The Doctor Can Not See You Anymore
Written in conjunction with guest author LRM.
In our continuing “Pie in the Sky” series (See “Cheap Medicine, 4/22/19), let’s take a look at the make believe numbers of “Medicare for All.” First off, the proposed Medicare plan is NOT Medicare as we know it today. Today’s Medicare has premiums (that increase with income), deductibles (about $1600 for EACH hospital visit), and copays (20% of the total bill if you don’t have Medigap insurance, which you have to pay for separately). Medicare Advantage plans eliminate some of this expense, but they are run by private insurance companies and function like an HMO. They can restrict your access to specific “in network” hospitals and physicians, whether you like them or not. And, going “out of network” for specialized cancer treatments, for example, can be a very expensive “surprise.” Medicare requires pre approval for many tests and procedures and sometimes arbitrarily refuses to pay for certain medications, treatments or devices because that’s “just the way it is”. Period. End of story.
But Bernie Sanders and Kamala Harris, as well as other dreamers off in the socialist stratosphere, have their sights set on much, much more. In what amounts to a takeover of the American Health care system, they promise NO premiums, NO copays, NO deductibles, and NO incentives that discourage over usage (so called ”skin in the game” provisions). Sanders and Harris imply that, in their plan, you could see ANY doctor, at ANY hospital, at ANY time you want to, and avoid “paperwork” to boot! The sky’s the limit! Oh, and it will also cover long term nursing home care, which Medicare doesn’t even pretend to cover now. And it will be for EVERYONE—whether they’re citizens, legal immigrants, illegal immigrants, “medical migrants” or visitors just passing through.
The cost? That’d be 30 TRILLION dollars over 10 years, or, roughly 3 trillion PER YEAR! And proponents hope to accomplish all this while paying doctors 40% LESS than current Medicare rates, already well below the actual cost of delivering care. Since private insurance will be outlawed, there won’t be any other payers from which doctors can make up the shortfall. There’s already a significant shortage of doctors in America. Appointments, even now, are scheduled months and months in advance. This will NOT improve with “Medicare For All.” Talented individuals that put 12-16 years of study AFTER HIGH SCHOOL into their education, and who often stay up all night on call making split-second life and death decisions, will need to be paid fairly for all of this intense effort. If salaries aren’t fair and competitive, the “best and the brightest” will simply go elsewhere with their career choices. The 40% less salary will likely result in 40% less doctors! Even if the government tries to compensate for this shortfall by utilizing “physician extenders” or, even, doctors from far away lands, these measures will be unlikely to maintain the quality of medical care that Americans have have come to expect.
Now thirty trillion dollars is a number that’s hard to wrap your head around, so let’s do a little math. (Don’t worry, you will be tested only at the voting booth). One trillion dollars is ONE THOUSAND BILLION dollars. To put this number in perspective, the yearly “after expenses” profits of Google is about $30 billion a year. Amazon is about 11 billion, Apple is 50 billion and Ford Motor Company, 3.7 billion. Total profits of these big companies, therefore, add up to less than $100 billion a year. That amounts to only 1 trillion dollars over 10 years. Where is the remaining 29 trillion going to come from? Good question! Even if you took every last dime of corporate profits, it still falls far short of what’s needed. Well, you might say, let’s look for “deeper pockets”: the good old American taxpayer. He’s good for it. Federal tax revenue in 2018 was about $3.5 TRILLION dollars (or 35 TRILLION dollars over 10 years). Now we’re getting somewhere! But, such a budget would, unfortunately, leave only a half a trillion dollars each year for defense, infrastructure, education and welfare, only ONE SEVENTH of what’s needed. So, to pay for “Medicare For All”, you could suck every last dollar out of federal taxes and still not have enough for a viable budget. By a long shot.
Something has to give. And that something will be quality of care. The reality of “Medicare for All” will be long waits, extreme rationing and yet another unfunded liability to pass on to our children. Remember, current Medicare, which most of us have paid into for years and years, and which puts a significant percentage of cost back on to patients, is set to go bankrupt in 2026, only 7 years from now! How in the world do they think they can offer so much more and remain solvent? In reality, I’m convinced that they don’t believe their own hype. These promises are merely slogans designed to bring in votes. As Democratic candidate John Delaney has said, the Democratic “medical plans” are “slogans posing as policies.” A surprising statement comming from a Democrat, and one that was loudly BOOED at a recent Democratic rally in California, but is, none-the-less true.
What “Medicare For All” really represents is a brazen attempt on the part of the Democrats to NATIONALIZE at least one fifth of our economy, thereby taking a huge step toward the socialist “paradise” they long for. The current Democratic plan would outlaw private insurance and even cash payments to physicians. Doctors will only be able to practice under the auspices of the government. Your doctor, therefore, will be working FOR the government, NOT for you. Consequently, his or her primary allegiance will be, of necessity, to the government. The doctor-patient relationship that Americans have long cherished will be a thing of the past.
So remember what your mother told you: “If something sounds too good to be true…. it probably is!” Think long and hard about this in 2020 when you walk in to that voting booth. “Medicare for All” sounds wonderful, but the reality is NOT what they advertise.