What’s improved in Improved Medicare for All (IM4A)

A mixed crowd of humans wear masks with slogans that read "Fix health care," "Save people. Save money. IM4A" and "Improved Medicare for All!"

Why do we refer to Improved Medicare for All and not just plain Medicare for All?  While customer satisfaction with Medicare ranks above employer sponsored insurance, it is not perfect.  It has some important areas that can be and need to be improved. Improved Medicare for All [1] would:

  • Include dental, vision, hearing, affordable drugs, durable medical equipment, long-term care, improved mental health services, all of the more comprehensive services that are part of Colorado Medicaid[2], and the popular Silver Sneakers program.
  • Eliminate the expensive middleman insurance companies that control Medicare Part D and Medicare Advantage.
  • Regulate the cost of drugs, devices, transport, and other services essential for life and health.
  • Make Medicare affordable by providing full benefits without deductibles, coinsurance, or copays, thus eliminating the need for supplemental or gap insurance.
  • Allow full choice of health care provider.
  • Cover the full range of reproductive health care including pregnancy, birth, contraceptives, and abortion services.
  • Negotiate with health care providers from each specialty for fair and equitable compensation that recognizes their experience, skills, and training.
  • Include public health services that prepare for pandemics; improve vulnerable, rural, and underserved community access; and focus on infectious disease and prevention.

Expansion of benefits and inclusion of Medicaid benefits

This expansion of benefits is necessary so that IM4A covers the full range of health care needs.

Eliminate middleman

In Medicare Advantage and Medicare Part D, insurance companies serve as middlemen between Medicare funds and the patient/provider team. They have tripled the amount of administration costs, increased overall costs, and are turning Medicare into a typical insurance package that promises a lot but in practice has obscure limitations and restrictions and excessive preauthorization requirements that are not part of traditional Medicare.

Regulate pharmaceuticals as an essential public good

Pharmaceuticals are a matter of life and death. If a product is essential, there is no limit to the amount a supplier may charge. IM4A would regulate the cost of pharmaceuticals in the same manner as essential public utilities. This type of regulation would allow for incentives for new medications, research, and a reasonable profit, but not allow profiteering or charging more than people in other countries pay for the same medication.

Eliminate harmful financial barriers including deductibles, co-insurance, and copays

Medicare has co-pays, co-insurance, and deductibles that keep many seniors and others from being able to afford it.

Full choice of health care provider

Medicare’s history and reputation for full choice of provider has been sullied by Medicare Advantage plans that use narrow provider networks to cut costs.  IM4A would restore full choice of provider.

Full reproductive services

A universal health care plan must ensure that every patient has the religious and personal freedom to choose the health care services they want and need, including reproductive services.

Fair provider compensation

IM4A needs a trustworthy mechanism for ensuring adequate provider compensation. In general, provider pay is not the cause of the out-of-control health care costs, and some specialties such as primary care and psychiatry are currently under-compensated.  IM4A needs a trustworthy method and a Board that includes provider representatives for ensuring adequate provider compensation while controlling the payments to some specialists who are overcharging.

Public health services

As the pandemic has shown us, we are all in this together. A universal health care system needs a public health mindset. Preparation for pandemics and epidemics is crucial. Vulnerable, underserved, and rural communities may need extra consideration. Infectious disease is a concern for the general public as well as the individual. And prevention, of course, is a priority for maintaining public health.

We know exactly what improvements are needed to fix and expand Medicare. With this list, IM4A fixes what does not work well. After 55 years of trying to fix the multi-payer system, our country has only created the most complex and expensive system in the world, while still leaving millions uninsured and under-insured. Medicare has been proven over 55 years, and we know how to fix the few problems it has. It is time to give it to everyone.

[1] There is no official list of the improvements in IM4A because the concept of IM4A is promoted by a number of independent groups, thought leaders, and elected officials. This list is the Foundation’s current version of the improvements that are commonly endorsed by IM4A. Other IM4A groups, leaders, or elected officials may choose to make their own definition by modifying this list or creating one of their own.

[2] The Colorado Medicaid program is used here rather than a generic Medicaid program because it is one of the most comprehensive in the country.

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