Robert Joseph Jr. was never a fan of Medicare for All.
A slow and steady expansion of the U.S. health care system – that’s what America needs, the retired 73-year-old Democrat had said for months. The Joe Biden and Pete Buttigieg signs outside his New Hampton home attest to that.
But that was before the bill he received at the end of January.
Joseph, a multiple myeloma patient, had driven to Concord Hospital to pick up his monthly prescription of Revlimid, the daily drug that helps rally his immune system to kill the abnormal cells. It was a familiar process for Joseph, who was first diagnosed in 2016 and who has been paying for his treatment partly through Medicare and partly through a grant from a foundation for patients.
This time, the physician had bad news. The grant had run out. To pick up the prescription, Joseph said, he’d need to pay the rest of the balance himself, a whopping $1,615.
Joseph’s Social Security allotment for the entire month was $1,676. Paying the bill himself was not an option.
He returned home, skipping out on the medication that he says keeps him alive. And he drove away with a conviction: Medicare for “some” was not going to cut it.
Up until that day, he was all in for “Medicare for all who want it,” he said in his home last week.
“Now I have to say, we need the Medicare for all, for everybody,” Joseph said. “Put the insurance companies out of business. They’re making profit on human lives. And to me that is unacceptable.”
Days before the New Hampshire primary, Granite Staters are nearing the end of a campaign process in which health care has stayed prominently in the limelight. And candidates have flooded the early primary states with health care plans. Some would take on prescription drug costs; others would tackle expanding mental health services or opioid treatment programs.
But explaining anything to do with health care policy in the 2020 field requires a detour into Medicare for All. It’s the proposal by which the whole race could be defined – the one that has both galvanized and polarized voters everywhere, especially in the Granite State.
The concept is simple enough. First outlined by Sen. Bernie Sanders in a 2017 Senate bill, Medicare for All would turn the U.S. into a “single-payer” for health coverage. That means that private insurance would be eliminated to make way for a national health insurance program that would cover its users’ health care expenses.
The new program would eliminate deductibles, monthly premiums, and co-pays. And it would be free for everyone “at the point of service,” Sanders says.
It would be rolled out over a four-year period but introduced as a piece of legislation, according to Sanders.
Why do this? A national system is the only way to deal with the market forces that let hospitals hike costs procedures while insurers charge patients more, Sanders says. Grouping all Americans into the same risk pool means that costs can be easily distributed, regardless of how sick people get.
That’s the pitch that attracts Joseph.
“These people who had their own private plan are taking from the pool from everybody else, which increases the premium,” he said. “...But when it’s spread over a larger pool – the larger the better – the costs stay down.”
But the program’s potential $32 trillion 10-year price tag and its unyielding requirement that Americans abandon their private insurance have caused alarm among some other candidates and proven an easy way to separate them.
Candidates such as Vice President Joe Biden and Pete Buttigieg have proposed less expansive overhauls, promoting a system of choice that doesn’t eliminate private insurance. That option works by creating a government option for health insurance akin to Medicare, but allowing citizens to opt into it.
Those plans have their own adherents. Take Randy Hayes, a retired family physician from Canterbury. Hayes was in Franklin on a recent Sunday morning, battling the lines outside a high school gymnasium to see Pete Buttigieg, the Indiana mayor who’s made moderate policy provisions a selling point.
A big factor in Hayes’s desire to be there, he said: Buttigieg’s position on health care. The Democratic Party is lurching toward acceptance of dramatic national steps to get universal coverage, he said. But to get the rest of the country on board, the plans needed to stay grounded.
“The country is gradually articulating a commitment to the aspirational goal of universal care, but also a commitment to the practicality of an incremental process to get there,” he said. “I think that’s the distinction.”
Hayes said the recent wave of public support for the Affordable Care Act, the broad-minded piece of legislation passed by the Obama administration in 2010, demonstrates the national appeal of expanded health care. That could make a public option a more attractive proposal, he said.
“I think that if the Democratic Party can be as successful nationally on that issue ... people will see that a public option is not as radical an idea as it had been framed several years ago,” he said.
A number of candidates have agreed with this approach, one of expanding government-run health care while keeping private insurance intact. Among them: Biden, Michael Bloomberg, Buttigieg, Sen. Amy Klobuchar, Tom Steyer and Andrew Yang.
Sen. Elizabeth Warren, meanwhile, has struck out on her own, supporting the introduction of the Medicare for All plan in her third year in office. Hawaii Rep. Tulsi Gabbard is backing the full Medicare for All plan.
Candidates have targeted health care plans, too. Each has a plan to bring down prescription drug prices, for instance.
All of them support allowing the existing Medicare program to negotiate drug prices – a power that Democrats argue could influence the rest of the market.
And many say they’d established caps on cost, either through their intended Medicare for All plan or their public option.
Biden would set up an oversight board to peg domestic sales to international prices, according to a Politico review. Buttigieg, Gabbard, Klobuchar and Sanders would support importation of drugs from abroad. Warren and Yang would support government manufacturing of drugs to bring costs down.
Some candidates say they would boost mental health coverage through Medicare for All – like Yang, Sanders and Warren. Others, like Buttigieg, have championed 10-year grants available to communities to start their own initiatives.
As the promises flow, voters are listening.
Jill Brown of Penacook says it’s the topic that most affects her. “Insurance,” she said at a recent campaign rally. “Most definitely that.”
Brown’s daughter was able to access insurance while was a teenager. But when she turned 18, she became uninsured – and has stayed in that position for a year and a half, Brown says.
Frank Guimont, another Penacook resident, has health care high on his priority list too. “Luckily I’m in a job right now where benefits are great,” he said. But he’s experienced times when he didn’t have it so good, and it’s a big factor driving his vote.
“It’s ridiculous that we’re the most powerful nation in the world, still, for now, but yet we have people that don’t have health care,” he said. “It’s ridiculous to me.”
Both Brown and Guimont said they would support Medicare for All, and the grand upheaval that would entail.
“I think it’s a really good option,” Brown said.
“I just think that I’m tired of insurance companies getting major money,” she added, saying she thought lawmakers should “cut out that middle company.”
Guimont agreed. “You know it would be nice to be able to take a job and not take it for the health benefits,” he said. “The health benefits are there – go do what you want. But you can’t because as you get older, you need the health care, right?”
Still, even while praising it as a concept, Brown and Guimont said the creation of an all-encompassing Medicare for All program is not a necessary condition for their vote. In fact, they’d be equally happy with a public option.
“Pete offers the choice,” Guimont said. “Stay with what you have, or Medicare for All.”
It’s a complicated mentality that could keep Sanders and Warren from scooping up progressively-minded voters who are closer to the middle. And it highlights another dynamic: While increased health care access is top of the minds of most New Hampshire voters, many say they’re flexible in what that looks like.
Mariah Olmstead has a personal perspective. Since she was a kid, the New England College student had a goal: to perform for Disney at a theme park. At 20, that dream took flight, with a job offer at Disney World in Florida. She packed up her things and moved to Disney.
Disney provided her rent and housing, and optional college credit.
But soon she got sick with endometriosis, a tissue condition in the uterus that brings with it sharp pain. The condition has no cure, but can be treated with surgery, an expensive process that brought Olmstead back to Vermont.
She had set aside her dream, and now she faced a bill. Now 24 and finishing up her bachelor’s degree, Olmstead has racked up $10,000 dollars in school and medical debt.
To cope, she’s had to go on Medicaid and get food stamps while in college. Her credit score has also taken a dive.
“It was really tough,” she recalled in an interview in September.
Olmstead told her story at a Sanders rally at New England College back in September. The candidate became immediately outraged.
“What terrible crime did this young lady commit?” Sanders said, turning to the crowd. “What she ran up a medical bill because she was sick. Is that a crime in America? Not that I’ve heard of.”
“That means we change the priorities of this country,” he added. “The value system of this country.”
“Even though I’ve been dealt some bad cards in my life, it doesn’t mean I’m a bad person,” she said. “It doesn’t mean that my life is completely horrible. And I just hope that one day I’ll be able to not be in a crazy amount of debt. That’d be great. So I can actually achieve … the life that I want.”
But that doesn’t mean she immediately knew who she wanted to support.
“There’s so many great candidates,” she said.
(Ethan DeWitt can be reached at edewitt@cmonitor.com, at (603) 369-3307, or on Twitter at @edewittNH.)
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