"MediCare for All" Becomes No Care at All

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.

 

 

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Comments

[DrInsula]

By the way, a cardiologist in the US can earn $ 1 mill/year, whereas in other advanced nations with health care FOR ALL, they get 400,000. Think this influenced the content of this diatribe?

[Deane Waldman - Huffpost Blogger]

I am a pediatric cardiologist.
Neither I nor any practicing pediatric cardiologist in the USA has EVER seen $400,000 per year.
I can take a newborn in shock with critical aortic valve obstruction to the catheterization lab; use all the skill, education, judgment (and luck) possible; open the valve with a balloon, with all the attendant risks; care for the baby afterward; and submit my bill for $5-7,000 and get paid the princely sum by MediCaid of...(drum­roll)...$3­87 max!
The truck driver who delivers the Enfamil to your pediatrician makes more than the doctor to whom he makes the delivery.
Please don't tell us about how rich we are getting.

[quinnscommentary]

Interesting observation and of course this has been going on for years and in the process shifting costs to the private sector. It is interesting that the average person cannot see the spiral that we are in. Expand coverage, blame the insurance companies for managing costs (no they are not perfect), get a low cost public option in place and gradually shift more people into it.

Of course in the process we end up with trying to find ways to manage the growing costs...think rationing in all its forms.

I have placed my views based on 47 years of experience on health care reform on my Blog at: http://www.quinnscommentary.com

[killmenow]

Instead of blogging, try reading. Read HR676. It's readable, and it has its own website.

[killmenow]

With the 380 billion saved annually from for-profit insurance adminstrative costs, it is possible to set Medicare doctor payments much higher and still cover the uninsured and have no copays, no deductibles, no out of pocket expenses for all.

Also full mental health, dental, pharmacy, some long term care, and still send a few bucks to pay down the deficit.

Current legislative proposals will cost an additional 100 billion a year. So we are talking Cadillac coverage for all Americans for what we pay now, and money left over.

No more employer based coverage, no more Medicaid (biggest item in state bugets), & tort reform in that the future medical expenses portion of personal injury litigation would be unecessary.

Additional advantage: greater emphasis on primary care. There is a reason almost every developed country uses single payer...it works. Reform includes ending fee-for-service with its incentives to over-treat and over-test. No one is suggesting just Medicare for all without substantial reforms. The doctor above would like you to believe that, however.

Some countries use highly regulated non-profits to mandate insurance, but that's difficult to get there from here with our big $$ political system funded by for-profits. Insurance companies are the #2 lobbyists in Washington.

Press your congressional reps to vote for the Weiner bill for single payer. The above is just... well, totally misleading and should be rather embarrassing to the doctor who wrote it.

[ButImNotSureAboutU]

So you're saying that Social Security and Medicare are "fraudulent investment operations that pay returns to separate investors from their own money or money paid by subsequent investors, rather than from any actual profit earned"? You lost me at Ponzi. That's not how they finance themselves regardless of your political affiliations. If you had an argument to make you lost the people you're trying to reach with such an inflammatory statement. You want to persuade, right?

[Deane Waldman - Huffpost Blogger]

I called MediCare and Social Security Ponzi schemes and stick by it.
Both were supposed to be longterm savings accounts where an individual pays in while working and takes out, from his or her contributions, after retirement. Their eventual withdrawals are supposed to be covered by their prior contributions (not others contributions).
In fact, retiree pay-outs from both MediCare & Social Security come from money paid in by those presently working, not former contributions by the retiree. Twenty-five years ago, one retiree was 'supported' by 12 then-current workers. Now the ratio is about 3:1. Both MediCare and Social Security, without drastic revisions, will be bankrupt by 2017 and 2026 respectively (GAO data).
That is why I call them Ponzi schemes.

[pinchesguru]

"...under government payment schedules doctors will be paid less than their costs to stay in business. End result: no doctors."

Right. I guess that's why there are no doctors or nurses in the UK. Or France. Or Canada. Or Japan. Or Sweden. Or...

In fact, most of these countries have more doctors and nurses per 1000 residents than the US. And France, whose single-payer system is rated the best healthcare system in the world, also has the most doctors per 1000 population than any other country: 3.37 That compares to just 2.56 doctors per 1000 US residents.

Care to try another scare tactic Dr Waldman?

[killmenow]

He was writing to stupid people. You are not supposed to be here. Please check your ticket. Exit to the back. Hurry up please. You are ruining this for the sheeple.

[WASanford]

Perhaps it's time for doctors to consider selling the Maserati and buying a nice middle class BMW. Too many enter the medical profession to make themselves wealthy, like those who are members of the AMA. No one needs to work simply to make themselves wealthy, there are much better benchmarks for success. in my long experience I've noticed that most of those who can be considered rich have no idea what to do with all the money they've collected. That's too bad because they have a tendency to use it making bad investments.

If medicare becomes available to all Americans it will certainly need to be modified to handle the task and I'm agreeable to that. (I've been on medicare for ten years, yes, I'm seventy five years old.)

Thanks for your post Doctor Waldman but I consider it to be just another scare tactic that will not go very far here. Nevertheless, you've been fanned (as anyone who gives me a chance to comment does) and you can come back as often as you like. PS I guarantee your taxes will rise if we extend medicare to all but I can also guarantee that you'll no longer have to pay health care premiums for a chance that your illness will be covered by your policy.

[PlaceboStudman]

Holy crap!

I actually agreed with something Mr Waldman said?? Well, at least just the last paragraph about how people cant...err...won't discuss personal responsibility and take some blame for doing things that make them ill in the first place.

Then there is the personal responsibility of the pharmaceutical industry, who often gives us treatments that are as bad as or worse than the ailment itself

But, he's right. Those are taboo topics we can't, or won't talk about

So, never mind

[WASanford]

How does being responsible keep someone from developing cancer or being run down by an errant car? This is the "why don't you just dig down into your own pockets?" argument, but at the price of most treatments a relatively few of us can do that. It just doesn't work for the vast majority of us, period! We have a government that in its founding document promises to "promote the general welfare." What part of that don't you get?

[Deane Waldman - Huffpost Blogger]

One should only be held responsible for consequences over which we had some control. Obviously, being hit by a car or developing colon cancer was not the patient's fault. But what about the smoker with emphysema or the 450 pound person who needs knee replacement?

Virtually no one can afford in-hospital stays (I certainly cannot). That is where we need a natl shared risk pool.

From a natl perspective health care should be considered infrastructure maintenance & repair and supported by the Federal gov. But any sustainable system requires feedback and some degree of personal responsibility.

Our country was founded on principles which are accepted by the populace. Healthcare needs the same and no, we currently do NOT have any consensus. Without agreed-upon principles, our grandchildren will still be arguing over why the system doesn't work.

[bg66astoria]

Would this MD be OK with Medicare if the Medicare payments were merged w/ Medicaid & he got to practice positive health care as he should be already with his patient population?

Probably not, since he thinks that the insurance companies are his saviors. But, currently the insurance companies are subsidized by Medicare/Medicaid. In New York State, Medicare won't keep you in most private offices, only clinics [though many of those offer comparable, or better care], but Medicare/Medicaid combo pays the bills because their e-filing software is in most, if not all offices.

This MDs next problem - When will large corporations drop private insurance since Medicare For All would relieve a 10-20% penalty overhead that makes our companies less competitive than the EU, etc. How quickly will the insurance premiums become too dear for employer & indidividual policyholders? 2 yrs, 3, 4, 5.

[Deane Waldman - Huffpost Blogger]

Private insurance companies are neither my nor your savior. My comments are not my preference (au contraire) but fiscal reality. Most hospitals and providers must shift revenue from profitable contracts (with private insurance companies ) to pay for shortfalls (payment less than costs) from government agencies and for unfunded mandated care.

Personally, I think profit should only be given (as a reward) for activities that add value to society. In my view, insurance is merely an accounting activity of a shared risk pool and needs no profit to reward it. By contrast, pharmaceuticals should be rewarded because they innovate and take risks, and they give us something we cannot get elsewhere. But that is just my opinion. What matters is what the majority wants to reward, not what I want.

As for what most nurses and doctors want: we neither expected nor wanted to get super rich. On the other hand, we (providers) do difficult, dangerous stressful things requiring judgment and extensive education...and we want to be valued for what we do. Increasingly, providers are treated like lazy dray horses, pampered rich boys, and ultimately, perpetrators. Wonder why applications to U.S. medical schools are down 18% in the past 15 years and why are there 500,000 open nursing positions? Take a guess...and it ain't money.

[thehummelr]

Lots of BS in this article. Methinks it was actually written by someone in a health care insurance agency! Scaring 'em just won't work. We are getting the truth on what the bills will and won't do and we are living MEDICARE. Last time I checked, 65% of Americans wanted the public option. Thant's because they have had experiences with insurers and that's where the rationing goes on. Cold Hard Rationing.

[Neal Jansons]

Ah, so nice to have a good ole all American extortioni­st...whoop­s I meant capitalist. Notice it's a DOCTOR threatening that if we hurt their precious profits then there won't be any doctors anymore. And notice the implied moralism...if you get sick it's your own fault and somehow "personal responsibility" comes into it.

That's right, Doc. All those poor people chose to be poor and all those sick people chose to be sick, just to scam something out of the system. They should have had the decency to be born to a privileged, white family, and since they didn't they deserve to suffer, right Doc?

Capitalism in health care = extortion. If you don't want to help people not be sick, you should quit your job. Maybe you would do well in organized crime. Oh wait, you ARE in organized crime...my mistake.

[Princemarko]

This article is right on the point. Dont take emotional stories and apply them to political solutions, its not realistic.

[eciaccio]

But of course! EVERYONE knows emotions have NOTHING to do with politics. Heart-wrenching stories, even if true, should only influence decisions for right wing and corporate interests.

Decisions which actually help ordinary people must NEVER be made. Who will look out for the poor, pitiable insurance companies and pharmaceutical companies?

[liberalgeezer]

What Baloney! My credentials? My wife and I are Medicare recipients.

#1Talking of Ponzi schemes...Iraq was sold as as a self-financing enterprise. No one thinks the Defense Department is a "house of cards" that is going to run out of money and close down. It will take a lot less money to fully fund Medicare and Social Security than the cost of one of our 12 carrier battle groups.

#2..All insurance programs deny coverage for certain treatments and procedures. Medicare has far fewer denials than private plans. . We live in a community where a majority of the 20,000 residents are on Medicare.and there is no rationing of care. People celebrate their 65th birthday because they finally have good coverage.
#3 Doctors and other providers aren't pulling out because of Medicare, the number of providers in our community is constantly growing.