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.
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.