Red flags to watch for when you consider proposed Medicare for all ideas

Ask people if they want health coverage that requires no payments when health care services are provided and you get a resounding yes.

Ask if they would like a choice in plans; again yes.

Ask if there should be no limits on enrollment or switching coverage; yup

Ask if they want to add coverage for dental and vision and hearing services; you betcha

Ask if they think this can be paid for by reducing administrative costs, cutting provider fees, negotiating drug prices and eliminating the insurance profit motive; plus taxing only someone else; of course

The Center for American Progress has yet another plan for universal coverage They call it Medicare Extra. It’s more modest then M4A, it makes more sense, but in essence it is a public option and it is deeply flawed.

I’ve underlined some of those flaws below. The other major flaw relates to additional taxes on so-called higher income Americans who already pay higher taxes for Medicare. There is no mention of premiums or average individual taxes and the assumption that lowering fees paid to Medicare providers will have no adverse consequences is naive.

The most poorly understood element of this is that today’s Medicare’s supposed administrative efficiency is a positive. That is not the case, in fact it is the source of massive fraud and the provision of unnecessary health care. In addition, you cannot apply Medicare administrative process geared toward an older population to the entire population.

To address these challenges, the Center for American Progress proposes a new system—“Medicare Extra for All.” Medicare Extra would include important enhancements to the current Medicare program: an out-of-pocket limit, coverage of dental care and hearing aids, and integrated drug benefits. Medicare Extra would be available to all Americans, regardless of income, health status, age, or insurance status.

Employers would have the option to sponsor Medicare Extra and employees would have the option to choose Medicare Extra over their employer coverage. Medicare Extra would strengthen, streamline, and integrate Medicaid coverage with guaranteed quality into a national program.

The cost of coverage would be offset significantly by reducing health care costs. The payment rates for medical providers would reference current Medicare rates—and importantly, employer plans would be able to take advantage of these savings. Medicare Extra would negotiate prescription drug prices by giving preference to drugs whose prices reflect value and innovation. Medicare Extra would also implement long overdue reforms to the payment and delivery system and take advantage of Medicare’s administrative efficiencies. In this report, CAP also outlines a package of tax revenue options to finance the remaining cost.

Medicare Extra for All would guarantee universal coverage and eliminate underinsurance. It would guarantee that all Americans can enroll in the same high-quality plan, modeled after the highly popular Medicare program. At the same time, it would preserve employer-based coverage as an option for millions of Americans who are satisfied with their coverage.

Paying for it all

Medicare Extra would be financed in part by taxes on high-income individuals. One option would be a surtax on adjusted gross income—including capital gains—on very high-income individuals. CAP’s modeling will determine the exact parameters of the surtax, including the rate. In addition, under current law, large accumulations of wealth are never subject to capital gains taxes if held until death and transferred to heirs. One option would be to eliminate this stepped-up basis so that large accumulations of wealth cannot avoid capital gains tax.

Medicare Extra would also be financed in part by increasing health care taxes and curtailing health care tax breaks. For high-earners—singles with income above $200,000 and couples with income above $250,000—the additional Medicare payroll tax and the Medicare net investment income tax (NIIT) could be increased. In addition, all business income of high-income taxpayers—including S corporation shareholders, limited partners, and members of limited liability companies—could be subject to the Medicare tax either through self-employment taxes or the NIIT. The tax benefit from the exclusion for employer-sponsored insurance would be capped at 28 percent. In addition, lower premiums for employer-sponsored insurance would significantly reduce this tax expenditure. Medicare Extra would also obviate the need for tax benefits for flexible spending accounts and health savings accounts.

Lastly, Medicare Extra would be financed in part through public health excise taxes. The federal excise tax on cigarettes would be increased by 50 cents per pack and adjusted for inflation. A tax could also be imposed on sugared drinks equal to 1 cent per ounce. These taxes would reduce health care spending, helping to offset the cost of Medicare Extra. 

One comment

  1. One of the things that I find funny is that Medicare Extra would be paid for in part by a 50 cent cigarette tax. One of the few things that Obamacare got right was almost free or free medication to quit smoking which would save in the long term because of reduced smoking related diseases. For the cities that have the soda sugar tax, consumption has dropped from 40 to 64% (depending on the study and the city tax rate). If you get people to quit smoking and raise the tax, how much more money will they collect from cigarettes? Another example is road repairs that depending on a gas tax that electric cars don’t pay. In the end, they will have to tax your income as it is the only constant source of revenue.

    You know that this will be for real when the federal government makes marijuana legal so they can tax weed cigarettes because they need the money. Of course, later we will find out of new marijuana smoking related diseases that will cost the healthcare system.


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