By Cyrus Moulton
Telegram & Gazette Staff Posted
Dec 7, 2019 at 7:29 PM
WORCESTER - Many hospitals hate the idea.
Pharmaceutical
companies, health insurance
groups and hospital trade
groups are lobbying against it. In fact, for many in the health care
industry, the only thing universal about Medicare for All is disdain.
But for UMass Memorial Health Care CEO Dr. Eric W.
Dickson, Medicare for All — specifically, Sen. Elizabeth’s Warren’s plan for
Medicare for All — is not only worth considering, it’s worth praising.
“It’s a bold and courageous plan, and the best plan that
any candidate has come out with to date,” Dickson said Tuesday. “It’s an option
to consider ... very few health care CEOs would say that at this point.”
Early last month, Warren released a plan to enact Medicare
for All that she said would not raise taxes on the middle class. The plan,
constructed with help from economists and health policy experts, estimates a
$20.5 trillion cost over a decade and moves the country to universal health
care over three years by first building on existing laws, including the
Affordable Care Act. The plan is largely paid for by requiring employers to pay
what they would normally pay in health insurance premiums to the government in
the form of an Employer Medicare Contribution.
Dickson wrote to the Massachusetts Democrat to offer his
support, earning a Nov. 2 Twitter shoutout from Warren, and Dickson tweeted in
support of a “redesigned Medicare for All plan,” the following week.
In an interview Tuesday, Dickson broke down two major
challenges in health care that he said Warren’s plan would address: people
without insurance, and care that costs too much and is getting more expensive.
The first challenge would be solved by definition by
Medicare for All, Dickson said.
The high cost of health care is a more difficult nut to
crack.
But Dickson said Warren’s plan has crucial elements that
make it work.
A “linchpin” to the proposal for Dickson is
administrative simplification — particularly simplifying the preauthorization
and denial processes through streamlined forms rather than a form unique to
each state and/or each medical insurer.
Not only would this go a long way to reducing costs by
freeing up physicians’ and workers’ time, it would also lessen physicians’
frustrations with — and burnout from — constant paperwork, Dickson said.
The Warren plan also “levels the playing field” for
health care providers by paying them all at 110% of Medicare rates, Dickson
said.
Hospitals generally rely on three sources of payments:
private insurance payments; Medicare, which is for seniors; and Medicaid, which
covers low-income individuals. Private insurance generally pays the most,
helping subsidize the cost of caring for Medicaid patients for whom hospitals
are reimbursed the least and at rates often below the cost of care. UMass
Memorial Health Care posted a nearly $20 million operating loss in 2018, which
Dickson previously told
the Telegram & Gazette was mostly due to reduced revenue from
managed-care organizations handling patients with Medicaid.
But these three sources of payment can lead to price and
profitability disparities among hospitals that treat a large proportion of
patients with private insurance and “safety-net hospitals,” like UMass
Memorial, which treat a high percentage of Medicaid patients.
″(Wealthier) organizations generally oppose Medicare for
All because they oppose the prospect of reducing commercial rates down to
Medicare rates,” Dickson wrote in his letter to Warren. “By contrast, safety
net hospitals should consider Medicare for All as an opportunity to be more
fairly reimbursed for treating those patients who are central to their missions
- i.e., those who are either uninsured or covered by Medicaid, which has rates
that are well below Medicare.”
Having all hospitals paid at the same rate should
standardize and reduce costs, the thinking goes, according to supporters of
Medicare for All and Warren’s plan.
And one of the major stumbling blocks of the Warren plan,
its cost — some experts have said the $20.5 trillion cost is too low,
calculating costs as up to $34 trillion — is something that Dickson said is
essentially a wash for him and other large employers.
“We spend $140 million a year on our employees’ health
insurance,” Dickson said. “If the government were to tax me $140 million a year
and give all of our employees insurance, I’m neutral ... With no new costs, we
could pay that to the government and then we could move to a single-payer
system.”
But Dickson has certain suggestions to improve the
senator’s plan.
He liked aspects of Gov. Charlie Baker’s plan to shift
spending from procedural care to behavioral health and primary care. Dickson
also encouraged the senator to consider allowing Medicare Advantage plans.
“If you had a Medicare Advantage option, all of the
people currently in Medicaid and commercial insurance could opt for a Medicare
Advantage option and then I could still have my Blue Cross Blue Shield card, I
could still have my Fallon Community Health Plan card as an option,” Dickson
said. “Then the millions of people who work for health insurance companies
could continue to work ... and would not be put out of jobs just because we
moved to Medicare for All.”
That being said, the ultimate question is whether a
President Warren could enact a plan given the health care infrastructure in
place.
Dickson thinks so. But like Warren, he advocates a
gradual approach rather than a “big bang.”
He recommends (and will recommend to the senator in
another letter) covering everybody 60 to 65 in the first year of the plan by
enacting the Employer Medicare Contribution tax and then expanding the system
over the next decade.
This would mean that the age group with the highest
health care costs would be enrolled first, driving down costs, and also gives
the health care industry time to adjust “in an incremental way,” Dickson said.
“We could tolerate that,” Dickson said. “There is an
incremental way here that we could get this done, and it’s going to just
require some patience and some will.”
Then there’s the political considerations.
Dickson acknowledges enacting Warren’s plan depends on a
number of hypotheticals — most notably, that Warren wins the nomination and
then the presidency. And Dickson admits that the current Republican Senate
would not enact the legislation, and that Medicare for All is not supported by
Speaker of the House Nancy Pelosi.
Still, he’s optimistic.
“I think it’s possible to propose a concept which is that
we’re going to get here, this is what we’re going to get to, and then work with
— assuming she got elected — the House and the Senate on a glide path which is
acceptable,” Dickson said.
But with so many hypotheticals, why even speak out about
it?
Well, opponents of Medicare for All, including the
American Medical Association, are certainly making their thoughts known.
A national group called the Partnership for America’s
Health Care Future has been criticizing Medicare for All and public-option
plans in television ads, on social media and in email messages. The group
includes the American Hospital Association, America’s Health Insurance Plans,
Blue Cross Blue Shield Association, the Federation of American Hospitals,
Pharmaceutical Researcher and Manufacturers of America, and dozens more.
Locally, St. Vincent Hospital declined to comment,
deferring to the Federation of American Hospitals trade group. The FAH did not
respond to requests for comment but has issued a report with the AHA examining
a public option. That report says the proposal would inflict “the largest ever
cut to hospitals — nearly $800 billion — and be particularly disruptive to the
employer-sponsored health insurance market. State by state, the Medicare Public
Option proposal would be equally as devastating, with cuts as high as $130.6
billion.”
Reliant Medical Group also declined to comment.
Others are taking more of a wait-and-see approach.
“We are watching the legislative actions on this topic
closely and working with our industry associations to understand the potential
impacts to all of our stakeholders,” said Christine Cassidy, chief
communications officer at Fallon Health. “As always, Fallon advocates for
health care solutions that offer affordability and access to high-quality
medical care, and that are in the best interests of those we serve.”
Dickson said he also believes that considering Medicare
for All is in the best interests of those he serves.
“I feel that as CEO of a health care system ... I have an
obligation despite the ramifications ... to continue to advocate for a system
that covers everyone,” Dickson said. “I have an obligation to speak out for
what I think is right for the patients I serve.”
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