The Medicare for All mystery

I have been with Medicare for twenty years. Four months ago, following a 12-year fight with cancer, my wife spent three weeks in the hospital. The medical bills just for those three weeks exceeded $650,000.

My out-of-pocket cost was less than $1,000. Medicare and the supplement paid the rest.

Based on my personal experience with Medicare, which has been excellent, I believe all Americans — not just those who are 65+ years old — should be able to avail themselves of this program.

Our Monetarily Sovereign government easily could pay for a comprehensive, no-deductible version, that not only would pay for everything but be generous-to-providers so as to attract more people into the healthcare professions.

My sense is that this belief is shared by the vast majority of those who already have Medicare.

And there surely is a need.

Here are excerpts from a health care report that though admittedly is old (2010), I feel quite certain very little has changed:

Among seven nations studied—Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States—the U.S. ranks last overall, as it did in the 2007, 2006, and 2004.

Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity.

The Netherlands ranks first, followed closely by the U.K. and Australia.

Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care. Compared with the other six countries, the U.S. fares best on provision and receipt of preventive and patient-centered care. However, its low scores on chronic care management and safe, coordinated care pull its overall quality score down.

Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries.

There is a frequent misperception that such tradeoffs are inevitable; but patients in the Netherlands and Germany have quick access to specialty services and face little out-of-pocket costs.

Efficiency: On indicators of efficiency, the U.S. ranks last among the seven countries,. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of the use of information technology, rehospitalization, and duplicative medical testing.

Equity: The U.S. ranks a clear last on nearly all measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment, or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs.

Long, healthy, and productive lives: The U.S. ranks last overall with poor scores on all three indicators of long, healthy, and productive lives.

Clearly, the American private insurance industry has been failing Americans, especially those in the lower half of the income/wealth measure.

Before we continue, please remember that of the seven nations compared, five are Monetarily Sovereign and two (Netherlands and Germany) are monetarily non-sovereign.

Why is this important? Because the Monetarily Sovereign nations like the U.S. have the unlimited ability to create their own sovereign currency.

They never can run short of money. Monetarily non-sovereign nations must rely on taxes to pay for things.

Contrary to popular myth, the FICA tax does not pay for Medicare or Social Security. It pays for nothing.

Even if our U.S. government were to collect zero taxes, we have the infinite ability to fund healthcare insurance, indefinitely. Though the U.S. government has this ability, it provides less service than do the two monetarily non-sovereign nations that must rely on taxes.

Because the U.S. private insurance industry has been unable or unwilling to support Americans, various plans under the label “Medicare for All” have been suggested.

Because of Gap Psychology (the desire to distance oneself from those below, on any social measure), the wealthy right-wing opposes such plans, just as it opposes all forms of federal aid to those who are not wealthy.

So, in describing a Medicare for All plan, they intentionally reference plans with shortcomings, then falsely declare those shortcomings are a necessary part of all plans.

Here is an example:

LFA Member Profile: J.D. Tuccille
J.D. TUCCILLE: Let ’em eat cake.

Medicare for All Is Bad Medicine
A better prescription would be to get the government entirely out of health care.

Opponents of choice in medicine are at it again, promoting Medicare for All with the U.S. government as the single payer and private alternatives outlawed.

“Private alternatives outlawed” is not a necessary feature of all Medicare for All plans.

It is not even a necessary feature of today’s Medicare.

For no good reason, today’s Medicare doesn’t pay 100%.

Rather, there are deductibles, that can be covered by private Medicare Supplement insurance.

To my knowledge, the sole purpose of “private alternatives outlawed” is to prevent people from double-dipping, i.e. receiving two payments for the same procedure.

But since the U.S. does offer Medicare, and private alternatives do exist, presumably double-dipping is not a true problem.

The push comes as health care systems around the world try to catch their breath from the stress test inflicted by the pandemic—and by normal demand for expensive services. While American medicine has its share of problems, single-payer supporters would take all of the flaws in the system and make them universal and mandatory.

No, single-payer supporters would take all the benefits of Medicare, and make them universal.

H.R.1976, the Medicare for All Act of 2021 makes it “unlawful for … a private health insurer to sell health insurance coverage that duplicates the benefits provided under this Act” or for employers to offer alternative coverage.

Providers wouldn’t be forced to participate; the proposed law lets Americans pay non-participating physicians out of pocket for services—subject to regulations.

Why would Americans pay for services covered by a hypothetical Medicare for All? To answer that question, look north of the border, where Canada’s single-payer system, commonly called Medicare, struggles to meet patients’ needs.

“With COVID-19 fuelling a surge in hospitalizations, the latest data provided by the Ministry of Health shows that as of December 31, 2020, there were 29,650 people on a waiting list for surgery” in Saskatchewan, the Canadian Broadcasting Corporation (CBC) reported earlier this month. The CBC noted similar delays in other provinces.

“Specialist physicians surveyed report a median waiting time of 22.6 weeks between referral from a general practitioner and receipt of treatment,” which is the longest wait recorded, according to the free-market Fraser Institute.

The article continues with a litany of examples demonstrating how, under some forms of single-payer insurance, patients must wait a long time for service.

This is supposed to make you believe that long waits are a necessary problem with a Medicare for All plan, but not with private insurance.

However, any discussion of Medicare only tells you who is paying, the government or the private insurance companies. It says nothing about services from doctors, hospitals, nurses, et al.

Given the federal government’s infinite ability to spend, and no need to scrimp for profits, the federal government has far greater power to pay for any level of service.

It could make the entire health care industry so financially attractive that the numbers of doctors hospitals and nurses could double or triple. Taken to an extreme, the government even could afford to fund a private doctor for every man, woman, and child in America.

OK, no one recommends that, but it merely demonstrates how the government easily can pay — much more easily than private insurance can — for the world’s greatest service. There would be no need for the long waits with which Mr. Tuccille threatens you.

Such waits cost more than money—although they cost plenty of that. “[T]wice as many Ontarians with heart ailments passed away waiting for surgery during the pandemic than before COVID-19 hit,” according to the National Post.

To relieve the backlog, Canadian provincial governments, which manage the single-payer system, are turning to private clinics. In Quebec, “without the private sector contracts, a region like Laval would have delayed 76 per cent of surgeries instead of 31 per cent,” the CBC noted in February.

“Private sector contracts”? Without realizing it, the author, J.D. Tuccille just demonstrated that a Monetarily Sovereign government like Canada’s has the unlimited ability to fund good service.

“Private sector contracts” are simply an example of single-payer insurance. The government pays for service.

It demonstrates that the private insurance sector was unable or unwilling to provide enough coverage, so the government had to step in and pay what the citizenry could not afford to pay.

As the data suggests, though, the public sector in many places had trouble delivering as advertised long before anybody had heard of COVID-19.

No, Mr. Tuccille, the data demonstrate that the private sector could not and did not deliver health care for all. That is exactly what is happening in America.

In Germany, where those making less than €64,350 per year must participate in the government health insurance system which is funded on a quarterly basis, the system runs out of money on a regular basis.

Unlike the U.S., the German government is monetarily non-sovereign. It can, and does, run short of money.

“State health insurance patients are struggling to see their doctors towards the end of every quarter, while privately insured patients get easy access,” Deutsche Welle reported in 2018.

“The researchers traced the phenomenon to Germany’s ‘budget’ system, which means that state health insurance companies only reimburse the full cost of certain treatments up to a particular number of patients or a particular monetary value … Once that budget has been exhausted for the quarter, doctors slow down — and sometimes even shut their practices altogether.”

The “budget” acts as backdoor rationing, limiting costs by choking off access for publicly insured patients to all but emergency medical care once the magic number is hit.

Single-payer advocates often criticize private medicine for being cost-conscious, but government systems put at least as much emphasis on the bottom line as any corporate accountant.

Again, without realizing it, J.D. Tuccille demonstrates why Medicare for All is necessary for America.

You and I and the German government are monetarily non-sovereign. We all can run short of dollars. The U.S. government cannot.

The U.S. government has no profit motive — no “bottom line” — to emphasize.

Sadly, even some Monetarily Sovereign governments are (intentionally??) as ignorant of economics as is Mr. Tuccille.

The Libertarians who bleat and moan about the U.S. deficit and debt, seem to have no memory of the fact that despite massive spending for the past 80 years, and numerous tax cuts, the U.S. government never has struggled to pay its bills.

It hasn’t run out of dollars. It hasn’t had to bounce any checks.

This all relates to the Big Lie in economics that says: “Federal taxes fund federal spending.” It simply is not true.

Federal spending always has been funded the same way: The government passes laws from thin air, and these laws provide for dollars being created from thin air. There is no limit on the laws the government can pass, thus there is no limit on the dollars the government can create.

That’s especially obvious in the United Kingdom, where the National Health Service has a cult-like status.

During the pandemic, this took the form of a “Stay Home. Protect the NHS. Save Lives.” campaign.

“The NHS is under severe strain and we must take action to protect it, both so our doctors and nurses can continue to save lives and so they can vaccinate as many people as possible as quickly as we can,” Prime Minister Boris Johnson scolded the public.

Utter nonsense. Boris Johnson either doesn’t know what he’s talking about, or more likely, he is conning the British public. England, being Monetarily Sovereign, never unintentionally can run short of British pounds. Never.

The campaign worked. Even people with medical concerns stayed home, resulting in a drop in doctor visits and a 90 percent plunge in hospital admissions.

Truly sad that sick people are being lied to by their elected leaders. One might say, it’s sickening.

And now comes the overt statement of the Big Lie:

It’s difficult to imagine Americans venerating government bureaucracy (although feelings about Social Security come disturbingly close).

American’s love Social Security because it provides something they otherwise could not afford to obtain on the private market: Financial support in their old age.

But it’s impossible to pretend that Medicare for All could escape the concerns that plague all tax-paid medicine.

Again, the Big Lie. Medicare is not “tax-paid medicine.” It is government-paid medicine.

“A doubling of all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan,” the Mercatus Center’s Charles Blahous pointed out about an earlier Medicare for All proposal.


Health care in the United States requires reform, without doubt.

But rather than emulate the heavy state involvement that evokes headaches elsewhere in the world, a better prescription would be to get government entirely out of medicine and encourage more competition and choice.

What a pitiful close to a pitiful article. Mr. Tuccille wants your healthcare to rely on the profit motive of American business.

Mr. Tuccille blithely omits the central issue: The unaffordability of healthcare for millions of Americans.

If you are not rich, and you do not have a job that pays for your healthcare, you better not get sick. You either will suffer physically and die early from lack of care and/or suffer financially from trying to pay for your care.

I am retired. I am not poor by any measure, but my wife’s $650,000+ medical bills in January, plus those huge bills we received for all previous12 years of her cancer, would have been financially painful.

As you contemplate Mr. Tuccille’s (and the entire conservative wing’s) thoughtless comments, ask yourself: “What would I do about a $650,000+ hospital bill. And what would my private insurer do about it?”

The federal government not only could afford to pay that bill, but it even could afford to pay a $6 million, or $60 million bill, and never blink an eye. Could your private insurance company afford that?

If you lost your job, would you even be able to find a private carrier who would accept you?

Let us all pray for Mr. Tuccille’s continuing financial ability to afford his private insurance so he can close his eyes to those less affluent than him, and continue his “Let ’em eat cake” articles.

Rodger Malcolm Mitchell

Monetary Sovereignty Twitter: @rodgermitchell Search #monetarysovereignty Facebook: Rodger Malcolm Mitchell ………………………………………………………………………………………………………………………………


The most important problems in economics involve:

  1. Monetary Sovereignty describes money creation and destruction.
  2. Gap Psychology describes the common desire to distance oneself from those “below” in any socio-economic ranking, and to come nearer those “above.” The socio-economic distance is referred to as “The Gap.”

Wide Gaps negatively affect poverty, health and longevity, education, housing, law and crime, war, leadership, ownership, bigotry, supply and demand, taxation, GDP, international relations, scientific advancement, the environment, human motivation and well-being, and virtually every other issue in economics. Implementation of Monetary Sovereignty and The Ten Steps To Prosperity can grow the economy and narrow the Gaps:

Ten Steps To Prosperity:

  1. Eliminate FICA
  2. Federally funded Medicare — parts A, B & D, plus long-term care — for everyone
  3. Social Security for all
  4. Free education (including post-grad) for everyone
  5. Salary for attending school
  6. Eliminate federal taxes on business
  7. Increase the standard income tax deduction, annually. 
  8. Tax the very rich (the “.1%”) more, with higher progressive tax rates on all forms of income.
  9. Federal ownership of all banks
  10. Increase federal spending on the myriad initiatives that benefit America’s 99.9% 

The Ten Steps will grow the economy and narrow the income/wealth/power Gap between the rich and the rest.


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