Beware Medicare For All!

I have thoroughly enjoyed writing my weekly blogs during the last 16 months. I have written on many topics of current interest, but one topic I have largely avoided is healthcare. So why is that? Great question with an easy answer. As I discussed in my book, Almost Finished {https://a.co/d/0isf0TkV}, after working as an attorney in healthcare for 39 years, I can say without fear of contradiction that healthcare is incredibly complex. And anyone who professes a clear understanding for the current problems today in healthcare and professes to have a silver bullet solution is only kidding himself and anyone foolish enough to believe him! With that said, why am I writing about the topic today? Frankly, it is because I am reading and hearing so much nonsense in the news today about healthcare that I feel compelled to share a few thoughts.

By no means is the substance of my blog intended to be a blueprint for solving the problems that afflict our healthcare system today. Solutions will be complicated with arduous study and debate. I am convinced that healthcare, just like much of life, is local and needs to be addressed far more on the state and local level. The federal government should have a role but should certainly not be the all-knowing final word for healthcare. It is my hope that the things I share in this blog will connect with others who have experienced frustrating challenges in today’s healthcare system and encourage informed discussion which will in turn result in much needed improvement. I sincerely trust this will be the case.

The battle cry for many individuals running for the U.S. House of Representatives and the U.S. Senate as Democratic Socialists or at least sympathetic with Democratic Socialist policies is “Medicare for All!” How wonderful! Just like switching on a bedroom lamp or turning on the kitchen faucet, free healthcare is at your disposal just like an “all you can eat buffet!” Yes, how nice and how foolish at the same time! Why do these individuals fail to understand and acknowledge that there is healthcare rationing today in our healthcare system and there will be far more rationing if Medicare for All is enacted. When was the last time you were told by your physician that a certain medical procedure or medication the physician would like to use in your care plan would likely not be covered by private insurance or Medicare or Medicaid? Do any of these individuals running for office ever stop to even attempt to explain what their Medicare for All plan will cost and how to pay for it beyond some pious platitude of having the “rich pay their fair share of taxes!” It is certainly fair to discuss marginal tax rates and tax loopholes available to wealthy individuals, but anyone who thinks that just “soaking the rich” will pay the bill for Medicare for All is not being honest. No one now paying taxes will escape paying far more in taxes if Medicare for All is ever adopted.

One of the most credible actuarial estimates for increased federal spending following the adoption of Medicare for All is from the Urban Institute. The Urban Institute estimates that federal healthcare spending would increase by approximately $34 trillion dollars over the first 10 years following the adoption of Medicare for All. Other estimates from other reputable actuarial sources have similar estimates, with some greater and some less. While healthcare spending by employers, households, and state government would likely be reduced if Medicare for All is adopted, you can be certain that taxes will be increased for every taxpayer. There are just not enough rich taxpayers to “soak.” Someone will have to pay, and it will not be the Tooth Fairy!

But what will the public receive if Medicare for All is adopted. Will same day doctor appointments be available and will surgical procedures be scheduled promptly? Anyone who has had recent interactions with the healthcare system surely knows the answer to these questions.  Appointments to see a physician and schedules for surgery are routinely delayed. There is now a shortage of primary care physicians. Current Medicare and Medicaid payments to primary care physicians and specialists are far lower than payments from private insurance. Consequently, many primary care physicians, physical therapists, psychiatrists, and personal counselors have adopted a “Concierge” practice model where they do not serve Medicare, Medicaid, or private insurance patients but only private pay patients who pay for the office visit out of pocket themselves through a subscription service. Does anyone believe that this trend will not accelerate if Medicare for All and Medicare type payment rates are the rule for all medical providers?

Before concluding this blog on healthcare, it is only fitting to share a few thoughts on Congress’ last major effort for healthcare reform in 2010 with The Affordable Care Act (ACA) sometimes also known as Obama Care. Unfortunately, once the dust settled on the ACA, healthcare is now far more expensive and far less available than ever. What are some of the reasons for this? As stated above, payments to physicians and hospitals under Medicare and Medicaid are far less than payments under private insurance, so guess what has happened? Hospital Systems have acquired physician practices in spades and now have increased bargaining power in negotiating with private insurance companies for increased payments to offset lower payments received from Medicare and Medicaid. So, when health insurance companies pay hospital systems more, the health insurance companies charge higher premiums to employers. Healthcare becomes exponentially more expensive. So where does this leave you and your primary care physician? Many primary care physicians have “thrown in the towel” and have become employees of hospitals/health systems or other corporate entities. The Physician Advocacy Institute estimates that approximately 78% of all physicians have taken this step. Many established primary care physicians with strong patient bases have declined to become employees of a hospital/health system or continue in independent private practice dealing with private health insurance plans and Medicare and Medicaid. These physicians have decided to adopt the Concierge practice model discussed above and now only treat patients who pay for care out of pocket themselves. Most individuals cannot afford or choose not to use the Concierge model and are left to deal with a shrinking universe of independent primary care physicians in private practice who will take them as patients.

I am incredibly thankful that my excellent primary care physician has remained independent and provides incredibly good care to me and his other patients. I feel sorry for individuals who seek treatment from physicians employed by hospitals/health systems and experience delays in securing appointments and have the added “pleasure” of dealing with an even larger healthcare bureaucracy with physicians now employed by a hospital/health system. We have so much to thank the ACA for in “improving” our healthcare experience!

So, the next time you hear a speech by any politician running for Congress, Governor, or state legislature extolling the virtues of Medicare for All as a silver bullet solution for the challenges facing our healthcare system today, just remember that this silver bullet has a great deal of rust on it!  And just like stepping on a rusty nail barefoot, if Medicare for All is enacted it will not be a pleasant experience for patients receiving care in our healthcare system!

God bless you and thank you for the privilege of your time in reading my blog.

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