Eyes Wide Shut.

• Author: Singleton, Marilyn M.
• Position: HEALTH BEAT - Medicare for All

A KEY FEATURE of the Medicare-for-All bills is the elimination of private health insurance that duplicates benefits offered by the government. Given the coercive nature of the existing Medicare program, we should be quite concerned. Medicare Part A (hospital insurance) is mandatory for those eligible for Medicare who receive Social Security payments. If beneficiaries want to opt out of Part A, they must forfeit all of their Social Security payments--including paying back any Social Security benefits received up to the time Part A was declined. So, a "beneficiary" is punished for saving Federal dollars by declining to be on the government health-care dole.

Enrollment in Medicare Part B (all physician and most outpatient services) is not mandatory, but beneficiaries financially are coerced to enroll. The standard 2019 Part B premium amount is $135.50 per month, progressing to $460.50 based on income. However, if a beneficiary does not sign up for Part B when first eligible, that individual must pay a lifelong penalty of 10% for each full 12-month period that he or she could have had Part B. So, if the beneficiary waited three years before signing up, he or she would pay a 30% higher premium throughout his or her lifetime.

Medicare Part D (prescription drugs) also imposes penalties on those who do not sign up when eligible unless they are in a Medicare Part C/Medicare Advantage HMO that covers drugs. The lifetime penalty is not trivial: one percent per month of the average monthly premium (currently about $33) for all the months a person was not signed up. Will we somehow be punished if we do not want to enroll in the new government program? Will there be an "individual mandate" penalty?

Another troubling aspect of a new government health program is the lack of an articulated budget or cost controls. According to the Medicare Board of Trustees 2018 Report, Medicare's Part A trust fund will be depleted in 2026, three years earlier than the 2017 projection. Our 2017 health-care costs were 3.5 trillion dollars with 1.2 trillion attributed to Medicare, Medicaid, and the Children's Health Insurance Program (CHIP). Apparently, financing would depend on monies earmarked for existing Federal health programs, heavily taxing "the rich," and an unspecified increase in everyone's taxes.

In addition to notoriously underestimated cost projections, Medicare underpayments to hospitals must be addressed. Hospitals receive 88 cents on the dollar from Medicare...