Make Medicare available to all

By Laurence S. Jacobs, M.D.
Democrat and Chronicle (Rochester, N.Y.), July 15, 2013

On July 30, Medicare will be 48 years old. It covers over 50 million Americans — those over 65 and the disabled.

Medicare has improved financial security for the elderly and disabled, and reduced health disparities related to race and socioeconomic status. Medicare recipients go to doctors and hospitals of their choice, not to a restricted panel of caregivers. Medicare has overhead costs of about 2 percent, compared with private insurers’ overheads from 12 percent to over 20 percent.

Medicare does have its flaws; it doesn’t cover vision or hearing problems, and the drug program (Part D) has the insane congressional restriction that it cannot negotiate with pharmaceutical manufacturers over medication costs, the way the Veterans Administration can. That’s why the VA spends 40 percent less for the same drugs.

An improved Medicare for all would make terrific sense. Low overhead, a single set of approved forms (not a separate one for each insurer, as is now the case), no outrageous CEO salaries, no marketing costs, first dollar coverage without co-payments or deductibles, no restrictions on choice of doctor or hospital. All medically approved treatments would be covered, and there would be no issue of physicians refusing to see certain classes of patients because of poorly paying insurance coverage.

Funding, from progressive taxes, would cost people less than they now pay in premium, co-pay, deductible, and out-of-pocket expenses. Further, employers would be rid of health care costs, which impair their global competitiveness. Finally, Medicare as the only payer would be able to negotiate robustly over prices of drugs, medical devices, and hospital bills.

Medicare recipients are happier with their health insurance, have fewer problems with access to care, delays in payment, and the like, and are more likely to have a medical home with a primary care provider who knows them well than are people with private health insurance.

So, why don’t we already have Medicare for all? Because of intense lobbying by those who profit from the status quo, and because of lies by ideologues about government intrusion into health care. It’s the private insurance companies that intrude into medical decision-making, deny expensive care to maximize profits, and restrict access to care.

Medicare for all would simply be a payment mechanism. Ask current Medicare recipients whether the program interferes with their care in any way. Like other developed nations, we need to find a way to offer comprehensive health insurance to all residents. The best way to do this is to improve and expand our Medicare program by making its coverage truly comprehensive, and by enrolling everyone. That would make the birthday of Medicare a truly happy one for all.

Dr. Jacobs is a retired professor of medicine at the University of Rochester School of Medicine and Dentistry.

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