Few people would argue that the US healthcare system is riddled with major problems. Patients are paying more for their medical services than ever before, from increasing premium costs to overly inflated deductibles. As a practicing doctor, I see every day how insurance companies pay for fewer and fewer services including diagnostic tests, procedures, hospitalizations and medications.
In fact, the US is the only country in the world where its citizens file bankruptcy due to medical expenses. For many of these patients, they are unable to pay these medical costs despite the fact that they have active insurance coverage at the time these expenses were incurred. In debates regarding our broken healthcare system, many people propose Medicare for all as a solution to our current healthcare crisis. But is this truly a reasonable option?
Why is Medicare for all not a viable solution?
- People who suggest this as a solution fail to acknowledge the fact that Medicare for those over 65 years of age hasn’t worked so well. Medicare was built upon the fatally flawed SGR (Sustainable Growth Rate). Medicare was first created as a catastrophic plan but evolved into something it was never intended to be.
- Medical care is expensive. Our government has proved to be ineffective at managing money on many occasions. Plus, where is the extra money going to come from to pay for this initiative?
- Third party insurance companies have a lot of power. How will they be compelled to go away? They are too vested in the healthcare industry and entrenched in the pockets of politicians.
- Every state now has their own state-run plans (Medicaid). They are all run and funded differently. It would be difficult to roll that all into a single plan.
- The needs of patients are full of varying complexities so a one-size fits all plan may not actually work for every patient across the US.
- Medicare, as it stands currently, only pays 80% of medical costs after the patient meets a deductible. Patients would then be expected to pay the remaining 20% or have a secondary coverage, which, therefore, would not eliminate third-party insurance companies from the healthcare system.
- Having Medicare for all does nothing to address the exploding costs of healthcare services and pharmaceuticals. It merely addresses who would pay for those services, i.e. the government-run medical plan.
- Making such a drastic change to how medical services are covered will destabilize the whole system.
Clearly, our current healthcare system is dysfunctional and cannot survive on its current course. Patients are not receiving equal medical care based on economic factors: those having the most money will be able to afford the insurance plans that cover the most services. Those with no insurance or Medicaid often cannot receive medical care because it is either too expensive or the services are not covered. A true financial disparity has been created where the more money you have, the better medical care you receive based on insurance company coverage determinations.
While many debate universal healthcare, patients are currently self-rationing healthcare or completely forgoing it due to financial constraints. Many people are not taking life-saving medications prescribed for them or skipping doses to save costs. The defects in the US system is obviously putting lives at risk. Yet, third-party insurance companies make little move to find a fix. Rather, they continue to drive up the cost of premiums and deductibles while at the same time narrow formularies and doctor panels. Additionally, many services and medications now are required to go through a draconian prior-authorization process where they end up most often being denied.
Yes, most of us recognize that drastic changes are needed to heal our ailing healthcare system. However, these changes should not be implemented all at once. Perhaps, a good first step would be greater transparency into the business practices of third-party health insurance companies. Those that are found covering real patients lives unethically should be penalized and/or shut down. Eliminating corrupt practices could save lives and cut costs.
Despite the fact that the debate for universal healthcare is a heated one, no one can argue that the system needs improvement. Until the root causes of the problems are investigated, we will be left with poorly executed solutions that do nothing. It is time to conduct that study, before more lives are adversely affected.
Photo image: Wellesley Institute ( http://www.wellesleyinstitute.com/publications/patients-first-consultation-submission-to-the-ministry-of-health-long-term-care/)
Copyright secured by Digiprove © 2018 Linda Girgis, MD, FAAFP
You’re certainly on target about how bad our medical system is. But I believe you’re unduly pessimistic about the possibility of major change and too optimistic about gradual change. The fact is, the insurance companies have to go. They do not add value. Nor would they be willing to shrink into the kind of insurance companies that other countries have, offering equal benefits and equal prices with very marginal differences and highly government-regulated.
Minus insurance companies, the health system could regulate prices. Medicare already lowers the standard payments, but Medicare has been too privitized. We may indeed need finance reform in our elections to make progress in the major issues of our time — social, environmental and in health. But numerous other countries provide health care for all without cost and in a timely manner. Canada is much-maligned, but their waiting times are not actually longer than ours, and when care is critical, you will get what you need immediately, without questions, and with appropriate follow-up care. Doctors don’t make as much there as here, but their office costs are so much lower — simple, painless billing all to one destination — that the net is similar.
When those of us working for a single-payer system speak of Medicare, we speak of Improved Medicare for All. Medicare has flaws it doesn’t need to have and doesn’t contain costs as much as necessary. But for those who reach Medicare after a lifetime of uncertain system, what a blessing it is. There is no reason that a country with our reaches can’t make this blessing extend to all.
There are tremendous cost savings in a single-payer system for all involved. And it eliminate the trauma of inadequate health care. Done state by state, the transition is possible, and more and more people consider it feasible.