why medicare-for-all is not good for America
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Why Medicare-for-All Is Not Good for America
Senator Bernie Sanders recently announced his Medicare-for-All bill. This is basically the senate version of the congressional bill introduced by Pramila Jayapal. The bill would eliminate the insurance industry and much of the billing bureaucracy that exists today. It would provide health care coverage for everyone and eliminate copays and deductibles. It would expand Medicare coverage to include dental, vision and long-term nursing home care.
There are many questions about how this approach to universal care would be funded. No budget has been provided, though estimates vary from an annual increase in cost of $3.2 trillion to an annual savings of $600 billion. Jayapal said it would likely require raising taxes on the wealthy, and Sanders suggested this could be up to 70%. Another option could be taxing investment income at the same rate as stock sales.
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Commentary: Time’s Up Is Healthcare’s Much-Needed #MeToo Movement ]Under the Medicare-for-All plan, private insurance would be eliminated and physicians who are in private practice would be paid on a fee-for-service basis through a national fee schedule, likely at the current Medicare rate or slightly lower. By eliminating the insurance industry, the plan would also eliminate one million jobs. The new fee schedule would be significantly lower than the current industry fee schedule, which means Medicare-for-All would likely lower physician incomes in a significant way, making a bad situation for physicians even worse.
There are three basic objections to Medicare-for-All. The first is that taxes would go up, so it would not receive bipartisan support. The second is that it's a vote loser. When Americans are polled, 70% say that they approve of Medicare-for-All. However, when a follow-up question is asked, in which it is made clear that this means everybody would be required to have it, support drops to 38%. The third and perhaps most important objection is that many experienced doctors would simply leave the profession, and this problem is not solved by retaining the commercial insurance corporations, since this is merely retaining a system that needs to change.
Physicians are the single most important service provider in any healthcare system, and we are facing a shortage. The Association of American Medical Colleges projects that this shortage will worsen, even without the negative influence of Medicare-for-All. And doctors face the highest burnout rate among all professions -- as many as 46% of doctors in the U.S. have suffered from burnout at some time in their careers, according to Dr. Dike Drummond in his article from Family Practice Management Journal.
In our book, "Healing American Healthcare," we describe our Eichhorn-Hutchinson plan. There are six critical objectives that, if achieved, could improve quality while reducing the cost of healthcare by as much $1 trillion per year:
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1. Provide universal health care by requiring all employers to provide health insurance for their employees. Establish and provide a national health care option, which we have named Allcare, which would provide the same minimum benefits of the Medicare program. We estimate that the cost of Allcare would be 30% below the average cost of employer-based health insurance today as established by the annual Kaiser Family Foundation Survey. Existing insurers would be invited to compete, and could develop Medicare Advantage-like plans to expand benefit offerings to people under the age of 65.
2. Control drug costs through the establishment of a national negotiating platform that would be shared with all health care systems to prevent and eliminate price gouging in the pharmaceutical industry and unreasonable hospital markups of drugs they administer to their patients. The goal is to reduce the per capita costs of our medications to match the per capita cost of other industrialized democracies. Nonprofit hospitals and nonprofit hospital systems that earn operating profits would be required to pay income tax at the corporate rate.
3. Reduce the complexity and bureaucracy of billing by having a national standard for the cost of care: a national chargemaster for all services provided for patients at any hospital or clinic or doctor's office anywhere in the US regardless of the provider's tax status as for-profit or nonprofit entities.
4. Eliminate hospital facility fees for outpatient testing and standardize all imaging and lab testing fees. While this would be a loss of revenue for hospitals, at the same time hospitals would gain by not having to provide indigent care, since everyone would be insured, and by shedding much of their bureaucratic overhead.
5. Use the health care data that is available to monitor costs, improve quality, and reduce waste, and recommend that Accountable Care Organizations be provided with this data as they work to control costs and improve patient outcomes.
6. Massively reduce the complexity of the Electronic Health Record, or EHR, and EHR-associated measures of efficiency and quality, which are burdensome, insulting and actually reduce efficiency and quality. The EHR is the number one cause of physician burnout – let's let doctors go back to being doctors.
We also believe that employers and individuals should have choice in selecting health insurance. Under our plan, employers could be self-insured, contract with private insurance companies or contract with Allcare. In each case they could have Gold, Silver or Bronze plans to expand physician networks for their employees. This layered plan would allow anyone to be insured at the level of basic Medicare, but by paying extra would gain access to larger pools of doctors. Individuals could also choose between Allcare and private insurance.
Our proposed plan reduces bureaucracy and medical waste, while improving quality and creating much-needed competition. Savings to corporations alone would be as much as $174 billion annually.
Today, 15 million Medicaid beneficiaries are employed. Under our plan, they and their families would receive health insurance through their employers. This would reduce the cost of the Medicaid program by 31%.
We believe that our plan provides an opportunity for legislative compromise. Both liberal and moderate Democrats want a universal health care system that covers all Americans. They would like a single-payer system like Medicare-for-All or a combination of public and private payers that would cover everyone. Historically Republicans would like to reduce the federal deficit, and it is likely that they feel a more urgent need to do so with the passage of the tax cut of 2018 that is projected to increase the deficit. Efforts to reduce the federal deficit will likely in part focus on expenditures for Medicare and Medicaid. They also want to give people more choice in health care. All of these goals could be accomplished with the adoption of the Eichhorn Hutchinson Health Care Plan.
There are some key differences between our plan and Medicare-for-All:
· Medicare-for-All is funded by taxation. Our plan is largely employer-based.
· Medicare-for-All eliminates the health insurance industry. Our plan does not.
· Medicare-for-All eliminates choice in healthcare. Our plan increases choice.
· Medicare-for-All requires hospitals to go to regulated budgeting. Our plan does not.
· Medicare-for-All does not directly address hospital markups. Our plan does.
· Medicare-for-All dictates staffing levels for all hospitals. Our plan does not.
· Medicare-for-All controls and lowers physician income. Our plan does not.
· Medicare-for-All does not address the high cost of medical education. Our plan does.
· Medicare-for-All does not address clinical waste. Our plan does.
· Medicare-for-All saves $6 trillion over 10 years. Our plan saves $10 trillion.
· Medicare-for-All negotiates drug price. Our plan would also limit patent extensions.
· Medicare-for-All is a plan proposed by Democrats. Our plan has bipartisan appeal.
While it has good intentions, Medicare-for-All is the wrong path for the future of healthcare in America. We need a plan which brings universal healthcare to America, one that would improve quality, improve outcomes, expand competition and lower costs.
Our plan would make American healthcare once again the envy of the world, as it should be.
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