What’s Wrong With Medicare For All? – Part I

 

There’s a lot of talk these days about Medicare for All. Already it is shaping up to be the hottest topic of the 2020 Presidential Campaign. What does it mean and is it good for the American people?

Medicare for All is a catchphrase and a legislative bill, both introduced by Vermont Senator Bernie Sanders. Sanders, an avowed socialist, is promoting a government-run, single-payer healthcare system. He promoted this cause in his unsuccessful 2016 bid for the presidency.

The idea has gained traction since then with other Democratic presidential hopefuls. Recently announced Democratic presidential candidates Kamala Harris, Elizabeth Warren, Kirsten Gillibrand and Corey Booker are all supporters of Medicare for All. It is likely to become a platform plank for Democrats in the 2020 election. Therefore, understanding what it means and the impact it will have on healthcare and the nation’s economy is paramount.

Democratic Claims

There are many claims being made about the benefits of Medicare for All. I have heard all of the following:

  • Universal access to healthcare
  • Elimination of insurance company approvals for treatment
  • Increased taxes will be no more than current expenses for healthcare
  • Lowered healthcare costs for patients and the government
  • Improved healthcare quality for all Americans
  • Americans will love this “free healthcare”

 

All of these claims have been made by politicians or their supporters at one time or another. Sorting out the truth from the fiction is necessary if we’re going to make an intelligent conclusion about this new healthcare idea. Let’s analyze each of these statements one at a time.

Universal Access to Healthcare

Prior to ObamaCare about 84% of the population had healthcare insurance of one kind or another. Since ObamaCare it is now about 90%, mostly because of increased Medicaid eligibility and enrollment. That still leaves about 10% of Americans without healthcare insurance. That does not mean they are without healthcare.

Those 10% are mostly individuals who do not receive employer-provided insurance, are not eligible for Medicare or Medicaid and they have chosen not to purchase ObamaCare insurance because they do not receive a subsidy.

These people are not the poorest Americans. They make too much money to be eligible for Medicaid or ObamaCare subsidies. They may have the money to purchase insurance but they have elected to remain uninsured because it is not cost-effective. This may be a very responsible decision on their part, given the current cost of ObamaCare insurance without subsidies.

Medicare for All would increase the roles of those eligible for healthcare insurance provided by the government. It would also eliminatethe private health insurance industry that currently provides health insurance for about 155 million Americans through their employers, as well as all those with private insurance supplements for their Medicare gap insurance or Medicare Advantage plans. That means the current insurance system for about 200 million Americans would be eliminated!

Advocates of Medicare for All claim this would eliminate the 10% coverage gap and provide universal access to healthcare. Is this true? Would this really improve our healthcare system?

One of the most widely misunderstood words in the healthcare debate is access.Insurance coverage does not mean access. An insurance enrollment card does not increase your access to healthcare unless you can more readily see the doctor. When it comes to Medicaid, this is especially a problem.

In 2007 the State of Oregon was forced to begin an experiment with their Medicaid system because they had inadequate funding to cover everyone eligible. Therefore, they devised a lottery system that arbitrarily determined who would be eligible and who would not. This began what is now known as The Oregon Health Insurance Experiment. This ongoing study has drawn several important conclusions including:

  • Medicaid enrollees do not have better health than the uninsured– when comparing standard measurements of blood pressure, blood sugar, and cholesterol. Medicaid reduced observed rates of depression by 30% but increased the probability of depression. Medicaid increased the probability of being diagnosed with diabetes, but had no impacton lowering blood sugar.
  • Medicaid lowers access to healthcare– Medicaid enrollees were 40% more likely to use emergency rooms for care than the uninsured. This same finding was confirmed by the Colorado Hospital Association, which reported that emergency room use is higher in those states that expanded Medicaid (about 3 times higher). This is explained by the fact that the uninsured (that 10% who chose not to purchase insurance) can pay cash for discounted doctor visits but this is illegal for Medicaid patients. The Medicaid patients cannot get into doctors’ offices so they resort to using emergency rooms for primary care.

 

Government-run healthcare does not increase access to healthcare unless it can provide quality treatment without undue delay. In the Oregon study, access to healthcare was better without insurance! So access to healthcare has not improvedby Medicaid expansion. Will Medicare for All be any better?

(More on this topic next post in Part II of this series.)

Note: Future posts will now be weekly.

DNA Testing or Not?

 

Is DNA testing a good or a bad idea?

Recent advances in DNA testing have made the cost reasonable for everyday people. As a result, many people may have received such a gift for Christmas, or at least are considering the test on their own.

AncestryDNA and 23andMe are the two most widely used commercial products for DNA testing to research your ancestry. A simple saliva swab makes these tests simple and painless. But are there drawbacks to digging into your family heritage?

Paul Hsieh, writing for Forbes, says there are issues to consider. Sometimes background checks through DNA testing will reveal family information best left unknown. These tests can reveal marital infidelity, previously unknown parentage, secret affairs, and other unpleasant family secrets.

Furthermore, if you choose to post your genealogy information on public websites, you may compromise the privacy of others who have never even been tested.

Hsieh gives an example of a man we’ll call “George Doe” who gave 23and Mekits to his parents and himself. He and his sister learned they had an unknown half-brother who shared the same father but was given up for adoption at birth. The result of this new information was his parents divorced and the family isn’t talking to his father. “George” would have never done this if he knew what trouble it would cause.

As Doe told the staff at 23andMe: “I’m not sure all your customers realize that when they participate in your family finder program, they’re participating in what are essentially really advanced paternity tests.”

When Catherine St. Clair took her test from AncestryDNA, she learned that the man she knew all her life as her father was not actually her biological father. Similarly, her siblings were actually half-siblings. It rocked her world.  She said, “I looked into a mirror and started crying. I’ve taken for granted my whole life that what I was looking at in the mirror was part my mother and part my dad. And now that half of that person I was looking at in the mirror, I didn’t know who that was.”

Both companies warn customers of such dangers in the fine print but most people never bother to read the warnings.

Another risk concerns privacy violations. Investigators have learned they can use DNA testing to find individuals they are investigating. Even though you may not personally be tested, if enough of your relatives are tested and they submit the results to a public genealogy data base such as GEDMatch, you may find your privacy violated.

This methodology was used to find the suspected Golden State Killer, James DeAngelo, who is charged with 13 counts of murder and 13 counts of attempted kidnapping. Since DeAngelo was caught last April, 13 other suspected criminals have been identified in the same way.

There are benefits to DNA testing that go beyond your curiosity about your genealogy. Adoptees have been able to find biological parents and siblings, while others have found remote cousins that enrich their family experience. But the old saying certainly applies, “Let the buyer beware.”

The Gender Neutral Option

 

Parenting just got easier, thanks to big government. No longer do parents need to struggle with deciding their child’s gender. Progressive New York City Mayor Bill de Blasio just announced a new law in New York City to make it easier to choose your own sex – or none at all!

For those New Yorkers who choose to be transgender or “non-binary” individuals, they can change their birth certificate to match their choice without needing a signed affidavit from a healthcare provider. De Blasio proudly proclaimed, “Transgender and gender non-conforming New Yorkers deserve the right to choose how they identify and to live with respect and dignity.” 

He went on to say in a tweet, “Our city respects your gender identity and the right to have it affirmed on your birth certificate.”If you were born in New York City, you can apply to have the gender marker on your birth certificate changed by submitting a notarized application stating that the revision is to reflect their “true gender identity and is not for any fraudulent purpose.”

As a medical doctor who has performed deliveries, I know it is the doctor’s responsibility to declare the sex of the new baby and to certify that sex and day of birth on a birth certificate. This new law essentially says the doctor who delivered you and certified your sex and day of birth was wrong. Does that mean you can also change the day of birth to suit your choice? What about the place of birth? If this is up for grabs, too, perhaps foreign nationals can select an American city of choice for their birth certificate so they can run for president? Where does this “choice” end?

The City of New York thinks differently. “You don’t need a doctor to tell you who you are and you shouldn’t need a doctor to change your birth certificate to reflect your true self,” said New York City Council Speaker Corey Johnson.

The “X” option will not be available at the time of birth, according to Michael Lanza, spokesman for the New York City Health Department told CNN. However, it will be an option for those who want to alter their birth certificate later.

This new law is apparently in response to pressure on the city to relieve the legal red tape for transgender and non-binary individuals (those who can’t make up their minds.) The city began easing requirements for a gender marker change in 2015, eliminating the need for a healthcare provider’s signature. Prior to that time any change in the gender marker on the birth certificate required proof of sex-reassignment surgery.

New York City is not alone. The states of California, Oregon, Washington, and Idaho all allow birth certificate changes without the signature of a medical authority. New Jersey will follow suit in February.

Progressives have now made it clear they support choosing your own gender, choosing an abortion or same sex marriage, even choosing to enter our country illegally. They simply won’t allow anyone to choose Christianity if it will have any influence on their behavior in the public marketplace.