As someone who has spent most of his career in healthcare policy and/or health corporations, I support the recently introduced Senate Bill 4204- the Medicare for All Act of 2022. One of the key aspects of the bill is that it prohibits the federal government from reimbursing provider marketing costs, worrying about provider net profitability or being influenced by political contributions. This money will be spent on patient care.
It's time for the USA to seriously consider single payer health insurance, which provides for freedom of choice. Citizens can go to any physician or facility. Under 4204, all residents of the US will be automatically enrolled in Medicare at birth and able to obtain healthcare services as an entitlement... rather than a privilege as it is now for those under 65. Further, all US healthcare providers in good standing will be able to participate in Medicare for All as outlined in the bill.
Specifically, the following services will be covered: hospital services, including inpatient and outpatient hospital care, pediatrics, emergency services and drugs; Ambulatory patient services; Primary and preventive services; Prescription drugs and medical devices; Mental health and substance use treatment services; Laboratory and diagnostic services; Comprehensive reproductive, maternity, and newborn care; Oral health, audiology, and vision services; Rehabilitative and habilitative services ; and Home and community-based long-term services.
Key to understanding this legislation is the fact that there is no expense sharing. A resident of America is fully covered without deductibles, coinsurance, and copayments.
Under this Act, single payer will be affordable. In fact, affordability is the concept behind establishing a broad-based annual “National Health Budget.” As outlined in the bill, it will primarily consist of an operating budget, a capital expenditures budget, and a special projects budget.
This global budget is the basis for lump sum payments to institutional providers including hospitals, skilled nursing facilities, and independent dialysis facilities, adjusted quarterly based on past and projected service volume, actual provider expenditures/operating expense, wages, accessibility and other considerations.
Non-institutional providers will be compensated via a fee-for-service arrangement based on the expertise of these providers and the value of items and services furnished by them. This fee schedule will be updated annually. Such providers can be in single or group practices (not salaried, working for an institution), and providers of home- and community-based services. To improve upon the current maze of electronic records systems, DHS will establish a uniform national system for electronic billing for provider payments.
The prices paid by DHHS for covered pharmaceutical products, medical supplies, and medically necessary assistive equipment will be established annually. And a formulary will be established to ensure best practices in prescribing, discouraging the use of ineffective, or excessively costly medications and emphasizing generics.
We are the strongest and most affluent democracy in the world. Yet, studies have shown that the healthcare status of US citizens is far below that of other democracies. In fact, even after the ACA, 12% of Americans under 65 still have no insurance.
But the figure is much greater for Georgia, which has the third highest rate of uninsured in the nation, 16% for the non-elderly. That’s nearly 1.4 million Georgians without coverage and millions more with inadequate private policies leaving them underinsured.
Georgians fortunate enough to have good insurance tend to like their doctors, nurses, clinics and hospitals. However, few will say they “like” their commercial insurance plan... especially after they have become sick and have high deductibles and co-pays for providers and pharmaceuticals.
Senate Bill 4204, the Medicare for All Act of 2022, is sponsored by Senators from Rhode Island to Hawaii. Georgians elected to the US House, including Reps Nikema Williams and Hank Johnson, are established co-sponsors of HR 1976, a similar Medicare for All bill. I believe the majority of Georgians are ready to support single payer and hope both of our Senators will join them.
Jack Bernard was formerly SVP of a national healthcare corporation and the first Director of Health Planning for GA. He was Chairman of the Jasper County GA GOP. He's now Vice Chairman of a Board of Health in Fayette County, a suburb of Atlanta.