I’ve written many articles on this subject, starting with this one: “Medicare For All Americans – Everywhere.” I wrote, “Most Americans who receive Medicare do not realize that they cannot get those benefits if they live outside the United States. Basically, Medicare is geographically limited. The program is only good (for the most part) within the borders of the United States. If you live outside the United States more or less permanently, you aren’t covered unless you have some way of getting back inside relatively easily.
If you live outside the United States more or less permanently, you aren’t covered unless you have some way of getting back inside relatively easily.
“What’s the point of this exclusionary rule? While it is not expressed specifically, the reason for the rule is plain: the government wants retired persons with their disposable income to remain within the American economy. And, of course, the American medical establishment wants older patients to remain within their economic grasp.” I published this article in both LA Progressive and Nation of Change. I even followed it up in our local Mexican ex-pat newspaper with a letter to the editor. That’s because using Medicare outside the United States is important to all American ex patriots.
Incidentally, it would be foolish to permit doctors to try and keep older patients inside the U.S. “As America's population ages and demand outpaces supply, a physician shortage is intensifying. Projections from the Association of American Medical Colleges say the U.S. will see a shortage of 46,900 to 121,900 physicians by 2032 in primary and specialty care.”
I wrote the article and a follow-up at the beginning of 2019. While I was writing the follow-up, I came upon an article written by Democrats Abroad, in which they asked both Hillary Clinton and Bernie whether Medicare should be available to Americans living outside the country. Hillary answered:
Medicare portability: Would you support an amendment to the Medicare law permitting American citizens to use Medicare benefits to pay for health care in approved medical facilities located outside the USA?
I’ve fought to protect and strengthen Medicare throughout my career and have continued to press the importance of this lifeline in this campaign. I support further examination of how Americans over 65 living abroad and eligible for Medicare could apply their benefits to care at approved medical facilities located outside the U.S.
That was not a definite vote in favor. Bernie did better:
Question: Would you support an amendment to the Medicare law permitting American citizens to use Medicare benefits to pay for health care in approved medical facilities located outside the United States?
I support a Medicare-for-all single-payer health care plan to make health care a right, not a privilege, for all Americans, including Americans living and working abroad. Instead of spending federal health care dollars on the multi-million dollar salaries of insurance company CEOs, it is time to use this money to guarantee health care to every American citizen.
As you know, retired U.S. military personnel and their dependents living overseas are reimbursed by the U.S. government for most of their medical bills through the TriCare For Life system. In my view, there is no reason why we cannot use the Tricare program as a model for a Medicare delivery program for all Americans living overseas.
Incidentally, Rocky De La Fuente, a perennial candidate then still in the 2016 Democratic primary, also answered the question:
Medicare portability: Would you support an amendment to the Medicare law permitting American citizens to use Medicare benefits to pay for health care in approved medical facilities located outside the USA.
While I understand the countervailing argument that the United States has an interest having Medicare disbursements “recirculate” within its economy and that there may be legitimate concern about monitoring fraud in foreign countries, the reality is that Medicare is truly an entitlement since its funding comes from those who have made forced contributions to it. Individuals who have contributed to the Medicare systems should be able to deploy any disbursements where and as they choose to secure the medical treatment they need. Imposing limitations that are for the convenience of our government as opposed to the best interests of its citizens does not reflect the values upon which our Nation was founded. It is not only an unsound economic approach, it is morally wrong.
This is an interesting answer because Mr. De La Fuente is presently running for President as a Republican. I have asked several Republicans here in Mexico if they saw anything wrong with extending Medicare outside the U.S. borders and they all said they didn’t. De La Fuente was the nominee of both the Reform Party (founded by Ross Perot) and his self-created American Delta Party for President of the United States in the 2016 election. He appears to be economically conservative but socially more liberal.
I feel a lot of comfort reading Bernie’s words now. But I would feel a lot more comfort if in the past three years he had proposed in “Medicare for All” or amendments to the operative Medicare law provisions which made one or both applicable to Americans outside the U.S. Unfortunately, he has yet to do that. His Medicare for All Bill, introduced in April 2019, states:
SEC. 102. Universal entitlement.
(a) In general.—Every individual who is a resident of the United States is entitled to benefits for health care services under this Act. The Secretary shall promulgate a rule that provides criteria for determining residency for eligibility purposes under this Act.”
Stated bluntly, he did not provide that “Every individual who is a citizen or a resident of the United States” is entitled to coverage. Consequently, non-resident citizens are left out in the cold, despite the clear statement he made to Democrats Abroad during the 2016 primary.
I remain a Bernieite, confident that he will propose the changes. Bernie is not a lawyer, and I suspect that whoever drafted “Medicare for All” just copied the existing Medicare law so far as the residency requirement was concerned. That’s because few lawyers other than those who live outside the U.S. or are true experts in Medicare realize that non-resident Americans do not qualify.
As I have written recently, Bernie’s best political strategy would be to confirm his statement to Democrats Abroad that the changes will be made soon and then make them in the draft legislation to “Medicare for All.” He should also file a similar amendment to the existing Medicare law This would immediately increase his popularity with Americans abroad. Three million can vote, but only about 7% do (in the general election). If voting went up to the normal amount within the U.S., Bernie would benefit in the primaries (Democrats turned out 14.4% in the 2016 primaries). In the general election, the likely outcome is that even Republicans would vote for him.
Overall, I think Mr. De La Fuente is right: “Imposing limitations that are for the convenience of our government as opposed to the best interests of its citizens does not reflect the values upon which our Nation was founded. It is not only an unsound economic approach, it is morally wrong.”
Michael T. Hertz