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Letter To The Editor: Medicare For All Can Work

on March 27, 2018 - 4:23pm
Los Alamos

Lisa Shin’s op-ed in the LA Daily Post (link) talks a lot about potential problems associated with a “single-payer” model for healthcare in the U.S., but her arguments for the main part are focused on how Obamacare works now, not on a single-payer model. 

In the process, she ignores the fundamental question of how do we provide healthcare for everyone. Even with Obamacare and Medicaid expansion, millions of people still have no healthcare coverage, which means that their only recourse is to go to the emergency room when they get sick. What is her plan?

Making the transition from our current health insurance system to a “single-payer” system such as “Medicare-for-All” will not be easy or simple, but we need to look carefully at that option, unless, of course, we are not interested in providing a path to universal healthcare insurance.

First of all, the “talking point” that President Obama promised “if you like your plan, you can keep your plan; if you like your doctor, you can keep your doctor” should be put to rest.  When Obama said this, he meant that the government was not going to purposely target your plan for cancellation or force doctors out of a plan under the Affordable Care Act (ACA or Obamacare). 

However, that did not stop private insurance companies under Obamacare from choosing NOT to offer a plan that had covered someone in previous years. Plans were cancelled, and people did lose coverage, but this was because the plan did not offer the health coverage required under the ACA, or the company decided that their plan would not be competitive in the insurance market place, or they hoped that Obamacare would fail if enough companies refused to offer policies.

The fact that you can't go to your doctor under Obamacare is because the doctor was either kicked out of your network by your private health insurance company, or the provider opted out of the plan because the reimbursements offered to the provider for the services rendered wasn't large enough to satisfy the provider. 

Surely, Ms. Shin understands that in her practice. Who controls how much she charges her patients now? What she feels she deserves for providing her services, or what the health plan decides to reimburse her for that service? Whether reimbursement is offered via a private health insurer or the government will not change this problem.

In my own experience, the health insurance plans offered through my employer during my working years, as well as the Medicare supplemental plans I have had in retirement, often changed over the years, which meant my coverage also changed.  Private health insurance companies changed the plans they offered all the time prior to Obamacare. They changed what they covered, the deductibles they charged, the particular doctors included in their network, and the cost of the plans offered, almost every year, and if you had personal insurance rather than employer-sponsored insurance, they could opt not to cover you the following year.  How is that process any different under Obamacare, except for the fact that under Obamacare, the coverage doesn't change from year to year and you can't be denied coverage?

The bottom line is that keeping your doctor under any health insurance plan was never guaranteed.

Another misleading argument is the idea that there should be different plans available for different circumstances, e.g., different plans for men and women, or different plans for the young and the old. Private life insurance companies use this approach, i.e., men and women pay different rates for life insurance, and the cost of life insurance goes up depending on your age at the time you purchase your policy, but there are very few other distinctions permitted for life insurance. A similar approach could be used for health insurance, but most private health insurance plans do not make these kind of distinctions now, and of course the whole idea of insurance is to spread the risk.

Ms. Shin also mentions the fact that there aren't enough providers in New Mexico. However, this is really a red-herring, since both private and government insurers suffer from that problem.  If we want more providers in the State of New Mexico we need to make it more attractive for students to attend medical school and then return to New Mexico to practice. That means scholarships (or loans which are forgiven over time) for qualified students to obtain the training needed (medical school and beyond), coupled together with a requirement to return to New Mexico for a stipulated time period, e.g., a minimum of one year of service for every year of support. 

Finally, what about the cost of a “Medicare-for-All” plan? Whether such a plan will increase the current costs paid by government, businesses and all the individuals covered is strongly dependent on your assumptions of how the plan will operate and how you will levy charges. Obamacare is not a good model, because the ACA was constructed with the idea of keeping in place as much as possible of the private health insurance structure.

However, there is no intrinsic reason for government health insurance to cost more than private health insurance, but it will require a major change in how we allocate the cost of healthcare in the country. The Bernie Sanders plan shifted all the premiums now paid by companies and employees to pay for his plan.

The free market approach for health insurance has never worked well for providers or patients, as anyone having to deal with a claim denied already knows. Even large employers have difficulty in negotiating to get the lowest price and best care for their employees, because the healthcare industry is almost a monopoly, especially in small states like New Mexico where very few companies offer plans. Neither the providers nor the patients have the ability to negotiate effectively for lower rates or better healthcare coverage. 

The one issue that Ms. Shin raises, which does need to be carefully considered in going forward with a “Medicare-for-All” plan is protection of the doctor-patient relationship. Neither the government nor private health-insurers should interfere with that relationship, but as it now stands, private health insurers have enormous control over the services for which providers can expect to be reimbursed, and at what percentage of the charge. 

The same is true of Medicare. Whether we move to a single-payer system or continue with the current private-government system we now have, this issue will need constant oversight to prevent the needle from moving too far in either direction.

Medicare works well; let’s see if there is a way to make it work for everyone. Obamacare was a beginning in the effort to provide health insurance for all, not an end.