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Friday, October 02, 2009

Medicare-for-All, No Care for All

By Dr. J. Deane Waldman
University of New Mexico professor
      A recent letter writer, rightly decrying our dysfunctional health care system, raised her head, screamed “Medicare for all” and then returned to her ostrich position. Apparently she has no understanding of Medicare, and she probably did not read the package of letters in the Journal on Sept. 22 titled “Does Medicare Work?”
       The answer was clear: No.
       Medicare was intended to be self-sustaining by having workers pay in while employed and taking out of the fund as needed after they retired. It was supposed to pay for itself: no additional funds required. Hah!
       Inconvenient truth #1: Medicare quickly became a Ponzi scheme just like Social Security. According to the Government Accounting Office, Medicare will run out of funds in 2017, even before Social Security. The addition of President Bush's ill-conceived Drug Program For Seniors sped up a process of collapse by adding another (unpaid for by the contributors) entitlement. Medicare-for-all will be no care for all.
       Medicare tries to contain its costs in two ways: neither works and neither is what patients want. First, it rations care. Yes, I said it. Many things your doctor would like for you are denied as not “cost effective.”
       Let's just ignore inconvenient truth #2, that there are at present virtually no scientific cost effectiveness studies on which the government denies payment. Denying payment means denying care and thus again, Medicare-for-all is no care for all.
       Inconvenient truth #2A: Beware of what President Obama is touting as cost-effectiveness studies in the proposed health care reform bill. Just like in Great Britain and Australia, what the government defines as effective is often not what patients and doctors want as positive effects.
       The second “cost saving” method used by Medicare is to reduce reimbursements. Put aside for a moment that this actually increases costs. Current payments to physicians are now below their marginal costs. The more Medicare patients a doctor sees, the quicker she goes broke. That is why fewer and fewer physicians accept Medicare patients: They cannot afford to. Those who can make up their losses on the ever-shrinking pool of privately insured patients — the infamous cost- or more correctly revenue-shifting.
       I guarantee that your hospital does the same kind of money-shifting. How do I know? It's doors are still open.
       Low payment schedules make it fiscal suicide for doctors to see Medicare patients. So what will health care reform (HR 3200) do to increase access to doctors for Medicare patients? Answer: It cuts reimbursements even further. Perfect!
       Final inconvenient truth: When there is Medicare-for-all or when a “public option” drives private insurance out of business, all doctors will be paid below their marginal costs. There will be no doctors. Then Medicare-for-all will truly be No-care-for-all.
       Dr. J. Deane Waldman is a University of New Mexico professor in the Health Sciences Center and the Robert O. Anderson Graduate Schools of Management.
       

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