Sen. Bernie Sanders, I-Vt., was recently on comedian Jimmy Kimmel’s late night show to discuss, among other items on his agenda, his vision for health care in America.
In one interesting statement, Sanders described the rollout
of his plan: “I want to expand Medicare to include dental care, hearing aids,
and eyeglasses, and then what I want to do is lower the eligibility age the first
year from 65 down to 55, then to 45, then to 35, then we cover everybody.”
There is a sleight of hand here.
What Sanders seems to be describing is the gradual expansion of the existing Medicare program, which currently covers Americans 65 and over, to include everyone eventually. In reality, Sanders’ signature bill, “Medicare for All,” is anything but Medicare.
Medicare comes in several forms, including Parts A and B,
which pay for inpatient and outpatient visits along a fee schedule with premiums
and deductibles, and Part C, also known as Medicare Advantage.
This is the system that covers 60
million Americans and enjoys high
satisfaction ratings.
Medicare for All would scrap all of this.
One of the most misleading aspects of Medicare for All is
that it is not Medicare at all.
Medicare offers several choices between traditional Medicare
and Medicare Advantage, which itself offers a whole marketplace of health
plans. In addition, supplemental insurance is available that helps pay for
additional costs and services, so beneficiaries are able to tailor coverage to
fit their needs.
Medicare for All, however, would replace all of this with a
system that is free at the point of care but paid for by taxes. Essentially,
this is not Medicare but Medicaid for all.
If every provision of Medicare for All rolled out smoothly, millions of American seniors necessarily would have their current health care stripped from them and replaced with whatever the Department of Health and Human Services decides is health care.
Far from being a gradual transition, Medicare for All inevitably would cause the immediate disruption of health care for our seniors. Then, over the course of two years, hundreds of millions more Americans would be covered under the same system that previously was reserved for seniors.
Furthermore, once everyone is on the Medicare-cum-Medicaid for
All program, will our health necessarily improve?
According to Gallup, Americans
on Medicaid reported having the poorest health. Of respondents on Medicaid,
40% reported having fair or poor health, which is a greater proportion than
uninsured respondents, 31% of whom reported similarly.
Health outcomes aside, receiving care for free at the point
of service sounds very good to those who can receive it, but it may not be
there if we find no way to pay for it.
Medicare for All would cost over $30
trillion in the next 10 years in ideal conditions, but still require
physicians and providers to take a pay cut of up to 40% and continue working
with the same productivity.
The problem is that physicians already are heavily burdened
with their workload. In the 2018 Physicians Foundation survey, up to 80% of
physicians reported working at their maximum
capacity or beyond.
In the same survey, about 15% of physicians reported
limiting the number of Medicaid patients they see and an additional 16% did not
see Medicaid patients at all.
Of these physicians who do not see Medicaid patients, or
limit the number they see, over a third are in primary care, exactly the kind
of physicians we need in greater numbers.
It is not that doctors or greedy, but a combination of administrative
burdens, delays in processing claims, and low reimbursement rates made it
difficult to justify seeing many Medicaid patients.
As Medicaid and Medicare both drastically
underpay relative to private health insurance, hospitals and providers have
to charge private insurance more to make up the difference.
If private insurers disappear, as they would under Medicare
for All, the whole system would crumble. Health care for free at point of
service is great, if anyone is there to give it.
Medicaid exists as a social safety net for low-income
households. It is intended to fully cover medical costs for the Americans least
able to pay for it.
Providers who participate in Medicaid must accept the
government-mandated prices for services and deal with oftentimes long delays in
receiving reimbursement that is below the cost of practice.
Structurally, Sanders’ Medicare for All bill bears little resemblance to Medicare, but instead is very similar to Medicaid. Likewise, it would very likely carry with it all of the flaws of Medicaid.
It is a common trope of the left to say that we can’t afford
health care in America any longer. But in truth, we can afford placing all of
America on Medicaid even less.
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