A new study released by Charles Blahous at the Mercatus Center at George Mason University has received a lot of attention this week. It concludes that the “Medicare for all” proposal endorsed by Sen. Bernie Sanders (I-Vt.) and others would “increase federal budget commitments by approximately $32.6 trillion during its first 10 years of full implementation.”
The study goes on to point out that “doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan.”
The study states that the new plan would increase health-care demand and utilization by “roughly 89 percent.” This increased utilization would be partly due to reaching people with dental, vision, hearing, and other essential services who weren’t covered before, but also because doing away with deductibles and co-pays —which are the brakes on the current system would lead directly to overuse.
So what are people saying about this?
At first, liberal thinkers dismissed the study’s findings as being more conservative think tank propaganda from an institution who receives donations from the Koch brothers and other wealthy conservative donors. But liberal ears perked up with the study’s estimate that $846 billion would be saved from negotiating lower prices for prescription drugs as well as administrative savings because public insurance is cheaper to administer than private (6 versus 13 percent).
What do doctors think?
Well, Medicare reimburses health-care providers at much lower rates than private health insurance does, and according to the study doctors can expect to be reimbursed 40 percent less.
Keep in mind that we doctors are already struggling under the current system because of computerization and excess regulation so paying us less to do more at a time of rapidly increasing technology and innovation does not sit well with us.
Not only that, but single payer (Canada for example), has a habit of rationing care to save on costs which leads to long waiting times for elective procedures. This puts increasing pressures on both patients and doctors and is particularly problematic at a time with emerging personalized treatments including CAR-T (the immunotherapy for cancer where your white blood cells are removed from your body, genetically engineered to fight the cancer, and re-injected) are routinely costing over $300,000 per treatment.
But the real elephant in the room is not the enormous cost expenditures of transition or the ultimate belt-tightening/procedure-tightening cost savings, but the fact that Medicare for all would completely upend the current system, which is actually, to a large extent, working. This is a typical politician’s trick. Promise huge sweeping changes to garner votes and support. Yes the 28 million people in the U.S. who are currently uninsured are an enormous problem that we have a public health responsibility to address.
But consider that 170 million people already receive health care from their employers. This has been the backbone of our health care system since the 1950s, with employers offering the benefit tax free while employees frequently taking a job to make sure their health care needs are covered. Many improvements including portability are definitely needed, but the essential concept is still working, and Single Payer would directly compete with and undermine this.
Plus, an additional 130 million people are receiving insurance coverage targeted to their needs provided by the government in the form of Medicare or Medicaid. And though this system too is far from perfect, reform rather than expand to Medicare for all is by far the more practical right way to go.
Current attempts by Health and Human Services, FDA, and CMS are underway to bring down drug prices through increased transparency, more generics approved which means more choice, and making sure that rebates go to the patient rather than the middleman — pharmacy benefit managers. Renewable skinny insurance plans up to twelve months are being introduced to pick up the slack for those who aren’t able to obtain or don’t want ObamaCare.
With the individual mandate on its way out, I now believe that a public option should be considered for the 28 million uninsured. As a practicing physician it never made sense to me to mandate coverage for a young healthy person in order to provide funds to cover an older sicker person. That’s the obligation of the government perhaps, not the individual citizen’s. ObamaCare also hasn’t worked well in the doctor’s office, where ObamaCare plans include high deductibles that often interfere with a patient coming to see me for basic health care.
I believe that everyone should be covered with at least basic health coverage that provides for an emergency. I also believe that the government should provide a health care safety net directly, as it is already doing via the Federally Qualified Health Centers and the National Health Service Corp, which provide care for millions, have both been expanded with increased funding under the Affordable Care Act and should both be expanded further. But this functioning safety net is a far cry from the overly ambitious enormously expensive bells and whistles of Medicare for all.
Finally, the insurance lobby is strong, and will never allow Medicare for all to pass Congress. And if it were to somehow become a reality, it would it would never work well in the American doctor’s office.
Not only shouldn’t we be over-restricting or over-regulating care at a time of great innovation, but we also don’t need to replace too much insurance oversight with too much government oversight. The better solution is to provide directly for the have nots without taking away from the haves, or for that matter, from their doctors.
