Democratic Debates

Is “Medicare For All (Who Want it)” Enough?

By MIKE MAGEE

In the 2nd night of the Democratic Primary debate on June 27, 2019, Pete Buttigieg was asked whether he supported Medicare-For-All. He responded, “I support Medicare for all who want it.” 

In doing so, he side-stepped the controversial debate over shifts of power from states to the federal government, and trusted that logic would eventually prevail over a collusive Medical-Industrial Complex with an iron lock grip on a system that deals everyone imaginable in on the sickness profitability curve – except the patient.

On July 30, 1965, President Lyndon B. Johnson signed into law “Medicare,” a national insurance plan for all Americans over 65. He did so in front of former President Truman, who 20 years earlier had proposed a national health plan for all Americans, and for his trouble was labeled by the AMA as the future father of “socialized medicine.”

For Truman, there was a double irony that day in 1965. First of all, the signing was occurring at around the same time as our neighbor to the north was signing their own national health plan, also called “Medicare”, but their’s covered all Canadian citizens, not just the elderly.

The second incongruity was that Truman was fully aware that in 1945, as he was being tarred and feathered as unpatriotic by taxpayers for having the gall to suggest that health care was a human right, those very same citizens were unknowingly funding the creation of national health plans as democracy stabilizers in our two primary vanquished enemies – Germany and Japan – as part of the US taxpayer funded Marshall Plan.

Fast-forward more than a half-century, and we’re still trying to correct the error, and make Medicare available to all citizens. For nearly all Democrats, and for some Republicans, the focus now is on “for all”. The battle is centered on how we get there.

Our Medicare continues to have very high satisfaction scores among citizens over 65. So theoretically, it shouldn’t have to be forced on anyone, suggesting that pull vs. push is the way to go.

Medicare-For-All (who want it) would allow anyone who chooses to buy into Medicare. You like your employer insurance, with diminishing benefits and ever increasing deductibles and co-pays? Terrific, keep it! But if you would prefer the public plan with maternity benefits and mental health, with prevention and safeguards for pre-existing conditions, join the team. 

However, such an offering, left unaccompanied by ancillary actions, stands little chance of avoiding the same fate of the ACA with endless chipping away at benefits by self-interested detractors. 

First and foremost, everyone in America must be insured period, and the profiteering at patient expense has to stop. 

Here are three principles to guide our next steps. 

1. Less is more. Insurance Simplicity = Savings and Improved Quality and Performance. 16 health workers for every physician with half of these having no clinical function – that’s ridiculous. 

2. Health = Full Human Potential (not the elimination of disease). Innovative research is great, but it is no substitute for national health planning and public health programming.

3. The Public Option must reinsert appropriate checks and balances. The integrated career ladder that currently entangles academic medicine, pharma, insurers, hospitals and government regulators is a cesspool of conflicts of interest and no longer deserves safe haven.

In addition to eliminating insurance gaming of the system, reference pricing pharmaceuticals and outlawing DTC advertising are long overdue, and addressing physicians prescribing behaviors that can only generously be labeled “sloppy” should receive our focused attention.

Consider these latest figures on Adverse Drug Events (ADE):

● 5 million older adults sought medical attention for ADEs in 2018.

● 42% of older adults take 5 or more prescription medications.

● There was a 300% increase in polypharmacy over 20 years.

● 750 hospitalizations every day are due to ADEs in older adults.

● $62 billion in unnecessary hospitalizations over 10 years.

● 150,000 premature deaths in next 10 years due to ADEs.

Finally, there are the hospitals, whose lobbyists are already misinforming the public that Medicare rates will drive them into bankruptcy. That claim has been actively debunked. These are organizations that are interventional expansionary to their core, are chronically cobbled by preventable infections and preventable deaths, reward executive teams with automatic raises and rich benefit packages, and maintain a voluntary credentialing process, the JCAHO, that regularly green lights organizations which deserve a flashing red, or at the very least a cautionary yellow.

While we lack quality and efficiency in health care in America, we don’t lack money or talent. We have already sidelined 1 in every five dollars, and have an array of talented doctors, nurses, pharmacists and public health professionals. What we have avoided until now is the discipline and solidarity to create an actual national health plan that will utilize these precious resources to best avail.

Buttigieg is right in suggesting that Medicare, extended to all comers, will have little difficulty competing with private plans and their purposeful complexity. But to achieve the desired outcome of high quality, low variability and efficiency, our nation today requires the same deliberate trust-busting actions utilized by national leaders over a century ago to bring the robber barons to heel. Medicare-for-all (who want it) is certainly a useful carrot, but will have limited corrective effect unless accompanied by appropriate regulatory sticks.

Mike Magee is a Medical Historian and author of “Code Blue: Inside the Medical Industrial Complex” (Grove Atlantic/June, 2019).

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Dave Moskowitz MDBarry Carol Recent comment authors
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Dave Moskowitz MD
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Dave Moskowitz MD

Both the public sector (Medicare and the VA, National Health Services in the UK, Canada, Israel, Australia, etc.) and the private sector (Blue Cross/Blue Shield, Kaiser Permanente, Intermountain Health Care, Aetna, Cigna, Humana, etc.) have failed my personal test over the past quarter century. In 1994, I discovered how to prevent dialysis. Nobody in healthcare has wanted to eliminate it; dialysis is simply too lucrative. No matter that it’s hell for patients, and is tantamount to medical slavery: patients of color are affected 3 to 5 times more than whites. References are in: https://www.bmj.com/content/363/bmj.k4303/rr So how do you improve a… Read more »

Barry Carol
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Barry Carol

Medicare polls well mainly because beneficiaries pay only a small percentage of the total cost. Medicare Part A is free to beneficiaries while Part B premiums are set to cover only 25% of Part B costs. By contrast, employees pay about 25% of costs for employer coverage on average and most understand that the portion nominally covered by the employer is part of compensation that would have been paid as higher wages if the health insurance benefit didn’t exist. Those who purchase health insurance in the individual market, of course, must pay the entire premium out of pocket. It’s also… Read more »