May 6, 2019
Medicare For All: Not The System You Want
By Michael D. Shaw
Given the 21 declared Democratic candidates for president, we have heard a whole lot about free stuff, including various proposals for universal healthcare—some of which are termed “Medicare For All.” This column has already run a few articles on the subject, including this one, which destroyed the flower child notion of healthcare being a right, with a dose of reality on how such programs work in other countries.
If healthcare is a right, then why does massive rationing occur under essentially all “universal coverage” situations? If healthcare is a right, why do people such as the mother of Sally Pipes die because they could not get a timely colonoscopy? You may have a card in your wallet promising free care, but if you can’t find a provider, what good is it?
The Congressional Budget Office just released a report entitled “Key Design Components and Considerations for Establishing a Single-Payer Health Care System.” Among the findings…
“The transition toward a single-payer system could be complicated, challenging, and potentially disruptive.” Given that some providers might opt out if typical Medicare reimbursements are invoked, patients would experience “increased wait times and reduced access to care.” “Unlike a system with competing private insurers, the public plan might not be as quick to meet patients’ needs, such as covering new treatments.”
Notably, Medicare fraud comprises nearly ten percent of Medicare expenses, within a system that mostly deals with patients 65 and over. If abuse (unneeded services are rendered) is included, some authorities put this figure up to 30 percent. Can you even imagine how much fraud and abuse there would be if this system covered everyone, and private insurance did not exist (per most Medicare for All plans)?
Healthcare reform activist Alieta Eck, MD relates the story of her patient who visited an optometrist for an eye exam and a pair of glasses. Although Medicare does not generally cover eyeglasses for a well patient, her optometrist was able to conjure up $817.09 worth of charges with which to bill Medicare, and Medicare approved $552.07, paying $432.02. She was told that the maximum she may be billed would be $110.41 or 20 percent of the approved amount. She never received a bill. The provider did perform the services, some of which were overkill, but did succeed in “covering” the eye exam and glasses for the patient.
Eck told me that stopping such abuse is virtually impossible, since the services billed were genuinely rendered. Unless the practice were to show extraordinary Medicare billing over a period of time, it would probably be missed by the Medicare Fraud Strike Force.
A large factor in the runaway inflation of healthcare costs is that virtually every service is paid by a third party. The original notion of medical insurance (as it was then called) was to cover “Major Medical” expenses, and leave routine office visits and drugs to be paid directly by the patient. Of course, the cost of such insurance was a mere fraction of today’s far more comprehensive plans.
I recently spoke with Dr. Eck, and she explained her three components of how healthcare should be paid for. The first component is routine care and normal meds and lab tests. For these, remove insurance, and have them covered directly by the patient. A riff on this is the idea of direct primary care, whereby a monthly fee is paid to the doctor, and this covers all services. This could also apply to specialists. For example, a similar monthly plan could be offered by an endocrinologist for his diabetes patients.
The second component is old-fashioned major medical, covering those big hospital expenses. And the third component is true non-governmental charity, for those who can’t pay.
Eck and her physician husband John run the Zarephath Health Center, a free clinic for the poor and uninsured that currently cares for 300-400 patients per month utilizing the donated services of volunteer physicians and nurses. Moreover, local suppliers have been donating common medicines—and the charity is multiplying. What a superb model!
Drs. Alieta and John Eck have been promoting NJ S239, the Volunteer Medical Professional Health Care Act. The Act states that physicians who provide care through free clinics receive free medical malpractice coverage under the Federal Tort Claims Act (FTCA), which deems them part of the national public health service for the purpose of such coverage.
There are many benefits to such a program, not the least which is a significant savings in Medicaid costs. While support for this bill is growing, there are also the usual suspects (Medicaid HMOs and trial lawyers) who are dead set against it.
Healthcare can only be reformed by getting the providers closer to the patients, and not by further increasing the government control and bureaucracy, that has already spawned untold waste, corruption, and overregulation. Tell your elected officials about this New Jersey bill, and how you need a similar law in your state.