Medicare For NONE?
The following essay was written by guest writer LRM.
Recently Senator Kamala Harris announced her candidacy for the Presidency of the United States. Like many of her fellow “progressives” in the Democratic Party, she promises “Medicare for all”. In a CNN town hall interview she stated that health care was a “right” and like all rights, it would need to be supplied by the government. Further, she indicated that her intention was to eliminate private health insurance entirely. So, this time around, if you like your insurance, well too bad! You won’t get to keep it.
Harris then went on to make a number or statements that make it quite clear that she is not, in the foggiest, familiar with the actual workings of Medicare. In the good Senators own words:
With Medicare, “you won’t have to go through the process of going through an insurance company, having them give you approval, going through paperwork and the delay that may require. Who of us has not had the situation where you’ve got to wait for approval and your doctor says “I’m not sure whether your insurance company is going to cover this.”
Now, anyone who actually HAS Medicare will take issue with this statement straight away. As ALL Medicare subscribers know, Medicare IS an insurance company, and operates exactly like every other insurance company in America! Extensive paperwork is STILL required. Pre authorization for non emergency procedures is STILL required. Arbitrary limitations and restrictions are sometimes STILL applied. And the appeal process in Medicare is even less responsive than it is in the private sector.
Because I have recently transitioned to Medicare myself, I can tell you, from personal experience, that, in some ways, Medicare can make private insurance look GOOD. It often makes rules that conflict with your physicians orders— things like how often you can check your blood sugar, what blood pressure medication you can use, and what treatments are “unnecessary”. And, as is typical of government bureaucracy, many of their rules make no sense. Medicare, for example, will pay for you to go to a hospital infusion center for the administration of intravenous medications, thereby incurring exorbitant facility fees, instead of authorizing home infusion which is much LESS expensive. Along similar lines, Medicare will pay for nursing home care ONLY if the patient has stayed in the hospital for THREE NIGHTS prior to the transfer. Not unexpectedly, this results in many patients being held over in hospitals for the three nights to fulfill the requirement when they could have been discharged, in some cases, 1 or two days earlier.
Aside from these issues with Medicare as a insurance company, there’s another very important problem, one that is discussed rarely. It’s a dirty little secret: if Medicare reimbursement were the sole source of physician reimbursement, at current Medicare reimbursement rates, many medical practices would go out of business, and some will do so very quickly. It turns out that physicians are so underpaid by Medicare and Medicaid that the actual cost of treating those patients ends up being covered by the more reasonable fees paid to physicians by private insurance and self pay patients. While I was working as an anesthesiologist in group practice, I remember being astonished to learn that while Medicare was 40% of our “business” it was only 6% of our revenue! SIX PERCENT! I think you can see that if all insurance companies paid us Medicare rates, we would not have been able to afford our office staff, let alone provide the necessary clinical services.
So if the government truly wants to take over health care, then it needs to prepare itself to provide fair reimbursement to doctors or risk a radical change in either the quantity of health care we enjoy or the quality of such care. Ask yourself, are the “best and the brightest” young men and women going to invest in 12 to 15 years AFTER high school in medical education and training, when other professions require less training and are more lucrative and less stressful to boot? Our most talented individuals will look elsewhere.
Cynics among us might suspect that such a result may actually be the government’s clandestine goal: less doctors mean less treatment, and less treatment means less medical costs. How convenient! So, if Medicare does indeed become “single payer” for our nation’s health care, be prepared for long waits for appointments and even longer waits for treatment. Be ready for less “face time” with the doctor and endless time spent with paraprofessionals. Expect restrictions on the the availability of state of the art medications and treatments. Expect loosening standards of monitoring and follow up. Unfortunately, “Medicare for all” will be feasible only if all these sorry eventualities come to pass. We used to call this process “rationing“, but lately the euphemism that Medicare likes to use is “rationalizing”! As if excellence in timely medical care is somehow irrational.
It’s an “inconvenient truth” that having insurance is not the same as having access to medical care. Your “right” to medical care may be significantly compromised by a lack of physicians to treat you, and by the lack of available treatments and medications for them to treat you with. Don’t be surprised, ladies and gentlemen, if “Medicare for all” inexorably evolves into “Medicare for NONE”.