Medicare for all – Boon or Bane?
With the kickoff of 2020 presidential elections, healthcare debate started afresh. All the democratic presidential candidates are trying hard to outdo each other to offer “best” healthcare plan, which covers all the uninsured! But none of the candidates seem to have a coherent plan, which meets basic objective of the so called “healthcare is a right”, without bankrupting already “debt ridden” great nation of US of A!
Is Medicare for all a boon or bane?
While Trump administration defanged the already unpopular Obamacare, by removing the mandatory penalty clause, the plan itself continues to be controversial. It has disrupted the healthcare insurance market, complicating the model even further without any sight of problems of the industry such as a) year over year increasing premiums, b) monopoly of players in some states and c) inefficient medical facilities with no clear value proposition, to name a few. So, what is the solution to this ticking time bomb, with majority of baby boomers already retired and are on Medicare?
If one looks at the healthcare problem holistically, the problem seems to be much bigger than just covering the uninsured. Healthcare needs to be broken down further into medical care. All the plans whether they are Obamacare, or any others address the medical care of the Americans. This debate needs to be elevated to a higher level and I reserve that debate for another day!
Surprisingly the plans proposed by the presidential candidates fall flat, when one does a “like-to-like” comparison with current plans. For instance, how does the program support a) employer sponsored plans with high deductibles and for people who are under 65 years of age, b) how do laid off workers get into and out of the program depending on their employment situation? c) how does it support people in small businesses, d) does the plan support choices of doctor, specialist, hospitals? e) what is the maximums for individual and family co-insurance, f) does it cover vision and dental health, g) what about immunizations and h) finally how much will be out-of-pocket premiums for comprehensive vs. limited coverage etc. and many other such questions. Most important question is, how will it get funded and how will providers get paid? Out-of-pocket expenses for customers always depend on the payments paid to providers.
There are lot of other questions which crop up such as a) How does this plan address insurance for groups such as veterans, illegal immigrants and others? What happens to Medicaid program? What happens to employer sponsored plans? How does this impact the larger US economy and debt from an entitlement standpoint?
Every debate of Democratic presidential candidates introduces a new element of confusion to the proposal, as each candidate tries to sell their own plan as the best solution to all the ills of current healthcare models. But none of the plans provide details on addressing systemic weaknesses which result in higher hospital, drug, short-term and long-term costs bankrupting the system. I recently met an older couple in an international flight, who were coming back from another country they visited, to get procedure done. They paid a fraction of out-of-pocket expenses they would have paid in USA for the entire procedure and post-procedure care. Why does medical care cost so much in USA compared to other countries? Some countries are marketing “medical tourism” to Americans, a code word for cheaper medical procedures, performed by equally qualified and competent medical professionals
So, what is the way forward to this mess? Any discussion on health care should not only address the coverage but also address value vs. cost of medical care. Our policy planners can learn a lot about medical costs in other countries with comparable delivery systems for the patients. Failure to address healthcare in a holistic manner will just be “noise” as opposed to efficient and sustainable healthcare for Americans.
Stay tuned and watch this space for proposals for addressing this issue!!
Author Information: This article is co-authored by Jerry Rhoads and Karthik Kandamuri. Jerry is an author and an expert on health care with multiple years of experience in the space. Karthik Kandamuri is a concerned citizen, analyzing the policies and long term effects on the country, with a bipartisan lens.