December 17, 2018
Medicare For All
By Michael D. Shaw
The Kaiser Family Foundation lists eight current proposals in Congress under the headings of Medicare-for-All and Public Plan Buy-In. As KFF summarizes it…
- Two proposals would create Medicare-For-All, a single national health insurance program for all U.S. residents.
- Three proposals would create a new public plan option, based on Medicare, that would be offered to individuals and some or all employers through the Affordable Care Act marketplace.
- Two proposals would create a Medicare buy-in option for older individuals not yet eligible for the current Medicare program.
- One proposal would create a Medicaid buy-in option that states can elect to offer to individuals through the ACA marketplace.
Medicare-For-All—as exemplified by S.1804—is the most radical of the proposals, given its “No Cost Sharing” (other than a small amount for prescription drugs) provision. (Title II, Sec. 202) Current Medicare, of course, does have cost-sharing, which is paid monthly whether or not services are used. Deductibles and co-pays also apply.
During any discussion of socialized medicine, it is worthwhile to remember that what started in the 1880s as a beneficent program under Bismarck deteriorated into the blindingly autocratic system under Hitler. With full control of all doctors, Hitler could then force them into the ghastly Aktion T4 program, mandating that untold thousands of “unfit” individuals be euthanized.
A significant number of Germans opposed these killings, and the program was officially stopped in 1941, around the time of the invasion of the Soviet Union. Nonetheless, it continued in secret, and certainly provided the groundwork for the unimaginable killings occurring in the concentration camps.
Think Aktion T4 couldn’t happen here? As reported by the Hospice Patients Alliance, The Euthanasia Society of America changed names, and is now the hospice industry trade organization. Outrageous abuses have been reported in the media—so far mostly in Europe.
I recently interviewed Marilyn Singleton, MD, JD, outspoken advocate for medical freedom, patients’ rights, and preserving the doctor-patient relationship. At one point she commented on how the relatively new medical specialty of palliative care is growing. To be sure, there are plenty of aging boomers around who may soon be candidates. However, creepy situations occur, such as when her mother with no serious chronic conditions (and not on any meds) was admitted to a hospital for pneumonia…and the hospice team was brought in. How reassuring.
Moving back to S.1804, here are some of the criticisms that have been raised:
1. A study from George Mason University’s Mercatus Center estimates that the bill would add $32.6 trillion to federal spending in its first ten years, with costs steadily rising from there. Note that a doubling of all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan.
Mercatus feels that this estimate is conservative since it assumes that all of the bill’s dodgy precepts (massively lowering payments to providers, lowering drug prices, and lowering administrative costs) would come true. As a provider, why wouldn’t you want your fees to be reduced by 40 percent (per typical Medicare rates)? I guess that the brain trust behind this bill doesn’t know that the current low reimbursements on Medicare can only exist in light of the shortfall being made up by private payers.
2. Investor’s Business Daily remarks that the “No Cost Sharing” provision is unprecedented anywhere in the world, with the possible exception of Cuba. In every other country with socialized medicine, a co-pay is expected. (Australia 20%; Britain and Canada 15%; Denmark 14%; Switzerland 28%.)
3. Based on experience in several other countries, IBD imagines life under S.1804…
There would be chronic shortages of doctors nationwide. Hospital overcrowding would be epidemic. Waits for everything from hip replacements to cataract surgery to cancer treatments would be extensive. Drug innovation would come to a virtual standstill. And there would be endless fights over the size of the government’s health budget, along with massive amounts of waste, fraud, and abuse.
4. As IBD and many others contend, the biggest problem with a bill like S.1804 is that it assumes that “A handful of government central planners can manage trillions of dollars’ worth of resources better than hundreds of millions of people making trillions of decisions every day in the free market. They can’t.”
Since Nancy Pelosi is opposed to a Medicare-For-All plan, Dr. Singleton thinks that a likely compromise will be some form of a Medicare buy-in option. Interestingly, this column presented such a program.