Thursday, May 23, 2019

Crowdfunding Medicare for us all

I believe that anyone covered under Medicare for All should be permitted to obtain services anywhere in the world, so long as the services are similar to those provided in the United States and at a price that is no greater than that charged in the U.S.

Image Credit: Michael T. Hertz

I’ve been a big fan of Bernie Sanders ever since I worked for his campaign in 2016.  I assumed that I’d be there for him in 2020, particularly since I was also a fan of Medicare for All.  Living as I do in San Miguel de Allende, MX, I innocently assumed that Bernie’s Medicare for All really meant for all Americans, whether or not they lived in the U.S. and whether or not they got healthcare in the U.S. Silly me! When I finally got around to reading Bernie’s 2017 legislation “Medicare for All” I discovered that he really didn’t mean “for all.” Like me, you could be born in the U.S., could have paid all the money required for Social Security and Medicare, and could continue to pay faithfully your American taxes, but if you didn’t actually reside in the U.S., you couldn’t get Medicare under his bill.

The major flaw in the bill is:

SEC. 102. UNIVERSAL ENTITLEMENT.

(a) In General. – Every individual who is a resident of the United States is entitled to benefits for health care services under this Act. The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under this Act.

(b) Treatment Of Other Individuals. – The Secretary may make eligible for benefits for health care services under this Act other individuals not described in subsection (a), and regulate the nature of eligibility of such individuals, while inhibiting travel and immigration to the United States for the sole purpose of obtaining health care services.

Oh, my. Not only must you be a resident of the United States, but even if somehow the Secretary might include you, you cannot travel to the U.S. for the sole purpose of obtaining health care services. And you cannot get your services outside the U.S. because Medicare will only pay for services provided by healthcare providers in the U.S.

Looking over this bill, I think it’s even more stringently directed against non-resident Americans than the present Medicare law. I can at least travel from Mexico to Los Angeles and get coverage. But under this new law I couldn’t go to L.A. for healthcare purposes.

So what should I and perhaps 4.5 million Americans living outside the country do to protect ourselves? To me, the answer is raise money through crowdfunding and try to encourage our politicians to take another look at this Medicare language.

First of all, how many of us will be impacted? Remember, Medicare for All doesn’t mean just people over 65. It means everyone. No one is really clear how many Americans live outside U.S. borders, but a comfortable number is around 4.5 million.

And how many of that number vote? Perhaps 562,000 (the number who voted in the 2016 election.) That’s only 12.5% of those eligible, which is far below the 41% or so who voted within the U.S. So there’s room for expansion. But even if the voters donated an average of $10 to protecting their rights, that would be $5.62 million, which isn’t bad.

So, let’s try. Let’s propose a change in the law which provides coverage for all Americans everywhere. We’ll just change Sec. 102(a) to read:

  1. In General. – Every individual who is either a resident of the United States or a citizen or national of the United States, or both, is entitled to benefits for health care services under this Act. The Secretary shall promulgate a rule that provides criteria for determining eligibility under this Act..

 

  1. Treatment Of Other Individuals. – The Secretary may make eligible for benefits for health care services under this Act other individuals not described in subsection (a), and regulate the nature of eligibility of such individuals.

What about obtaining health care services outside the U.S.? Personally, I believe that anyone covered under Medicare for All should be permitted to obtain services anywhere in the world, so long as the services are similar to those provided in the United States and at a price that is no greater than that charged in the U.S. The patient should be allowed to pay for the services out of pocket and then seek reimbursement from Medicare. In seeking reimbursement, the patient should provide a copy of the bill from the doctor or hospital, plus a copy of any paperwork or electronic data obtained from the doctor or hospital. The patient should provide a translation of any foreign language in the bill, paperwork or electronic data. (The patient can do the translating himself or use Google or some other mechanism to do the translating). The patient shall provide the name, address, telephone number, and email (if any) of the doctor or hospital so that Medicare can communicate with the doctor or hospital. If Medicare should believe that the billing is fraudulent or not truthful, it shall have the burden of so proving.

Notice that since obtaining health care services outside the U.S. can be reimbursed to any covered patient, Americans would no longer need to buy medical travel insurance if they are willing to pay for health care out of pocket and seek reimbursement. Basically, they are insured anywhere. So this improvement in Medicare for All helps all Americans, both inside and outside the U.S.

Now, let’s suppose we raise $5 million from voters who like these changes. Who should get that money? There is already a bill filed by Bernie Sanders. What we want him to do is amend his bill to include the changes described above. If he should do this, and if his amended bill should become law, then he should be entitled to direct the disposition of  50% of the money raised by the crowdfunding effort. We’ll allow until 2022 for his bill (or a successor bill) to be enacted. If a different bill is enacted, but provides at least as many benefits to Americans as Bernie’s bill (as amended), then the politicians proposing that bill shall share evenly in the right to direct the disposition of 50% of the money raised.  If Bernie’s amended bill or such a successor bill is enacted by 2022, then the right to direct disposition of the remaining 50% shall be divided evenly among all congressional politicians voting in favor of the law.

And if the law is not enacted by 2022, then the funds gathered shall be returned to the donors, less any crowdfunding fees and costs for redistribution. If there should be a dispute between any members of Congress and those handling the crowdfunding about any aspect of the crowdfunding, those handling the crowdfunding shall have the absolute and final right to the making of any decision or interpretation.

Now, I believe that this proposal may actually draw a lot of interest. It encourages the enactment of single-payer health care. And it eliminates the need for any sort of health care insurance by anyone. Medicare would become the only payer, whether the services are provided inside or outside the U.S., and it allows all Americans, anywhere, to be covered. If you’re traveling somewhere, you become ill, and you trust the local healthcare, you can pay for it and get reimbursed. So this crowdfunding doesn’t just help people who live outside the U.S., but it supports Bernie’s bill (as amended) or one like it, and encourages all voters everywhere to put up money. If we could get every voter to kick in $1, then we would have $130 million. That would be plenty enough to get Congress to pass it.

Notice that I didn’t say that the congressmen would get the money, but merely that they could direct the disposition of the money. I assume that members of Congress can direct disposition of money in a manner permitted by law. It will be up to them to determine the purposes for which the money can be used so that no one can accuse them of being bribed.  At worst, they can direct that the money be used for an appropriate public purpose.

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