Choosing is an important freedom and responsibility we have as Americans. As we prepare to choose our next president, let’s consider what choices really matter to us and for us. Although it matters to the Democratic candidates for president that we all have access to quality, affordable health care, the choices they’re debating can be confusing.

During the discussion about “Medicare for all” and “Medicare for all who want it,” I’ve realized that more than 50% of the voting public doesn’t know much about Medicare as it is. I’m hoping to fill in some blanks as we consider various choices.

As a Medicare plan participant, I have the freedom to see doctors of my choice, while many of my friends with private insurance don’t. And, with few exceptions (maintenance chiropractic care, for example), all of my medical needs have been covered by Medicare. I have not experienced the feared extreme wait times for services, tests or procedures; nor do I know anyone with Medicare who has.

A friend predicts this would change under Medicare for all, because the government does, and will negotiate lower fees for doctors and hospitals. The result, my friend fears, would be more patients and fewer doctors and hospitals.

Various analysis shows that the health costs through Medicare for all would be reduced by only 11% overall, so fewer doctors and long wait times are not inevitable.

Medicare is already comprehensive, but Medicare for all proposes even more generous coverage — including dental, vision, hearing, in home care and long-term care.

Prescription drug coverage is not included. “Why not?” I asked.

In 2003, when the Republican Congress passed Medicare Part D (Prescription Drug Coverage), the bill legally prohibited the government from negotiating prescription drug costs! And, now, here we are. People are dying because they can’t afford life-saving drugs such as EpiPens and insulin.

The Medicare for All plan proposes no cost-sharing for plan participants. There will not be premiums, deductibles or co-pays, except for some brand-name pharmaceuticals (capped at $200/year). An average person on Medicare (me, for example) would save $360 per month in premiums: Medicare ($145); supplemental plan ($215) — which covers Medicare co-pays and some additional services, including prescriptions. Medicare monthly premiums range in cost from $0-$415, depending on income and the number of qualifying quarters of work in which we have paid Medicare taxes. Yes, we American workers already pay Medicare taxes!

Although we don’t see advertisements with seniors and disabled people talking about how terrible Medicare coverage is, many current Medicare participants can’t afford the supplemental coverage. They are financially responsible for an annual deductible and 20% of their health care costs, and many have become bankrupt beneath the burden of that 20%. I met one such senior at the Rescue Mission. His wife had recently died from cancer and all of their savings and substantial debt went to paying for the uncovered parts of her care. He was homeless as a result.

We also need to be attentive to details of the “Medicare for all who want it” plans. According to reporting by The Washington Post, the more accurate title for the Buttigieg plan is: “Medicare for all who want it and those who don’t want any insurance at all.” Those who don’t enroll in any plan will be automatically enrolled in Medicare and sent a retroactive bill at year’s end — which could be as much as $7,000, 10 times higher than the Obamacare tax penalty for opting out. This mandate is needed because large numbers of people must participate in insurance plans in order to keep the costs reasonable.

Health care has become an arena where a battle over choice is taking place. Do we want to make choices about our doctors and our care? Or do we want to make choices about which insurance company we hire to pay our health care bills? Most importantly, are we paying attention to the details and consequences of what we are choosing?

The author is a Unitarian Universalist Minister and a member of Downtown Dubuque Christian Outreach. Her email address is