, including coverage of hearing aids.

(16) Podiatric care.

Who will provide all the care? The definition of "legally qualified" is unspecified and remains of concern. The government regulatory strings attached to legal qualification and licensure could be long, expensive, coercive, and destructive to physician and patient autonomy.

(b) Portability--Such benefits are available through any licensed health care clinician anywhere in the United States that is legally qualified to provide the benefits.

What will each beneficiary pay? Reportedly nothing at the time of service; there is no specific mention of premiums in the 18 pages of the bill. Currently, Medicare beneficiaries pay premiums, which are means tested. I suspect means-tested premiums eventually will become part of this as additional layers of compounded redistribution will be added in response to the reality that this Utopian scheme must be paid...