Expanded and Improved Medicare for All: Beware of Greeks Bearing Broccoli.

AuthorSingleton, Marilyn M.
Position[GUEST ARTICLE]

During the Supreme Court oral arguments in the challenge to the Affordable Care Act's mandate to purchase health insurance, people laughed when the late Justice Scalia asked whether the government could make you buy broccoli. Never happen? The laughable has become reality. A California bill awaiting the governor's signature forbids restaurants from serving any beverage other than water or unflavored milk with kiddie meals. As of yet, the meal's purchasers, unlike the restaurant, won't be fined for ordering another beverage for their child.

Shrugging off assertions that the ACA was about control, not care, President Obama quipped that his opponents acted like the ACA "was a Bolshevik plot." That supposedly ludicrous plot is embodied in a too-good-to-be-true congressional bill, H.R. 676, the "Expanded & Improved Medicare For All". Vote-seeking congresspersons have breathed new life into this 2003 creation. With no dollar amounts in Sight, the bill gives the government a blank check to exert total control over our medical care.

H.R. 676 provides that all individuals residing in the United States showing up at the doctor's office are "presumed to be eligible" for benefits. The federal government will pay for unlimited "medically necessary" health expenses, including pharmaceuticals, mental health, substance abuse, vision, dental, hearing, and long-term care--with no deductibles or other cost-sharing. Unless a patient opts out, all interactions will be memorialized in a "standardized, confidential electronic patient record system." Yes, those same electronic records that have been hacked and are contributing to physician burnout.

Overseen by regional offices and the Presidentially appointed IS-member National Board of Universal Quality and Access, participating institutions will receive separate monthly fixed sums for capital expenses (e.g., buildings, improvements) and for operating expenses (including physician salaries). Nonsalaried physicians can be paid based on a national fee schedule that is "fair and optimal" as decided by the government. Finally, each geographic region would receive a single allotment to cover longterm care.

There are some restrictions. Only public or not-for profit institutions may participate. Private physicians and clinics can exist but cannot be investor-owned. And to keep the patients on the reservation, private health insurers are prohibited from selling health insurance coverage that duplicates the government...

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