Medicare
for All government chokehold would be even worse than private insurance: Doctor
Marc Siegel,
Opinion columnist Published 4:00 a.m. ET April
30, 2019
Single-payer would bring rationing and long
waits. For me and my patients, overpriced private insurance ridden with red
tape would still be better.
Before Medicare for All could ever enter the
American doctor’s office, several economic and medical mountains would have to
be moved.
First, the transition to a plan like the one
Sen. Bernie Sanders has proposed would be enormously expensive, more than $30 trillion over a 10-year period
by some estimates.
Second, because the program bans private
insurance, it would displace nearly 177 million people from
their health insurance plans, including over 156 million from employer-based
health insurance — which for many employees is the reason they took the job in
the first place.
And for employers, health insurance provides a
tax deduction, which is an incentive for stretching the budget and hiring.
A transition to Medicare for All would be a definite job killer, affecting millions more in
addition to the close to 2 million health care workers who would be displaced
from their jobs in the transition.
Third, hospitals make more money on private
health insurance, so a transition to 100% government-based insurance would mean
less income for hospitals — income
frequently diverted to support research and academics. Even if the end result
is less expensive, because of government-negotiated prices, it will also be
less supportive of medical centers. Administrative costs might be lower
with single-payer, but as Centers for Medicare and Medicaid Services
Administrator Seema Verma has pointed out to me, this is partly because private
insurers spend more to ferret out fraud and misuse in their policies.
What about the doctor’s office? What would
single-payer Medicare for All mean for me and my patients on a day to day
basis?
On the surface, the lack of a copay and
deductible is very appealing. They are too frequently roadblocks to my
providing basic care. Patients who haven’t met their deductible too often go
without needed treatment. Similarly, having only one payer — the government —
means wider networks of doctors and hospitals to choose from. In addition, I
would not have to assign my staff to figure out whether I accept your
insurance or not.
Single-payer would
bring rationing, long waits
However, as I dig deeper into a potential
single-payer future, it looks less and less appetizing for me and my patients.
In the first place, as Medicare changes to single-payer, it would become a more
highly regulated restricted insurance that rations care. In other words, it
will feel and operate more like Medicaid than Medicare. Waiting lines for
procedures, surgeries and treatments would lengthen.
In single-payer Canada, a patient waits an
average of 20 weeks between referral from a general
practitioner and receipt of treatment from a specialist. Wait times for
Canadians average up to four weeks for a CT scan and over 10 weeks for an
MRI. According to the 2018 Fraser Institute Report, “Research has repeatedly
indicated that wait times for medically necessary treatment are not benign inconveniences.
Wait times can, and do, have serious consequences such as increased pain,
suffering, and mental anguish. In certain instances, they can also result in
poorer medical outcomes — transforming potentially reversible illnesses or
injuries into chronic, irreversible conditions, or even permanent
disabilities.”
If the Sanders plan is enacted, waiting
times here will increase, doctors will be paid less for doing more, and we will
become more frustrated and less effective. There could also be a worsening
doctor shortage, which would compound the
problem.
Private insurance
is flawed, costly and preferable
Picture your doctor or her office staff
waiting on telephone hold for a distant bureaucrat to approve or deny a
catheter-placed $50,000 heart valve for your 90-year-old father. Mine had
one because Medicare covered it. But the stretched thin Medicare for All of the
future isn’t as likely to say yes. Picture a patient with daily cardiac chest
pain or a damaged joint waiting for weeks for the proper doctor or center
to perform the procedure.
Keep in mind that the innovations of the
future will be more personalized, based on your individual genetics. Mutations
that lead to cancer will be treated with genetic editors and bioengineered
immunotherapies. Heart disease also will prompt individualized approaches,
with surgery replaced by catheters and remote procedures performed via
satellite and robots. Medicare for All is an antiquated one-size-fits-all
model that isn’t designed to either support the creation of or cover the
emergence of expensive, personalized biotech treatments.
Single-payer health care is probably not
going to happen here. The private insurance industry, as flawed and
profit-seeking and overpriced as it is, is powerful. It's not going to
simply roll over and allow itself to be destroyed and replaced. I'm not the
only doctor who is glad about this. As much as we struggle now with
red-tape-ridden reimbursements and excess demand for computer documentation,
the complete government chokehold is worse. Medicare for All may be a
politician’s dream, but it is a doctor-and-patient nightmare.
Marc Siegel, a member of USA TODAY's Board of
Contributors and a Fox News medical correspondent, is a clinical
professor of medicine and medical director of Doctor
Radio at NYU Langone Medical Center. Follow him on Twitter: @DrMarcSiegel
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