People from Nancy Pelosi to daily bloggers are screaming "MediCare-for-All" as the answer to our health care crisis. Is MediCare the solution for us all? The answer is clear: no.
Unlike MediCaid, MediCare was never intended as an entitlement. MediCare was supposed to be self-sustaining: people would pay in while working and take out as needed after they retired. It was sold as a program that would pay for itself: no additional funds required. Hah!
Inconvenient truth #1: MediCare quickly became a Ponzi scheme just like Social Security. Contributions of the presently employed are not saved for the future but are spent to pay for the expenses of the retired.
According to the GAO, Medicare will run out of funds just like the house of cards called Social Security, but sooner (2017). The addition of the President Bush's ill-conceived Drug Program For Seniors simply accelerated the slide to bankruptcy by adding another (unpaid for by the contributors) expenditure. When MediCare runs out of money, it will be No Care for All.
MediCare tries to contain its costs in two ways: neither works, and neither is what patients want. First, it rations care. Yes, I said it. Many things your doctor would like for you are denied as not "cost effective." Let's just ignore inconvenient truth #2 that there are, at present, virtually no scientific cost effectiveness studies on which the government denies payment. Denying payment means denying care and thus again, MediCare-for-All is No Care for All.
Inconvenient truth #2A: Beware of what President Obama is touting as cost effectiveness studies in the proposed Healthcare Reform Bill. Just like in Great Britain and Australia, what the government defines as effective is often not what patients and doctors want as positive effects.
The second "cost saving" method used by MediCare is to reduce reimbursements. Put aside for a moment that this actually increases costs. Current payments to physicians are now below their marginal costs. The more MediCare patients a doctor sees, the quicker she goes broke. That is why fewer and fewer physicians accept MediCare patients: they cannot afford to. Those who still do so make up their losses on the ever-shrinking pool of privately insured patients -- the infamous cost -- or more correctly revenue-shift.
I guarantee that your local hospital engages in money shifting. How do I know? It is still in business.
Low payment schedules make it fiscal suicide for doctors to see MediCare patients. So what will Healthcare Reform (HR 3200) do to increase access to doctors for MediCare patients? Answer: it cuts physician reimbursements even further. Perfect!
In a recent Letter to the Editor, a local resident complained that at age 65 he thought he had to choose between Medicare and carrying additional, supplemental insurance to cover those things that MediCare does not. The writer was wrong...for now. To add to the Perfect-Program-for-all-Americans called MediCare, Congress is now considering adding that very limitation to their "Healthcare Reform" Bill. Perfection indeed!
Final inconvenient truth: Whether we get MediCare-for-All or the infamous "public option," under government payment schedules doctors will be paid less than their costs to stay in business. End result: no doctors. Then for sure,
"MediCare-for-All" will be No-Care-For-All.
PS. The last paragraph is intended to defend NEITHER the status quo nor the private insurance industry. Both need to change drastically. Okay, both need to...go. We need a totally new system, not tinkering with what we have. We could begin with a discussion of personal responsibility. Oops, I'm sorry. That phrase (I'm whispering) is political cyanide and will never come up for serious national debate.