A gift that keeps giv­ing Low­ell Grisham

Medi­care cov­er­age should start at birth, not 65

Northwest Arkansas Democrat-Gazette - - EDITORIAL PAGE - Low­ell Grisham is an Epis­co­pal priest who lives in Fayet­teville. Email him at Low­ell@stpauls­fay.org.

Ihad a birth­day last week. It was a big one. This was the year when I got the best birth­day card ever, my Medi­care Health In­sur­ance card.

As an Amer­i­can, it seems to me ac­cess to health care should be a hu­man right. On the Fourth of July, our na­tion’s birth­day, we cel­e­brate our founders’ com­mit­ment to “life, lib­erty, and the pur­suit of hap­pi­ness” en­shrined in our bold Dec­la­ra­tion of In­de­pen­dence. We un­der­write our mil­i­tary, po­lice and fire­fight­ers to help pro­tect our life. We pro­vide free pub­lic ed­u­ca­tion to en­hance the pur­suit of hap­pi­ness. Shouldn’t all peo­ple have ac­cess to med­i­cal care to pro­tect their lives and safe­guard their po­ten­tial for lib­erty and for the pur­suit of hap­pi­ness?

As a Chris­tian, it seems to me that ac­cess to health care should be a hu­man right. Je­sus spent most of his pub­lic min­istry work­ing as a healer. He of­fered the same gifts of heal­ing to for­eign­ers and Gen­tiles as he gave to his own peo­ple. Heal­ing was at the cen­ter of Je­sus’ pri­or­i­ties and ac­tiv­ity.

It is a won­der­ful thing for Amer­i­cans when we reach age 65. We have in­sur­ance cov­er­age for the rest of our life — the most ex­pen­sive part of our med­i­cal lives for most peo­ple. Nearly ev­ery­body I’ve talked to who is older than I am is pleased with Medi­care cov­er­age.

From time to time in my pas­toral role, I’ve had to act as an ad­vo­cate for parish­ioners need­ing health care that was be­ing de­nied by their in­sur­ance car­rier. I’ve also begged for ser­vices on be­half of peo­ple who had no in­sur­ance. But I can’t re­mem­ber an in­ci­dent when I needed to go to bat for some­one be­cause Medi­care was not treat­ing them fairly. It seems like an ex­cel­lent health in­sur­ance pro­gram to me. I will stake the rest of my life’s health on it.

I won­der: Wouldn’t our cur­rent health care ker­fuf­fle be bet­ter solved and more ef­fi­ciently ad­dressed by putting ev­ery­one on Medi­care?

Medi­care is far more ef­fi­cient than pri­vate in­sur­ance. The non­par­ti­san Kaiser Fam­ily Foun­da­tion cal­cu­lates Medi­care’s ad­min­is­tra­tive costs at 2 per­cent, in­clud­ing the costs for col­lec­tion of taxes and in­ves­ti­ga­tion of fraud and abuse. In­sur­ance in­dus­tries’ ad­min­is­tra­tive costs are harder to doc­u­ment be­cause they are not al­ways trans­par­ent, but es­ti­mates that I have seen place costs at 11 per­cent to 14 per­cent, and one in­dus­try de­fender says they are 17 per­cent. Some com­pa­nies’ ad­min­is­tra­tive costs are much higher.

There is no ques­tion Medi­care gets more health care for the dol­lar than pri­vate in­sur­ance can. It makes sense. Medi­care doesn’t have to spend like pri­vate firms for mar­ket­ing, sales and ad­ver­tis­ing; for com­pli­cated billing and re­view pro­cesses, or for prof­its and stock­hold­ers.

Medi­care also ap­pears to be able to con­trol med­i­cal costs bet­ter than pri­vate in­sur­ance. The non­par­ti­san Cen­ter for Medi­care and Med­i­caid Ser­vices tracked a 10-year re­view of per capita spend­ing for com­mon ben­e­fits. Medi­care costs rose 4.3 per­cent while pri­vate in­sur­ance cost rose 6.5 per­cent. One of the rea­sons Oba­macare costs have in­creased is that Medi­care Ad­van­tage is ad­min­is­tered by pri­vate com­pa­nies whose costs con­tinue to go up. The Con­gres­sional Bud­get Of­fice pre­dicts pri­vate in­sur­ance will con­tinue to rise con­sid­er­ably faster than Medi­care for the fore­see­able fu­ture. Medi­care is in a stronger po­si­tion than pri­vate in­sur­ance com­pa­nies to ne­go­ti­ate prices for med­i­cal ser­vices.

These data track in­ter­na­tional norms as well. Most de­vel­oped coun­tries have uni­ver­sal cov­er­age with low or no de­ductibles. They spend far less per capita than we do and have far bet­ter health re­sults than we do. Among the wealthy na­tions, we are first in costs and last in out­comes.

So, at a time when Congress is de­bat­ing a very poor bill that cuts med­i­cal ser­vices to the poor and vul­ner­a­ble while giv­ing tax breaks to the wealthy, couldn’t we just ex­tend the med­i­cal pro­gram that we know works well and ef­fi­ciently? In­stead of wait­ing un­til age 65, let’s of­fer Medi­care from birth. It’s the right thing to do.

For the past 30 years wealth in­equal­ity and in­come in­equal­ity has ex­panded dra­mat­i­cally. The econ­omy has not been kind to the lower 80 per­cent. Eco­nomic pol­icy, au­to­ma­tion and tax pol­icy have tilted the eco­nomic ta­bles so that more wealth is in fewer and fewer hands, in­creas­ingly con­cen­trated among the wealth­i­est 1 per­cent and es­pe­cially the 0.1 per­cent. A more pro­gres­sive tax pol­icy could un­der­write a more ef­fi­cient uni­ver­sal Medi­care sys­tem and bring new en­ergy, pros­per­ity and pro­duc­tiv­ity to the whole na­tion.

Life, lib­erty and the pur­suit of hap­pi­ness is the right of ev­ery per­son. It starts with health.

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