The record number of candidates seeking to be the Democrat to go up against Republican Donald Trump in the 2020 election all have one thing in common: because they believe that health care is a right, they want to see universal health care in America — they just vary on how to get there.
The Democratic candidates’ plans range from the elimination of private insurance and the imposition of a single-payer, national-government health-care program to some form of “Medicare for All” to “Medicare at 50,” which would allow Americans to buy into Medicare early, to an undefined universal health-care system.
Although an increasing number of progressives are embracing the label “democratic socialist,” the Democratic presidential candidates have thus far avoided calling their plans for universal health care what they really are: socialized medicine.
Even so, Republicans want to make the socialism of Democrats an issue in the 2020 election. Senate Majority Leader Mitch McConnell (R-Ky.) has even told reporters that the path to Republican success in the 2020 election is “running to be the firewall that saves the country from socialism.”
There is just one problem with this: we already have socialized medicine in America.
Medicaid is government-funded health care for eligible low-income adults, children, pregnant women, elderly adults, and people with certain disabilities. It is the primary source of health-insurance coverage for low-income populations and nursing-home long-term care. More than 65.7 million Americans are enrolled in Medicaid. Medicaid is jointly financed by the federal and state governments, but designed and administered by state governments within federal guidelines. States can charge limited premiums or cost-sharing for Medicaid, subject to federal parameters, but the guidelines generally prohibit such charges for beneficiaries with an income below 150 percent of the federal poverty level. Certain groups (eligible children, pregnant women, eligible disabled people, people institutionalized, and people receiving hospice care) and certain services (emergency services, preventive services for children, pregnancy-related services, and family-planning services) are also exempt from cost-sharing.
The Children’s Health Insurance Program (CHIP) is a partnership between federal and state governments that provides health insurance to children in families with incomes too high to qualify for Medicaid. CHIP is jointly financed by the federal and state governments, but designed and administered by state governments within federal guidelines. More than 9.6 million children are enrolled in CHIP. States can charge limited enrollment fees, premiums, deductibles, co-insurance, and co-payments for those enrolled in CHIP, but cost-sharing is prohibited for some services, such as well-baby and well-child visits. States with Medicaid expansion programs must follow the Medicaid cost-sharing rules. In other states, premiums cannot exceed the amount permitted in the Medicaid program.
Medicare is government-funded health care for Americans 65 years old and older and for those under 65 who are permanently disabled. Medicare actually consists of four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plan), and Part D (prescription-drug plan). Part A is funded by a payroll tax “contribution” of 2.9 percent (split between employer and employee) on every dollar of an employee’s income. There is also an additional 0.9 percent tax on earnings above a threshold of $200,000 ($250,000 for married couples). Participation in Parts B, C, and D is voluntary. They are funded by a combination of income-based beneficiary premiums and taxpayer subsidies. Enrollment in Medicare is open to all U.S. citizens or those who have been permanent legal residents for five continuous years and who have paid Medicare taxes for a minimum of 40 quarters (ten years). Eligibility does not depend on income or health status. More than 58 million Americans are enrolled in Medicare at an annual cost of more than $700 billion.
And then there are the government insurance exchanges that help millions of Americans purchase health insurance that is subsidized by the federal government.
Those are all forms of socialized medicine wherein some Americans are forced to pay for the health care of other Americans.
But that’s not all.
There is a serious health condition that most Americans probably don’t realize is covered by Medicare even if one is under 65: permanent kidney failure or end-stage renal disease (ESRD). According to the Medicare Rights Center, for those with ESRD, Medicare covers kidney transplants, hospital inpatient dialysis, outpatient dialysis from a Medicare-certified hospital or free-standing dialysis facility, home dialysis training from a dialysis facility, home dialysis equipment and supplies, medications related to treatment, and immunosuppressant drugs after a kidney transplant. Medicare covers most services associated with ESRD treatment with standard Original Medicare cost-sharing. Moreover, beneficiaries receive coverage for all the usual services and items covered by Medicare.
And now Donald Trump wants to expand the ESRD Medicare program. He recently signed an executive order “directing the Department of Health and Human Services to develop policies addressing three goals: reducing the number of patients developing kidney failure, reducing how many Americans get dialysis treatment at dialysis centers and making more kidneys available for transplant.” “With today’s action, we’re making crucial progress on another core national priority: the fight against kidney disease,” said Trump at a speech prior to signing the order.
There are currently close to 100,000 people on a waiting list for a kidney transplant. “Many, many people are dying while they wait,” said Trump to a room full of kidney doctors, advocates, and patients in Washington, D.C., just before signing his executive order. “We’ll do everything we can to increase the supply … of the available kidneys and getting Americans off these waitlists.”
This is the same Donald Trump who, in his State of the Union Address earlier this year, warned of the dangers of socialism: “Here, in the United States, we are alarmed by new calls to adopt socialism in our country. America was founded on liberty and independence — not government coercion, domination, and control. We are born free, and we will stay free. Tonight, we renew our resolve that America will never be a socialist country.”
We already have socialized medicine in America. And we can thank Republicans — those archenemies of socialism — for it. Republicans failed to repeal Obamacare. Republicans created the CHIP program. Republicans failed to eliminate — or even make minuscule cuts — to Medicaid and Medicare when they had absolute control of Congress and the White House for more than four years under George W. Bush and for the first two years of Trump’s presidency. And Republicans greatly expanded Medicare with their Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
Thanks, Republicans. Thanks for helping Democrats to introduce and maintain socialized medicine in America.