Sunday, September 15, 2019

Medicare for All, Good Health Care for the Few

Medicare is great. Medicare is wonderful. Everyone should have Medicare because they will not need to deal with insurance companies. We can have it all, for free and have the best medical care in the world, at no extra expense. Except for the rich who will have access to a private health care system, where they pay out of pocket. 

Of course, the general principle, you cannot get everything for nothing must pertain here. The notion that Medicare never denies payment for a procedure is nonsense. If the government ends up paying for everything, with no copays or deductible, the nation will quickly descend into bankruptcy. 

To put this into perspective, I will share an anecdote. Several years ago I was having lunch with a cardio-thoracic surgeon. He was an experienced and top surgeon, having graduated from a leading residency program. I will not give you the details, for obvious reasons.

As you might expect, most of his patients were on Medicare. And, that was the problem. Medicare had been cutting  back on what it was willing to pay for open heart surgery. It had cut back so much that the fees received could not cover his overhead. That included his office, his nurse and, of course, malpractice insurance.

One does not know specifically how much a heart surgeon spends on malpractice insurance, but I am confident that it is into six figures. I will mention in passing that I for one will only take the calls to reform health insurance seriously when the government removes the vampire squid of the trial lawyers from the practice of medicine.

Anyway, the low fees were only part of the problem. The other part was that, by his professional judgment, a safe open heart surgical procedure required two surgeons and a number of nurses. Yet, Medicare had decided that paying for the second surgeon was too expensive. So, it decided that it would only pay for one surgeon and one registered nurse… to perform open heart surgery. The surgeon thought that this was inadequate and even dangerous. He could not fight Medicare.

Those who tout the virtue of Medicare for all never suggest that government bureaucrats might deny treatment. Besides, do you really believe that said bureaucrats have a better understanding of what is required for open heart surgery?

Medicare for all… is a trap. It will damage health care delivery and will certainly cause care to be rationed. All countries that have national health services do so. Why would we not?


Ominous Cowherd said...

The entire US tort industry is estimated to be worth about $340 billion per year. Only a portion of that is parasitic on the medical industry. The US medical industry is about one fifth the economy, about $3 trillion per year. Totally eliminating medical liability would be a drop in the bucket, wouldn't noticeably lower costs.

Stuart Schneiderman said...

Of course, it would. First, in terms of lowering expenses... as in, malpractice insurance. If a physician pays a quarter million dollars a year in malpractice premiums, someone bears the cost. And second, in terms of the practice of defensive medicine. Unnecessary tests and procedures are also costly. And they often manage to create more problems than the solve. The new problems require new treatments, and thus greater expense.

sestamibi said...

I have a Medicare supplementary insurance policy from a private carrier. So far so good, but if this continues to be the direction they're going, then such supplementary plans will have to cover a lot more as Medicare retreats. So more out of my pocket (and those of others similarly situated)--as long as we can afford it.

That brings us back to square one, in effect returning the health care system to private hands--at least until the Left decides that no one should be able to do that and establishes a single-payer system that will serve no one well. The rich and the well-connected, on the other hand, will continue to get all the care they need.

trigger warning said...

Regarding your reply to the tort cheerleader, virtually any engineer will agree that torts rarely, if ever, "solve" any problem. See, for example, the case of the "Defective" Gasoline Cans. Thanks to personal injury lawyers, every gasoline can sold in America is now defective in terms of the efficient delivery of gasoline from a can to a tank. And more expensive. As you say, torts obviously raise the cost of doing business. And tort lawyers are why, to pull a random example off my office shelf, that Black & Decker warns us all not to use an electric leaf blower in an explosive atmosphere.

The other matter not directly addressed is the popularity of, and mythos around, "evidence-based" medicine. It may well be true that the average open heart procedure does not demonstrably benefit from having two surgeons present. But the patient better damn well hope that everything goes as planned before the first incision is made. If medicine, or commercial air travel, were professions of the average, robots would probably suffice. In general, it's not the middle of the distribution that's worrisome; it's the tails (e.g., Chesley Sullenberger).

Linda Fox said...

The fastest growing type of Medicare insurance is Medicare Advantage (with/without drug coverage). It's essentially privatized Medicare. Here's how it works:

The government takes the money they estimate they would have used, on average, for its patients on A & B. It gives that money to companies (around $1000/month right now), and says, you set up a plan that is, at least as good as what that recipient would have gotten from original Medicare. If you spend less, you keep it. If you spend more, your loss.

The idea is that private companies, with incentive to stay profitable, will manage their plans better. Don't forget, unlike original Medicare, they have to risk losing patients if they get unreasonably stingy, and deny coverage.

User love the plans, and - with opportunity to return to original Medicare, overwhelmingly opt to stay on the MA plans. Many of them offer incentives to stay healthy, such as fitness plans and no-pay for preventive care.

Medicare for All would, in contrast, work like ACA - Obamacare. High cost, crappy policies, lots of fraud.