I really wanted to write about the Democrat debates, but it is just too important to respond to the recent commentaries on this editorial page arguing for the adoption of “Medicare for All.”
But first, I have some quick impressions on the two debates: Joe Biden is aging badly and Bernie Sanders came off as a caricature of a 1940 communist radical.
I need of bourbon to listen to Elizabeth Warren, for her everything she has to say is an emergency and extremely urgent. Cory Booker obviously spent too much time in front of the mirror practicing his earnest expression.
Beto O’Rourke, Bill de Blasio, and Eric Swalwell are just dumb. My biggest disappointments were in Tulsi Gabbard, Amy Klobuchar and Kamala Harris, all of whom have been smart and somewhat moderate in the past but sacrificed their integrity by genuflecting before the gods of the far left cosmos. Pete Buttigieg and John Delaney get my nod as winners simply for being reasonable.
A special acknowledgment goes to Harris for her impassioned story of her oppression as an impoverished minority child forced into school busing. The truth of her background is that her mother was a breast cancer scientist and her father was an economics professor at Stanford. Or was Warren the one who was bussed to white schools and Harris is a Cherokee? I can’t keep it straight.
Returning to the subject of “Medicare for All,” the Gazette had a letter penned by several economists and a guest column authored by two retired physicians arguing for a national single-payer health care system. We must keep in mind that at present, more than 91 percent of Americans are covered by health insurance, according to the U.S. Census. That’s not a terrible accomplishment for the third most populous nation in the world.
Most of the uninsured are comprised of those that have incomes too high to be eligible for Medicaid, but low enough to make standard insurance difficult to afford, and those who choose not to buy health care insurance.
Rather than dismantling the health coverage of 180 million Americans to create a socialized plan to cover that 9 percent, we could create a system of means testing for a standard insurance policy or allow for low-cost catastrophic insurance to be sold across state lines and made affordable for younger people who would otherwise choose not to purchase insurance.
Other countries are held up as having universal coverage as the argument always made for a socialized system in the U.S. We should not conflate universal coverage with socialized health care. Only England and Canada have socialized systems.
If you include countries that make the purchase of health insurance compulsory or offer universal minimal substandard insurance, then we start filling out the lists that are used as examples as having universal health care.
It is often argued that the United States has worse health care outcomes than these other countries. It is usually life expectancy that is used in these comparisons. The lower life expectancy in the United States is more due to social characteristics than it is to the health care delivery system.
This would include a more diverse population, excess deaths from homicide, suicide, and drug overdose, and an epidemic of obesity and its attendant health risks, such as diabetes and heart disease. The increased death rates that drop life expectancy in U.S. are not reflective of the health care delivery system, and is misleading when used as an argument for the implementation of government run health care.
In fact, if you look at cancer survival rates for the most common cancers, the U.S. does far better than its socialist counterparts in Canada and the U.K.
Medicare is held up as a paragon of financial managerial efficiency. Medicare is among the poorest payers for providers and hospitals, and as mentioned in my previous column, every hospitalization for a Medicare covered individual is a loss for that hospital. The hospitals make up their margin through the higher reimbursements garnered from private insurance.
If we went “Medicare for All” tomorrow, there would be widespread hospital bankruptcies and a severe reduction in services and staffing offered by those hospitals that survive.
Despite having nearly the lowest cost structure among insurance to providers of services, Medicare is projected to be bankrupt by 2026. That does not say good things about its managerial prowess.
Medicare recipients have prepaid their premiums for decades before receiving coverage, but the “corporate owner” of Medicare, which is the U.S. federal government, has pilfered the trust fund which was set up to support it.
And yet, the proponents of federal control of the health care system want us to trust that management system. It is possible that the increased administrative costs in the private insurance world provides for a better service.
The physicians who wrote for nationalized health insurance argued that Medicare would only handle finances, but not control providers or medical care. This is absolute nonsense. As a working physician, I can attest that Medicare’s denial of medications, therapies, and services to patients is already more intrusive than that of private insurance, and cannot be appealed. Call this rationing. Welcome to Canada and the U.K.
The economists wrote that health care is not a service that follows market rules. That is exactly the problem. We made it that way by our current health insurance system, which is not insurance at all, but is prepaid health care. The consumer has no exposure to or interest in the actual cost of health care services, but is only exposed to co-pays, which have little relationship to the cost of different types of services.
In our current system, there is no incentive for the consumer to decide against products or services which may offer less potential value and gain benefit from those decisions; but this is a discussion for some other time.
Jay Fleitman, MD, of Northampton writes a monthly column. He can be reach ed at opinion@gazettenet.com.