MODIFIED RAPTURE?!

In Gilbert & Sullivan's MIKADO, seen above in Jonathan Miller's famous version, Nanki-Poo (in the striped jacket) says to Yum Yum, "At last we are alone! I have sought you night and day for three weeks in the belief that your guardian was beheaded, and I find that you are to be married to him this afternoon!"

"Alas, yes!" replies the demure Yum Yum.

"But you do not love him?"

"Alas, no!"

"Modified rapture!" cries Nanki-Poo.

I wonder if that is what I am expected to cry now that I've learned that three congressman -- including Antonio Delgado -- the one from my own CD19 -- have re-introduced something called Medicare X. Delgado touted it as "a practical, robust way to achieve universal health care" in America. This is the "public option ,,,,available to all Americans" he campaigned on.  

Unlike Medicare for All, which would replace most of private insurance with a single payer (the government)  this plan would allow those who like their employer-sponsored insurance to keep it,  and it would give anyone of any age the option of buying into a Medicare-like plan which would use the doctors and hospitals currently accepting medicare, but would be funded not by the current Medicare Trust fund but by premiums being paid by those choosing it, with the aid of  government subsidies -- at least for the first 3 years -- and the aid of tax rebates to anyone whose premiums for health insurance exceed 13% of their total income. Coverage would be expanded to include obstetrics and pediatrics. It would first be rolled out in rural areas in which there is only one ACA provider or none at all, and it would be available to everyone by 2024.

Tim Kaine, a co-sponsor of the Senate version of the bill. extols what he says is the practicality of the proposal, the fact that “we preserve everything about the existing system. And we just put one additional element into it,”  But this micro-incremental approach did not go over well with a major nurses' union:

 A Major Nurses Union Calls Medicare X Plan 'Sub-Par and Wholly Inadequate to Address the Healthcare Crisis'

As far as the nurses union was concerned, this plan was merely a "Band-Aid" that does little to correct the huge systemic sickness in the current, profit-driven system, "which has left 30 million Americans uninsured and over 80 million more underinsured" and which,  "according to a Gallup report, forced Americans to borrow $88 billion to cover their healthcare expenses in 2018."

I just finished watching a recent video of Delgado explaining the proposal to Emily Burkhard on WNYT.  
                                          Delgado interviewed on WNYT
I was struck  by his passion -- which is to his credit. But when he said that the proposal would provide a "baseline" of care which would be less expensive, my ears pricked up. The suggestion I heard was that the more expensive private insurance might provide more than the baseline -- but you had to pay for it. I was also struck by the care he took to distance this proposal -- and himself -- from Ms Burkhard's asking if Medicare X would lead to single-payer. "What it will lead to," he said, "is universal health care."  I wondered if he was attempting to side step any suggestion of Medicare X being a slippery slope to socialized medicine.  

He kept saying that we needed "some form" of universal health care. All this left me wondering if the "some form" he was envisioning was two-tiered: There'd be the upper tier -- the premium tier -- for those who could afford it, and Medicare X -- the lower tier -- which would provide a "baseline."  What a contrast to the New York Health Act, the motto of which is "Everybody in, nobody out." 

Medicare X would divide the population of the country into two pools: One would be able-bodied and employed by companies who offer insurance, and the other -- by and large -- older and less healthy. My guess is that the Medicare X pool -- despite Delgado's grandiose projections -- would not, by itself, be able to afford what it cost to keep them healthy, and that the government would have to subsidize those expenses, causing the Medical/Industrial Establishment to fight even more fiercely against their competition -- not by lowering prices (heaven forbid!) but through their deep pockets, to buy enough legislators to crush it outright.  

Even if  not, my guess is that in order to make the Medicare X program self sustaining, premium prices would have to be raised to a point where there would be some unable to afford them. It would be Medicare for some. Yet Delgado optimistically projected a future in which so many people would flood into  Medicare X, that the Medicare doctors would be glad to treat them despite their somewhat lower rate of  pay. My own less rosy hunch is that the network of doctors willing to see Medicare X patients would shrink, and patients in this lower tier would have to put up with spending less time with their doctors, who all too often would turn out to  be second rate. 

And meanwhile our fragmented system would go on wasting billions, a substantial share of which would be the obscene profits made by reducing access to care, or denying it altogether.

I read somewhere that Medicare X is a lot like Medicare for America -- and, for sure, it does share some of the problems cited above. But at least it had a provision that every new-born would be enrolled into it, thus enabling its promoters to claim that it was a path to single-payer.  But Medicare preserves the status-quo: a two-tiered system where the upper tier gets better treatment -- and what the lower tier gets is...better than nothing.

Now that Medicare X has been re-introduced, should I cry, "rapture"? Hardly.

How about "modified rapture"?  Less than that, I fear.

Much less.

Dio

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PPS: We know that there are plenty out there who have stories to tell -- stories of your trying to cope with our dysfunctional healthcare system. Trouble is, we don't know what these stories are! That's where you come in. If you have a story to tell, you can email me at indivisible12401@gmail.com. You can be as anonymous as you like. Thanks!