Among the health reform plans likely to be considered is an expansion of Medicare, allowing non-seniors to “buy in” to Medicare.
This is a bad idea.
Space, my time, and your patience prevents a complete discussion of the myriad reasons “Medicare for all” won’t work well. Here are the two main issues.
While Medicare has succeeded admirably in ensuring seniors and the disabled have adequate medical care, it has done so on the backs of treating physicians. One of the primary reasons physician income has declined steadily over the last several years has been the drop in Medicare reimbursement (adjusted for inflation). If Medicare for all is a success, physician income will decline even more precipitously, leading to higher utilization, angry docs, unsatisfied patients, and howling politicians.
Political realities make Medicare for all highly unlikely. It would be perceived as a big-government, socialized medicine (whatever that is) approach, which is anathema to many. It’s just a political non-starter. And, Medicare for all would bring out the long knives of the managed care industry, health plans, and other stakeholders (AMA, AHA). These are well-funded and effective lobbyists, and will be very hard to overcome.
What does this mean for you?
There are lots of better ideas out there today, and more likely to come. By understanding the limitations of some of the trial balloons, we’ll be better equipped to assess the good ones.
What do you think about letting Medicare function as an ultimate assigned risk pool for people who are deemed uninsurable by private insurers but could afford to buy into Medicare at a rate equal to lesser of Medicare’s average spending per beneficiary in the county the prospective insured lives in or 15% of income? While this amounts to deliberate adverse selection, at least it could provide coverage, albeit at high cost, to people who need it most but can’t acquire it any other way.
Joe,I’m not sure this is as bad an idea as you suggest.Medicare for non-seniors could be an entirely optional program for physicians to partcipate in. They would do so based on how attractive they find the reimbursement. Non-seniors, in turn, would select this option on the basis of the cost and access, in comparison to commercial plans. The competitive marketplace may improve both commercial and government programs.
Universal medicare actually might work with the following adjustments:
1. Strict liability reform. Suing because some nebulous “standard of care” was not met has to be banned. Lawsuits could only be filed if a well defined, previously documented protocol was violated, and awards wuld be limited to strictly economic damages. This would lower insurance costs for docs, and would also greatly decrease the cost to medicare of CYA tests and their complications. Docs would also have to waste less time on documentation, and spend more of their time on patient care.
2. Allow balance billing. This would introduce some competition into the marketplace, as docs would be able to charge more and earn more if they pleased their customers (patients). Docs would then be motivated to provide a higher level of service, or basic service for basic reimbursement.
3. Predictable, realistic reimbursement levels. Stop the annual games with threatened 5% cuts. Raise the RVU every year by the same amount that Congress’ pay gets raised. Stop the silly 14 day payment delay. If medicare gets a clean honest claim, pay it now, preferably by direct transfer into the doc’s practice account. Develop a basic easy to use open software system that docs could get free from medicare that would allow them to get paid without paying megabucks for complex proprietary systems that offer bells and whistles that nobody needs. If the system were simple enough, docs could run their offices with far fewer clerical employees, and more would go to the bottom line.
I’m a surgeon, and I know it’s a lot harder for my office based colleagues out there, but often it seems to me that difficulties with medicare are easier to solve than similar problems with private companies, even though reimbursement rates are a little higher than medicare. A least with medicare, I always know to the penny what my payment will be for any particular service, and I can decide whether or not to offer that service. With private insurance, they do not easily divulge their payments until after the fact, and sometimes decide later that the service was not covered.
You are probably correct that political realities will prevent any real reform. THe 30% of medical payments that goes for overhead and administration would look good on my bottom line.
JB – good comments and helpful suggestions.
Don’t despair – we will have reform, just not for a couple plus years.
In the meantime, physicians can help themselves by documenting patient satisfaction. I know it’s not a panacea, but it is better than a lot of the alternative P4P stuff floating around.