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M4All IS NOT READY FOR PRIME TIME

“Medicare for All” is a slogan, not a policy.

University of Washington doctor Warren Guntheroth didn’t mince words when the UW’s medical centers paid a record $35 million penalty in 2004 for overbilling Medicare and Medicaid. He publicly blamed the dean of the medical school for the scandal.

If there is any real lesson to come from the Trump Presidency, the lesson may be the dangers of trying to base policy on a campaign slogan.  In 20 years, politicians will use the slogan “Remember the Wall” to accuse their competitors the way Reagan asked Mondale “Where’s the beef?”  

 
Medicare itself is dependent on a tax set aside as is Social Security. Does the Medicare for All policy include such a tax? Social Security works not because it is actually a savings program but because young workers pay into the system that benefits old workers. Will we have enough young workers to going to pay the M4D tax?
 
Medicare caps admin costs at 5%. This is touted by the M4A community as a triumph over private insurance.   It is not. The actualadmin costs for administration of Medicare are  born by cost shifting to other sources of income. Who will pay those costs?
 
Medicare is also designed around geriatric issues, including end of life. M4All needs to address very different health needs. Our provider systemes ..hospitals and clinics serve different functions. These  range from plastic surgery, to sex conversion, to naturopathy, to chiropractic, to fad diets, etc. A policy needs to consider how to deal with all that, The issue is not just what services to pay for, its is the nature of the business that provide the services.
 Americas providers are very divers.  The providers are where almost all of the costs are and often have string ties to different communities.  Thoise communities range fro  religions, to tribes,  Institutions range over profit gouging clinics to Catholic hospitals, Public Health Service clinics on reservation,  state medical schools, and faith h healing centers.  Providers include drug companies and pharamcy chains .. with Amazin emerging as a new force.  Would M4All just pay money to all these folks?  Would M4All have price controls? 
 

American healthcare is part of employment,  Finally, a key issue is the role of employers.  Employees are very protective of that care as are unions. A policy needs to describe how M#All effects employment. Would M4ALL make employer heath plans illegal? 

As a place to start, here is a list of countries with universal healthcare and the different ways they pay of healthcare.

 

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