Expanded and Improved Medicare for All: Beware of Greeks Bearing Broccoli

medicare repeal kickbackDuring the Supreme Court oral arguments in the challenge to the Affordable Care Act’s mandate to purchase health insurance, people laughed when the late Justice Scalia asked whether the government could make you buy broccoli. Never happen? The laughable has become reality. A California bill awaiting the governor’s signature forbids restaurants from serving any beverage other than water or unflavored milk with kiddie meals. As of yet, the meal’s purchasers, unlike the restaurant, won’t be fined for ordering another beverage for their child.

Shrugging off assertions that the ACA was about control, not care, President Obama quipped that his opponents acted like the ACA “was a Bolshevik plot.” That supposedly ludicrous plot is embodied in a too-good-to-be-true congressional bill, H.R. 676, the “Expanded & Improved Medicare For All”. With no dollar amounts in sight, the bill gives the government a blank check to exert total control over our medical care.

H.R. 676 provides that all individuals residing in the United States showing up at the doctor’s office are “presumed to be eligible” for benefits. The federal government will pay for unlimited “medically necessary” health expenses, including pharmaceuticals, mental health, substance abuse, vision, dental, hearing, and long-term care — with no deductibles or other cost-sharing. Unless a patient opts out, all interactions will be memorialized in a “standardized, confidential electronic patient record system.” Yes, those same electronic records that have been hacked and are contributing to physician burnout.

Overseen by regional offices and the Presidentially appointed 15-member National Board of Universal Quality and Access, participating institutions will receive separate monthly fixed sums for capital expenses (e.g., buildings, improvements) and for operating expenses (including physician salaries). Non-salaried physicians can be paid based on a national fee schedule that is “fair and optimal” as decided by the government. Finally, each geographic region would receive a single allotment to cover long-term care.

There are some restrictions. Only public or not-for profit institutions may participate. Private physicians and clinics can exist but cannot be investor-owned. And to keep the patients on the reservation, private health insurers are prohibited from selling health insurance coverage that duplicates the government-sponsored benefits.

Ever magnanimous, the government will pay for “reasonable financial losses” resulting from the conversion from for-profit to nonprofit status through the sale of U.S. Treasury bonds, assuming we choose to buy them. Additionally, the government will compensate insurance and other relevant clerical, administrative, and billing personnel up to $200,000 per person for losing their jobs.

Patients would have “free choice of participating physicians and other clinicians, hospitals, and inpatient care facilities.” But under the business restrictions and capped payments, the better institutions and clinicians may choose not to participate, thus decreasing access.

There is a big bad wolf in this fairy tale. In 2016, the feds spent more than $1.2 trillion on Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). Total national health expenditures by all government levels and private entities were $3.3 trillion.

H.R. 676 provides funding from appropriations for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP); an unspecified increase on personal income taxes on the top 5 percent of income earners; a “modest and progressive” excise tax on payroll and self-employment income; a “modest” tax on unearned income, and a “small” tax on stock and bond transactions.

Fast forward to 2026, when the government predicts that the Medicare Hospital Insurance Trust fund will be depleted and total national health expenditures will be $5.7 trillion. The federal government collected about $100 billion in Medicare premiums and a total of $3.32 trillion in taxes last year. Given the projected costs, no cost-sharing, and the $2.4 trillion shortfall, the bill’s “modest” tax increases will soon be obscene.

Not only will the benefits decrease as the money runs out, patients will see real world consequences of total control. For example, Oregon’s Medicaid program wants to limit coverage for opiates for some chronic pain conditions and taper off patients who have been taking opioids long-term — even if they have no signs of addiction. Long-term care will be an easy target; the ACA’s long-term care program was scuttled due to cost concerns. With current nursing home costs averaging $7,500 per month, inevitably when the monthly allotment is depleted, hospice care becomes the medically necessary treatment.

Tell the sponsors of H.R. 676 that it’s your money, your health, your privacy, your life. The government is neither our parent nor our benefactor. The government is not the middleman you want between you and your doctor. At a time when the movement toward innovative and personalized care is moving forward, care via government control is taking us backwards.

Please click below to tell the sponsors of H.R. 676 that it’s your money, your health, your privacy, your life.

Click Here

Dr. Singleton is a board-certified anesthesiologist. She is also a Board-of-Directors member and President-elect of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School.  Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law.  She interned at the National Health Law Project and practiced insurance and health law.  She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers.

Reprinted with permission from - Association of American Physicians and Surgeons - by Marilyn M. Singleton, MD, JD

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Michael Proctor
4 years ago

Seems like Pelosi’s vote for it now, then we will find whats in it. IMHO

Paul B
4 years ago

If you really want to produce a useful medical plan, require the politicans to use what you and I have access to. Eliminate their special medical benefits they put in place for themselves.

Donald F Rhamy
4 years ago

Indeed, your “click here” button left no discernible avenue of response – favorable or unfavorable. I DO NOT favor the proposal.

4 years ago

In 2009, when Obamacare was being conjured, I remarked to some of my friends and colleagues that the law would enable the feds to tell you what you can eat for breakfast. Most of them thought that was far-fetched, it could never happen. Although I said it tongue-in-cheek, the point that I had to explain to the naysayers was that this was an issue of CONTROL. Control is what socialists crave the most, and O’care is just another step in that direction….where John Conyers and Keith Ellison (democrats) are hoping to deal the fatal blow–levy several new taxes, and demand that all funds be “transferred” from Medicare, Medicaid, and CHIP.

I’ve grown weary of the plea “repeal and replace”. “Repeal” for sure, and let the private marketplace deal with the repercussions by keeping the industry in a competitive profit-driven market. “Replace”, for most, means to build a structure parallel to the government program—yet another losing proposition. The only way toward a sustainable health care delivery model is to divorce it, to the greatest extent possible, from interference or input from the federal government.

4 years ago

This is insane. The opiate debate is the same as gun control. Addicts make meth out of anything. When is our government going to learn they can’t control everything. All this does is hurt people who need medicine and their doctors are afraid to prescribe it. And I totally back President Trump, but back off suing the drug companies for opiates. I met a woman who had neck surgery and her insurance would only cover 7 pain pills a month. She was in horrible pain.
Control illegal drugs that are brought in or sold over the internet, but leave doctors alone!
What happened to common sense in this country?

Judith A Soper
4 years ago

I am totally against the big government takeover instituted by b.o. and feel that I’m imprisoned in it. But, I don’t know what to do about it. If you can tell me how to fight it, I will. I pray for Pres Trump and his family every day. He needs to NOT let this happen!!

4 years ago
Reply to  Judith A Soper

Hopefully, President Trump will stop the takeover. He needed to put his foot down on this.

Martin Steed
4 years ago

Whoa! I’m sorry. I didn’t see the button. I hit the button and discovered that this thing is OLD news from a year and a half ago. Original sponsor was old John Conyers. He must of come up with this pipe dream just before he was forced to resign when accused of molestation by a number of staffers. Of course it was picked up by Keith Ellison, congressman from ISIS and signed on to by what looks like every Democrat in the House. This thing went nowhere and will go nowhere unless people are dumb enough to turn over control to the Dems in November.

Martin Steed
4 years ago

Might be helpful IF you would tell us just who the “sponsors” of this pantload are. THEN, we could tell them what we think.

4 years ago
Reply to  Martin Steed

Click on the red button and it will take you to the sponser and co-sponsers and also will divide the co-sponsers by state and give their names!

4 years ago
Reply to  Martin Steed

I just posted a comment about this. You can look up H.R. 676 on DuckDuckGo, and see that the sponsors are democrats John Conyers and Keith Ellison.

Rev. R.S. Helms
4 years ago

This is where President Trump needs to put his foot down on Speaker Ryan! and force Congress to Repeal and replace with something AFFORDABLE!

Elton Yancey
4 years ago

Just repeal the damn thing.Ryan is,and has been part of the problem.If the dems.win in November,we can hang it all up.

4 years ago


4 years ago

i don’t think the click here button works – to tell them it’s my money, my heal, privacy and life.

4 years ago
Reply to  joni

I was also hoping to easily click a link to voice my opposition to H.R. 676, but the link does not work for that purpose.

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