News Analysis
How the 2024 presidential candidates will handle Medicare could be critical to changing the course of the country’s troubled health care system, which is currently facing a bleak future.
Twila Brase, a nurse and co-founder of the Minnesota-headquartered medical freedom advocacy organization Citizens’ Council for Health Freedom and founder of The Wedge of Health Freedom, shared with The Epoch Times her analysis of the presidential candidates’ positions.
Since its inception in 1965, Medicare enrollees have increased from 21 million in 1972 to 65 million in 2022.
Projected to reach 88 million in 30 years, increased enrollment is charged by a growing number of older Americans.
“There are currently 60 million people aged 65 and older, and that number is projected to increase by 43 percent over the next three decades,” according to a Peter G. Peterson Foundation (PPF) report.
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At $747 billion in 2022, Medicare falls just under Social Security in the federal mandatory spending budget, “representing 12 percent of the total federal spending.”
“Medicare has a large impact on the overall healthcare market: it finances over one-fifth of all health spending and nearly 40 percent of all home health spending,” the PPF report states. “In 2022, Medicare provided benefits to 20 percent of the population.”
Because of baby-boom generation retirement and the rise in health care costs, federal spending for Medicare is expected to increase the GDP from 3 percent in 2022 to 5.5 percent by fiscal year 2053, PPF reported.
According to a report by the media platform AllSides, Republicans and Democrats are “sharply divided” on Medicare, with 81 percent of Democrats contending that the federal government is responsible for healthcare coverage as 77 percent of Republicans argue that it isn’t.
Democratic President Joe Biden believes in a right to health care. However, Ms. Brase said, this means that the government “must impose that right.”
“But he also wants to increase competition and bring prices down and improve transparency, so he’s talking out of both sides of his mouth,” she added.
The current administration backs Medicare Advantage, which Ms. Brase called “the corporate version of socialized medicine.”
“Though Biden is talking about improving the current state of affairs, he’s not getting to the root of the problem, which is third-party payments and a declining number of people paying into Medicare with a rapidly increasing number of people entering Medicare,” she said.
Ms. Brase referenced the Biden administration’s proposal to strengthen Medicare Advantage in which it states that the Centers for Medicare & Medicaid Services “is concerned that certain prior authorization policies may disproportionately inhibit access to needed care for underserved enrollees.”
“Federal reports show that Medicare Advantage organizations wrongly deny payments and access to physician-ordered, medically necessary care,” she said. “It isn’t just the underserved; it’s all patients in Medicare who are threatened with the possibility that the health plan will say no to the care that they need.”
Twila Brase, 2023. Courtesy of Twila Brase
Medicare Disadvantage
However, the Biden administration’s plan to correct this is to focus on what it believes to be racial inequities by hiring an expert in health equity to the utilization management of these committees, Ms. Brase said, and to hold an annual health equity analysis.Instead of looking at the problems with the whole program, the Biden administration is focusing on race, she said.
“Medicare Advantage should actually be called Medicare disadvantage because it disadvantages anyone on it who gets significantly ill,” she said. They’re the ones who will find themselves without the care that they need.”
In addition, the Biden administration is proposing to bring the remaining 25 to 30 percent of independent practices into a managed care system, she said.
“They say it’s a wonderful thing because it’s going to help these doctors get into this new value-based payment system, but this value-based payment system is socialism,” she said. “It’s socialism on steroids.”
Instead of being value-centered based on the government’s definition of value, she said, it needs to be patient-centered.
Former Republican President Donald Trump has stated that Medicare shouldn’t be touched, she said.
“That’s not really the right thing to say, because Medicare will be insolvent in just eight years, in 2031,” she said. “That means it will only be able to pay 89 percent of bills.”
There’s no Medicare trust fund, she said, only extra funds from payroll taxes.
“But these extra dollars will be all gone in 2031,” she said. “So, the idea of not touching the program, which sounds politically good to people who don’t understand that Medicare will be insolvent in eight years, is fiscally unwise, and it deprives the American people of understanding the reality of the program.”
Presidential candidate Nikki Haley, a former South Carolina governor and U.S. ambassador to the United Nations, said she opposes the expansion of Medicare yet supports the expansion of Medicare Advantage.
“But Medicare Advantage is the problem, not the solution,” Ms. Brase said. “Politically, this allows for the rationing of health care through the health plan; they can promise you everything and then give you nothing because they have the authority to deny you access to care according to whether they believe it’s medically necessary.”
The Official U.S. Government Medicare Handbook for 2020 over pages of a Department of Health and Human Services, Office of the Inspector General report, are shown, in Washington, on Feb. 13, 2020. AP Photos/Wayne Partlow
‘An Escape Hatch From Medicare’
The real solution, Ms. Blase said, is to provide “an escape hatch from Medicare.”Giving the option to let people out will create a robust, real insurance system, she said.
“And we should have it be real insurance, which is catastrophic coverage, medical indemnity policies that pay you cash, and then you pay your doctor with no third-party intermediary,” she said. “Then there’s nobody who can take money out of the pot. Every price that comes is transparent and patient-centeredness returns.”
This was close to being accomplished in 2019 with a Trump administration executive order that would have separated Medicare enrollment from access to social security benefits.
“The Clinton administration tied those together in 1993,” she said, adding that though no law supports it, it stuck Americans with being required to enroll in Medicare to get social security.
During his term as New Jersey governor, presidential candidate Chris Christie expanded Medicare but is reportedly against expanding it nationally, according to AllSides.
“He believes cuts to Medicare are a necessary ‘political risk’ to maintain the US economy,” AllSides reported.
Mr. Christie has acknowledged that both Medicare and Social Security are going bankrupt.
Republican presidential candidate and Florida Gov. Ron DeSantis opposes the expansion of Medicare.
“In Florida, he expanded direct primary care involving contractual relationships between doctors and patients, partially cutting out the role of insurers,” AllSides reported.
Mr. DeSantis had supported transitioning Medicare from a program funded by the government to one in which the government would allocate funds for beneficiaries to spend, Ms. Brase said.
“Everyone Medicare age would get a certain amount of money and then they get to decide how to spend it so that they could buy a real insurance policy,” Ms. Brase said.
Yet Mr. DeSantis has also said he wouldn’t touch Medicare, Ms. Brase said, so “he’s vacillated a little bit.”
Republican Presidential candidate Vivek Ramaswamy told CNN he wouldn’t cut Medicare benefits.
According to Ms. Brase, he’s advocated for no cuts for seniors, zero-based budgeting, and a wide-scale government staff cut of 75 percent.
“And he does not believe that the government should be involved in health care,” she said.
Independent presidential candidate Robert F. Kennedy Jr. told Jimmy Dore that 80 percent of the $4.3 trillion the government spends on health care costs goes to treating chronic disease, which he vowed to implement programs to address.
“We have the highest chronic disease rate of any country in the world,” he said, adding that Medicare for All “ought to be available, with public and private options available as well.”
The Medicare Advantage plan provides more benefits than the original Medicare, including vision, dental, hearing, and possibly preventive care services. Azrin Aziri/ShutterStock
Medicare’s Bleak Future and Controversial Past
The real truth that the American people need to hear from these candidates is that these programs are running out of money and that their children and grandchildren will have their taxes significantly increased, Ms. Blase said.“There probably won’t be any Medicare available in the future for the young unless we’re in a complete socialized health care system,” she said. “This is why it’s important to give an escape hatch from Medicare and start letting younger people pick real insurance policies that will last them for a lifetime; let people who aren’t yet dependent upon Medicare find their own insurance while protecting those who are dependent on it.”
President Harry Truman advocated for universal health care but the American Medical Association (AMA) lobbied against what it called “socialized medicine” because the association believed it “would remove the entrepreneurial spirit from American healthcare.”
“They also feared universal healthcare would sever the intimate relationship between patient and doctor, and put the government squarely in the middle of medicine,” according to Medicare World.
Ms. Brase said President John F. Kennedy initially supported universal health care, but after hearing the AMA president at the time—Florida surgeon Dr. Edward Annis—speaking against the movement, President Kennedy changed his position.
“He realized this was a bad idea, but then he was killed,” Ms. Brase said.
Then, President Lyndon Johnson stepped in and signed Medicare into law with the Social Security Amendment Act of 1965.
“Johnson had his own plan,” she said. “He signed it into law and gave the first card to Harry Truman, who also wanted national insurance.”
It was the plan from the beginning to eventually have Americans on a single-payer, government-run health care system, she said, with the end result being a government that gets to decide whether a citizen’s life has value.
‘It’s a Terrible System’
“People don’t think about this, but when you turn 65, you are suddenly a senior,” she said. “It’s like you entered a whole new class in this country, and now you’re on the dole. You’re dependent on the government, and now taxpayers are having to fund your health.”Because those aged 65 years or older are required to get Medicare in order to obtain Social Security, it’s become a form of “age discrimination,” she said.
“It changes how people perceive seniors when they are suddenly seniors at 65, so it actually changes how people perceive American citizens when they are put in this class,” she said. “So, Medicare created a class of people who lost their rights and are discriminated against.”
It was an egregious act for President Johnson to pass Medicare, she said, adding that the country is just now seeing its consequences come to fruition.
“It’s a terrible system,” she said. “It’s unjust. It’s discriminatory. It’s impoverishing, and it’s just wrong.”
