Editorial counterpoint: Open up Medicare? First, try to understand how Medicare works

The Star Tribune editorial "Single-payer attack ads ill-serve debate" (Oct. 15) calls for a more nuanced discussion of Medicare and health system reform. I recently turned 65 and signed up for Medicare. To contribute to the conversation, I offer some firsthand lessons learned.

First, Medicare is complicated. Both Democrats and Republicans are slinging simplistic slogans, but Medicare itself is anything but simple.

Most people know about Part A (hospital) and Part B (outpatient) and perhaps Part D (prescription drugs). But the Medicare alphabet runs all the way from A to N. No wonder everyone who reaches 65 needs help from an adviser to choose a Medicare plan.

Second, Medicare is a good deal, or at least it can be. In fact, Medicare Advantage (Part C) plans in Minnesota are a great deal, if you are willing to go with private Medicare insurance and accept HMO-like limitations on provider networks. Part C plans combine Parts A, B and D (as I said, it is complicated). My wife and I paid $376 a month for our share of the premium for the employee-plus-spouse coverage we had from my wife's employer. That plan had a huge annual deductible. We now pay $356 a month for our Medicare Advantage plan. It has just a $195 deductible.

Of course, it is the Medicare Trust Fund that makes our plan so affordable. What would it cost for folks to "buy in" to Medicare? We already know what it costs for seniors who have not worked enough to qualify for Medicare to buy into Part A. If you paid Medicare taxes into the Trust Fund for less than 30 quarters, the standard Part A monthly premium for 2019 is $437. It is $240 if you paid Medicare taxes for 30-39 quarters. The standard Part B premium for 2019 is $135.50 (higher depending on your income).

Buying into Medicare, therefore, costs seniors about $375 to $572 per month. For a couple, $750 to $1,144 per month. How affordable is that? Good question.

What do you get with Part A and Part B? Another good question that leads to the third lesson: Medicare does not provide comprehensive coverage. What is and is not covered is very complicated, and Part B illustrates the limitations. The yearly deductible is low, only $180 per year. But, after that small deductible, beneficiaries pay 20 percent coinsurance, with no out-of-pocket maximum for physician and outpatient services.

That brings me to lesson No. 4: For most beneficiaries, Medicare is not "single payer." Advocates of Medicare-for-all may argue that it would eliminate private insurance companies, but real Medicare doesn't work that way. According to the Kaiser Family Foundation, only 14 percent of seniors go with only basic A and B. Every senior who can afford it buys some form of private supplemental insurance or opts for a Part C plan.

Does Medicare for all, or buying into Medicare, mean limited coverage for those who can only afford Parts A and B and much better coverage for those with the financial means to pay extra for extra private insurance? Good question.

In sum, working toward health system reform by building on Medicare can provide a way forward. But it is essential to understand how Medicare actually works.