Health Care


Bernard F. Cookson

1 February 2019

            The USA is the greatest country in the world, in my opinion. Can we do better? Sure, we can always do better. Look at what we have done over the last 60 years in the area of equal opportunity. Interracial marriage was against the law until 1967,Loving v. Virginia, 388 U.S. 1 (1967).Same sex marriage was against the law until Obergefell v. Hodges 576 U.S. ___ (2015). Do we still have room for improvement and can we do better? Of course, we can.

            The CIA World Factbook lists life expectancy as 80 years old in the USA. This statistic ranks the USA as number 43 on the life expectancy list by country. It seems I only have a few more years left to write about this issue so I thought I should get busy. 

Can and should we do better on this life expectancy list by country since we are the greatest country in the world? Sure, is again my answer. What are those other 42 countries doing that we are not doing that makes them live longer? I think healthcare is one big factor. The CIA World Factbook also ranks Healthcare expenditures on a Gross Domestic Product (GDP) basis by country. 

Monaco is number one on that life expectancy list, they have universal health care and spend 4.3% of GDP (2014) on healthcare. How much do we pay for health care in the USA? The CIA list indicates that we pay 17.1% of GDP (2014). Shouldn’t we therefore live 4 times longer than those Monacan’s that are living longer than us? This might be a hint that we are doing something wrong! 

How about those other 42 countries where they also live longer than us in the USA? 

Number 2 on that life expectancy list, Japan, they have universal health care and spend 10.2% of GDP (2014). Number 3 on that life expectancy list, Singapore, they have universal health care and spend 4.9% of GDP (2014). Number 27 on that life expectancy list, New Zealand, they have universal health care and spend 11% of GDP (2014). Number 14 on that life expectancy list, Australia, they have universal health care and spend 9.4% of GDP (2014). Number 21 on that life expectancy list, Canada, they have universal health care and spend 10.4% of GDP (2014). Number 47 on that life expectancy list, Denmark, they have universal health care and spend 10.8% of GDP (2014). Oops, they do not live as long as us but they do spend quite a bit less than us on health care. Number 33 on that life expectancy list, Ireland, they have universal health care and spend 7.8% of GDP (2014). I think you get the idea. In the USA we spend a larger percent of our GDP on health care than any other country in the world and we only rank as number 43 in life expectancy. These statistics were retrieved 30 January 2019 from the following websites:

            Two of the above websites belong to the CIA and unlike our President I tend to believe what the CIA publishes.

Some people have proposed Medicare for all. I have Medicare, I like it, I do buy a Medicare supplement that costs me $200 plus dollars a month. The media tends to indicate that private healthcare would be eliminated if we have Medicare for all. I have not been able to eliminate private health care and I have Medicare. I think the media is wrong, it seems even the President is right at times. 

Everyone else that I know that has Medicare also has a private health care supplement so I do not have the foggiest idea why anyone would say Medicare for all eliminates private health care. This is also the time to make the point that “insurance” is the wrong word to use for purchasing private healthcare. Insurance is protection against a contingency. A Health Care requirement is not a contingency, eventually you are going to get sick and die, assuming you do not get shot or runover by a fellow human being in the meantime. You buy fire insurance because your house may burn down. You buy healthcare coverage because you are eventually going to need it if you do not need it today. There is no contingency here.

Who pays for Medicare. Let us look to the Medicare website for that answer:

How is Medicare funded?

In 2016, Medicare covered over 56 million people. Total expenditures in 2016 were $678.7 billion. This money comes from the Medicare Trust Funds.

Medicare Trust Funds

Medicare is paid for through 2 trust fund accounts held by the U.S. Treasury. These funds can only be used for Medicare.

Hospital Insurance (HI) Trust Fund

How is it funded?

  • Payroll taxes paid by most employees, employers, and people who are self-employed
  • Other sources, like these:
    • Income taxes paid on Social Security benefits
    • Interest earned on the trust fund investments
    • Medicare Part A premiums from people who aren't eligible for premium-free Part A
      • Other sources, like interest earned on the trust fund investments
        • First, they must provide all patients with a medical screening examination to determine whether an emergency medical condition exists without regard for ability to pay for services.
        • Second, where an emergency medical condition exists, they must either provide treatment until the patient is stabilized, or if they do not have the capability, transfer the patient to another hospital.
        • Third, hospitals with specialized capabilities are obligated to accept transfers if they have the capabilities to treat them. Medical care cannot be delayed by questions about methods of payment or insurance coverage.

Supplementary Medical Insurance (SMI) Trust Fund

How is it funded?

·      Funds authorized by Congress

Retrieved 30 January 2019 from:


Today there are a large number of citizens without a Health Care program. The Affordable Care Act (ACA) tried to fix that but it seems nobody likes it. Many individuals did not join into the ACA. Do we in America just let them get sick and die? Well some of them we do, such as the homeless that may die in a makeshift street tent under a bridge or even on your doorstep in the city. For the rest of those Americans without a Healthcare Program we tell them to go to an emergency room for free care. Emergency rooms at hospitals are usually full with many people that do not look very wealthy. Sometimes they just have colds and they get in the way of those of us with Health Care programs that may be dying and really need that emergency room. 

This free care has to be paid somehow so who do you think is paying? The answer is the rest of us with Healthcare and/or various forms of government funding which is also paid for by the rest of us.

The Emergency Medical Treatment and Labor Act (EMTALA) is a Federal law enacted by Congress in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (42 U.S.C. §1395dd). Referred to as the “anti-dumping” law, it was designed to prevent hospitals from refusing to treat patients or transferring them to charity or public hospitals because they were unable to pay or had Medicaid coverage. EMTALA requires hospitals with emergency departments to provide emergency medical care to everyone who needs it, regardless of ability to pay or insurance status. Under the law, patients with similar medical conditions must be treated consistently. The law applies to hospitals that accept Medicare reimbursement, and to all their patients, not just those covered by Medicare. 

Hospitals have three basic obligations under EMTALA

Retrieved 1 February 2019 from:

All of this is to say it is really a no-brainer, we should have Medicare for all since this also means we need private healthcare insurance to supplement Medicare. Everyone I know on Medicare has a private insurance Medicare supplement. The system is in place, it works, it is funded by payroll deductions administered by the Internal Revenue Service. The Medicare administrative system does a great job at enforcing reasonable payments for all kinds of medical treatment.

The writing is on the wall, as the saying goes, what more could we possibly need to prove that Medicare for all is the only sensible answer to our Health Care crisis in America.

Coronavirus is unfortunately a prime example since those without insurance as well as those with insurance are showing up in Emergency rooms and the uninsured are being paid for by the federal government. 

Bernard "Bernie" Cookson

phone air: 508 864 6367

phone land: 415 888 8879

290 Shoreline Hwy

Mill Valley, California, USA