The knives are out. This is what we are up against in order to get real change in healthcare. But in one area I find myself in agreement with an argument against Medicare for All. The crux of one major issue is buried deep in the story.
Some members of the coalition have financial as well as philosophical reasons for resisting the push to expand Medicare. Doctors and hospitals say Medicare generally pays less than private insurance, and hospitals say the payments frequently do not cover the costs of providing care to Medicare patients.
“Chronic underpayment to providers creates access issues for seniors, particularly with physicians, who may limit the number of Medicare patients they see,” said Richard J. Pollack, the president of the American Hospital Association. Congress, he said, often makes changes in Medicare for reasons that have nothing to do with sound health policy — to offset the costs of tax cuts, for example.
This is a real issue, one that I hear from providers as a substantial problem for them. It has contributed to a decreasing base of providers that are willing to take Medicaid and Medicare patients. If we put everyone on Medicare without fixing the reimbursement problems, it will simply have the unintended consequence of driving more primary care doctors out of business, or into the hospitals. Today 40% of doctors work for hospitals which is up dramatically over the last few decades. Hospital care is more expensive than independent physicians.
Also, as I have pointed out elsewhere, not all doctors take Medicare! Even the ACA has numerous plans and many doctors, because the administrative cost is so high to take lots of programs, only take a couple of the various plans. So patients don’t have the flexibility that Medicare for All seems to promise. Add to that that Medicare doesn’t cover everything, it leads to wealthier patients getting better care and Medicare only patients sometimes getting none at all. Yes. That is one of the reasons why Medicare supplemental coverage exists.
So while politicians like Bernie and Warren use this as a campaign slogan, the critics of it will be beating the drum as we go into the election, using tens of millions of dollars to counter it and this issue could be the deciding factor in States that swung the election last time! It’s time we stopped just shouting campaign slogans and came up with something that could provide everyone decent healthcare as Canada does, while fixing issues like provider reimbursal rates and the shortage of physicians in this country in general.
NY Times today.
Health Care and Insurance Industries Mobilize to Kill ‘Medicare for All’