As a Doctor and Citizen, I’m a Little Wary of ‘Medicare for All’

All the problems of private insurance notwithstanding, I am not sure getting rid of private insurance is the solution

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Photo by Louis Velazquez on Unsplash

I have written hundreds of appeal letters, arguing against denials of payment by private health insurance companies. For one year after my daughter died, I had to deal with egregious health insurance tactics to avoid payment for services that she required while she was dying in the hospital. I have had my share of frustration with private, for-profit health insurance.

That does not mean I want it to be completely eliminated by “Medicare For All.”

I am a doctor. I have been practicing medicine for over 18 years. I have seen the devastation wrought by not having health insurance; by putting off needed medical care because the cost is way too much. I know all too well the ever-present risk of financial ruin from one illness. Lord knows, if I did not have good health insurance when my daughter was battling cancer, I would have been financially wiped out.

And so, I would love for everyone in our country to have access to good, quality, affordable healthcare, and this is why I don’t understand why the Trump Administration wants the entire Affordable Care Act to be struck down. Indeed, the ACA has problems and needs fixing. It has, nevertheless, given 21 million people access to healthcare they would not have had before.

That said, some of the proposals for “Medicare For All” — which would eliminate private health insurance altogether — make me wary.

First of all, a lot of people work in the private health insurance industy — at least 500,000 people — and if private healthcare is eliminated, those jobs would likely disappear. Where are all those people going to find work? Furthermore, as the NY Times recently reported, eliminating private insurance would cause even more disruption:

The private health insurance business employs at least a half a million people, covers about 250 million Americans, and generates roughly a trillion dollars in revenues. Its companies’ stocks are a staple of the mutual funds that make up millions of Americans’ retirement savings.

Furthermore, hospitals will suffer tremendously if they were suddenly paid Medicare rates for all patients:

Hospitals could lose as much as $151 billion in annual revenues, a 16 percent decline, under Medicare for all, according to Dr. Kevin Schulman, a professor of medicine at Stanford University and one of the authors of a recent article in JAMA looking at the possible effects on hospitals.

“There’s a hospital in every congressional district,” he said. Passing a Medicare for all proposal in which hospitals are paid Medicare rates “is going to be a really hard proposition.”

Many rural hospitals, according to the NY Times, would be hit especially hard, and this would jeopardize access to healthcare for millions of Americans living in rural areas.

Furthermore, the proposals for “Medicare For All” are silent on how such an expansive program is going to be paid for. Congressional advocates for “Medicare For All,” like Congresswoman Pramila Jayapal of Washington, talk about all of the costs of private health insurance, which are indeed substantial, when they discuss “Medicare For All.”

Yet, if these costs go away with “Medicare For All,” I really don’t think that we citizens are simply going to pocket the savings. No, we are likely just going to transfer those savings to the government in the form of higher taxes. That has to be the case, as some estimate that the costs of a single-payer system could be as high as $30 trillion or more over ten years. From where is this money going to come? So far, I have not heard an answer to this question, and this makes me nervous.

In addition, for all the frustrating things that private health insurance plans do, they are not all bad. A lot of people are very happy with their private health insurance. Moreover, just because a doctor does something, it doesn’t mean that it is backed by medical evidence. Private health plans have done some good in denying costly medical care that has no medical evidence to support its efficacy. In addition, there have been a lot of innovation in the healthcare field driven by the private health insurance industry.

One group, OptumCare, has done some amazing things with the patients that they treat: providing low-cost, high-quality, evidence-based medical care. I recently heard a speech by their Chief Medical Officer, and it was impressive what they have been able to accomplish. Making all of this go away with “Medicare For All” would be a shame.

Private health insurance has its issues, and I have been disturbed by some of the tactics I have seen private health insurance companies do to deny payment for medical care. That does not mean that eliminating private health insurance altogether by a single, comprehensive “Medicare For All” system is the answer.

I think there can be a compromise in our healthcare system; I really like the idea of offering Medicare to more people by letting them “opt in” and buy into Medicare if they so choose. While Medicare does indeed have its own issues, including not paying enough for services rendered by providers and hospitals, it is incredibly efficient, and it has helped millions of seniors get access to good, quality medical care without becoming wiped out financially. Expanding that to more people may be a good, viable option.

And I do think that the more egregious tactics of private insurance should continue to be constrained, such as denying care for pre-existing conditions and having “lifetime limits” on care delivered. There should be a balance, and with all the incredible minds we have in this country, a viable balance can definitely be struck.

NY Times featured Pulmonary and Critical Care Specialist | Physician Leader | Author and Blogger | His latest book is “Code Blue,” a medical thriller.

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