To Get Affordable Health Care, We Must Accept Compromise

By JOHN M. IMPERIALE | Mar 27, 2019

Turning 40 years old can be distressing, if I can remember that long ago. Fifty is also a milestone few people long for, and 60 can be downright traumatic. But 65? For most Americans, that is a welcome age as they become eligible for Medicare.

The healthcare system in this country is an unmitigated disaster – for everyone under 65 years of age, that is.

Medicare, however, for all of its faults, provides the overwhelming majority of senior citizens with (reasonably) affordable health care. Older recipients and those with significant prescription drug needs often find the system cumbersome and expensive. It is not a perfect system. It is, though, the system that took this country from over 9 million uninsured older Americans to approximately 4 percent of that number today.

Understand, Medicare is not free government health insurance. From the day a person begins working, payroll taxes go toward eventually being covered by Medicare. And once on Social Security, Medicare premiums come right out of a recipient’s benefits. Additionally, most people also buy supplemental insurance. There is no disputing that those covered by Medicare have paid for that coverage, and paid significantly for many years. Still, it is the best deal in America, a country where far too many citizens do not have proper health insurance.

So why not have the “Medicare For All” that many liberals and healthcare advocates are pushing? The answer is simple: because it will not happen, not for a very long time. The “How do you pay for it?” question could be answered by examining the costs of our current private insurance system, but that would be irrelevant. There is not the political will to fight the medical lobbyists.

This is the case, in spite of the fact that today’s Medicare expenditures are 20 percent of the nation’s healthcare costs, meaning that 80 percent of the nation’s healthcare costs go to cover the youngest and healthiest people in the country, those in the privately covered sector. That is a totally illogical system. “Medicare For All” might be economically feasible, but politically it is untenable so long as healthcare lobbyists keep politicians in power.

The president, though, called for universal health care. President Roosevelt, that is. President Theodore Roosevelt. Most presidents since Teddy have done the same. So, for over 110 years, the notion that government-backed health care should be available to all citizens has been a constant in the American dialogue. Medicare was enacted in 1965, roughly halfway between Teddy Roosevelt and today. It was part of Lyndon Johnson’s Great Society, and former President Harry Truman, who tried hard and failed to pass it, became Medicare’s first recipient.

Progress toward improving the program has been painstakingly slow ever since. The only significant advances were adding the disabled in 1972 and outpatient prescription drug benefits in 2003. At this pace, going all the way to universal health coverage will take another 60 years or so.

The current system is choking our economy and bankrupting families. Universal health care will not pass in our lifetime. Compromise is the only sensible solution. It is time for another intermediate step – time for a compromise.

A bill currently before Congress, sponsored by Senators Tammy Baldwin and Debbie Stabenow and Representatives Brian Higgins and Joe Courtney, would allow individuals over 50 to buy into Medicare. Note I said “buy into Medicare,” not “get Medicare.” They would have to pay higher premiums than those over 65, plus get supplemental insurance if they want. There would be nothing mandatory about the program. It would be another option for a vulnerable group of Americans.

The proposed legislation would certainly lower healthcare costs for everyone in the nation. Just consider what it would do to the two main risk-pool classes: those with Medicare and those without. Those without Medicare, i.e. younger consumers, would have the oldest of their population (people 50 to 65) removed from their risk pool. Similarly, the totality of Medicare recipients would be increased by having younger people, with fewer medical needs and costs, added to their ranks.

It is a balancing of risks that makes perfect sense.

Obamacare, like it or not, was an important first step in fixing this country’s healthcare system. For all its benefits and all of its faults, it had one major achievement: It brought to the American mindset the notion that the government can and should do something to fix a broken system. Sen. Stabenow noted that since Obamacare a majority of Americans now view health care as a basic right. Affordability for this “right” has simply not been achieved.

So do we do nothing or seek to do everything and, as a result, accomplish nothing?

Republicans have become defined by their total opposition to government-supported healthcare plans. Any progress is labeled “socialism.” Any attempt to rein in costs is castigated as government interference in the free-market system. They ignore the basic truth that, when it comes to health care, the current free-market system has not worked.

Democrats run the risk of becoming defined by the unrealistic “free health care for all” left wing of their party. Eliminating private insurers completely is not popular, not realistic and not sound policy. But instead of seeking incremental improvements to Medicare and Obamacare, they push for the all or nothing approach that leads only to nowhere.

And the country is left with the crippling system we have. Only compromise will work.

Only compromise has ever worked in America, starting with the compromises inherent in our Constitution.

The senators and representatives who sponsored the “buy in at 50” legislation and their cosponsors are trying to find that sweet middle ground where progress actually happens. Their bill needs to be seriously debated, modified as necessary, and ultimately molded into something that will work and will be able to pass into law.

That will require legislators to do their job. For that to happen, we, the people, must do our job: writing, calling, emailing, speaking out.

President Johnson, in urging the passage of Medicaid, said it was necessary because “by God, you just can’t treat Grandma this way.”

Now it is time to look at our healthcare system and say, “By God, you just can’t treat Americans this way.”

John M. Imperiale of Harvey Cedars can be reached at



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