It’s fall already and by this time next year we will all (I hope) be thinking about who we will vote for in November.  I’m not going to go into President Trump’s policies and promises as we will have 5 years worth of those, counting the time he was campaigning.  I do urge you to consider what the opposition is proposing because there is a good deal to choose from. Unfortunately, Hawaii being a relatively small State, our impact is limited.

At least two candidates are proposing “Medicare for All.”  Medicare by itself is not enough. Seniors that have Medicare already either have employer coverage that supplements their Medicare or they buy a 

Supplement or Medicare Advantage Plan.  Medicare for All would be extremely expensive but our health system is already extremely expensive and it doesn’t serve everyone.  Medicare for All would cut down on the costs for claims administration and other bureaucratic paperwork and could cut the cost of drugs.  There is a bill in Congress right now that would do that but chances of passage are slim.

On the negative side, many medical professionals are leaving Hawaii and they cite low reimbursement rates.  Reimbursement rates even for insurance companies are set by Medicare. The insurance companies look at what Medicare is paying and set their reimbursement rates as a percentage or ratio of what Medicare pays; generally, a few percentage points higher.  That means that medical professionals would be making less money than they are now. And every year Congress would be able to cut the reimbursement level. 

We don’t get to vote on whether to have Medicare for All or the Patient Protection Act but the candidate that is elected will decide.  President Trump has said he has a plan but we have not seen any specifics. If John McCain had not had the courage to vote against the bill to cancel the PPA  three quarters of the country would have been without any medical coverage at all because there was no plan to replace it and it would have taken time for the insurance companies to get any new plans through State Insurance Departments.  

Think about it, and vote.


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