Although the nuances of the beliefs of Democrats, liberals, and progressives may be obscure, there is one thing that they all agree on: the expansion of Medicare.
Medicare is a government health-insurance program for people age 65 or older, people under age 65 with certain disabilities, people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant), and people of all ages with ALS (Lou Gehrig’s disease). Medicare actually consists of four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plan), and Part D (prescription-drug plan). Parts A and B together are considered to be Original Medicare.
Medicare Part A is funded by a payroll tax “contribution” of 2.9 percent (split between employer and employee) on every dollar of an employee’s income. Self-employed individuals pay the full 2.9 percent but receive both a reduction in their net earnings from self-employment and a tax deduction equal to 50 percent of the amount of the Medicare tax they paid. There is also an additional 0.9 percent tax on earnings above a threshold of $200,000 ($250,000 for married couples).
Enrollment in Medicare is open to all U.S. citizens or those who have been permanent legal residents for five continuous years and who have paid Medicare taxes for a minimum of 40 quarters (10 years). As of last year, 65.6 million Americans were enrolled in Medicare, or roughly 25 percent of the adult population.
For years, Senator Bernie Sanders (I-VT), has pushed for expanding Medicare to cover dental, hearing, and vision services at no additional cost to beneficiaries. He also pushed for Medicare for All, which would expand Medicare to include working families who don’t have access to affordable health care.
The Congressional Progressive Caucus has called for Medicare eligibility to kick in at 60 instead of 65 and coverage extended to dental, vision, and hearing services.
Democratic presidential nominee Kamala Harris proposed expanding Medicare by having it subsidize in-home, long-term care and paying for caregivers who help seniors with activities of daily living.
Although Republicans don’t talk about expanding Medicare, they do talk about preserving it, saving it, modernizing it, and reforming it.
The Republican Party platforms of 2016 and 2020 said about Medicare:
More than 100 million Americans depend on Medicare or Medicaid for their healthcare; with our population aging, that number will increase. To preserve Medicare and Medicaid, the financing of these important programs must be brought under control before they consume most of the federal budget, including national defense. We intend to save Medicare by modernizing it, empowering its participants, and putting it on a secure financial footing. We will preserve the promise of Medicaid as well by making that program, designed for 1965 medicine, a vehicle for good health in an entirely new era.
The Republicans also proposed the following reforms:
Impose no changes for persons 55 or older. Give others the option of traditional Medicare or transition to a premium-support model designed to strengthen patient choice, promote cost-saving competition among providers, and better guard against the fraud and abuse that now diverts billions of dollars every year away from patient care. Guarantee to every enrollee an income-adjusted contribution toward a plan of their choice, with catastrophic protection. Without disadvantaging present retirees or those nearing retirement, set a more realistic age for eligibility in light of today’s longer life span.
The Republican Party platform of 2024 had much less to say about Medicare:
President Trump has made absolutely clear that he will not cut one penny from Medicare or Social Security. American Citizens work hard their whole lives, contributing to Social Security and Medicare. These programs are promises to our Seniors, ensuring they can live their golden years with dignity. Republicans will protect these vital programs and ensure Economic Stability. We will work with our Great Seniors, in order to allow them to be active and healthy. We commit to safeguarding the future for our Seniors and all American families.
In Donald Trump’s comments on his “America First Healthcare Plan,” he stated, “As long as I’m President, no one will lay a hand on your Medicare. Your Medicare is going to be safe and it’s going to be solid.”
Now, since Medicare is an unconstitutional income transfer program that forces some Americans to pay for the health care of other Americans, certainly all libertarians want to eliminate Medicare rather than expand it or reform it, right?
Certainly not.
Although I know of no libertarian who wants to expand Medicare, there are definitely some who want to reform it: not as a temporary measure or steppingstone toward a free market in medical care but to keep it in perpetuity.
The main Medicare reform that these libertarians are advocating is shifting it to a premium support system where the federal government would provide Medicare beneficiaries a voucher toward the purchase of a health insurance plan. This is said to be a market-based approach because health plans would compete for enrollees.
The problem, of course, is that the enrollees are not using their own money to purchase a health insurance plan from an insurance company. Thus, only one-half of the transaction can be considered market-based. But even that half is not fully market-based because of all the government mandates and regulations that insurance companies must follow.
There is definitely a third-party-payer crisis in American health care. Almost 90 percent of every health care dollar is paid for by someone other than the one receiving the health care. But the solution is not reforming Medicare (and block-granting Medicaid to the states, as advocated by some libertarians) but eliminating it altogether.
There is nothing libertarian about reforming Medicare. Not only is the program unconstitutional, it is an illegitimate purpose of the federal government to pay for, subsidize, or provide health care or health insurance. No American is entitled to health care or health insurance at the expense of any other American, and no American should be forced to pay for the health care or health insurance of any other American. Health care and health insurance are services that can and should be provided on the free market. Instead of coming up with a workable, humane, and real transition to a free market in medical care, libertarian reformers are wasting their time on perpetuating an unconstitutional and illegitimate government program.
