Let me start by saying I am a Warren supporter. BUT, I worry about the Medicare for All meme.
Supporters of M4ALL think it is full socialized medicine, covering all costs. Magic?
These folks do not account for the complex differences between the provider system in the US. What Sanders supporter, and perhaps my Warren friends, think is that M4A is an American version of the UK NHS model that is very hard to imagine here.
The supporters also think Canada has a full single payer plan. Our loonie friends have a great universal health care system but their system depends on private insurance for many costs in or out pf a hospital. The same is true in Scandanavia, Germany, France, and even Israel.
My guess is that few Bernie bots would be happy with the free care available in New Brunswick or Vancouver.
I hope the Warrenites have read her plan and understand why she avoids mimicking Moses parting the sea! Her plan describes a univeral coverage effort followed by implementation of changes that could actually lead to a single-payer system.
Let me start by discussing how M4All deals with costs. As a slogan, M4A slogan, falsely gives the idea that the huge cost of our system comes from profits paid to insurance companies. That is simply false, non-profit and profit plans in the US cost more or less the same.
What is true in the US that we have a major issue with administrative overhead and with provider prices. Both of these, however, have another problem .. wages and unions. What M4ALL proposes is that the bargaining power of a single-payer program would force prices down. That is only true if you feel our current system just wastes money on frill and that no jobs would have to be cut.
Admin overhead is monstrous even for Medicare. The latter is confusing because overhead charges for Medicare are fixed by law. So other income streams must, BY LAW, subsidize M4A. If we had only one single-payer this might decrease overall costs but not to Medicare levels.
Then there is the issue of who gets these admin dollars? Huge parts of the admin labor force would have to be laid off to achieve M4All levels of cost reduction. Some of that might be salaries for honchos and we can all jeer. But, most admin costs do not go to the $5,000,000/yr boss. Most costs go to her staff. Politics makes cost cuts in admin difficult since lots of medical assistants, nurse managers, social workers, executive assistant and receptionists are unionized.
Finally, admin costs do not explain provider costs. Providers include the folks who sell drugs, braces, heart valves as well as foks wo deliver patient care.
The Pharma part of the argument is relatively easy … cut drug company profits makes sense but it does raise issues of how drug development is funded. What effect of drug development would a single-payer have in what drugs are developed? It currently costs about a billion dollars to test a drug that meets FDA standards! How ill lower profist affect the decision to fund trials?
More difficult is the question of the prices Americans pay for procedures … from x-rays to brain surgery. All of this can cost 2 to three times what the same procedures costs elsewhere. Why? Where does the money go? Is it that our docs get paid more? Is it that our docs have huge med school debt? Is it the staffing … nurses, ward secretary, technicians of all types? How would M4All fix that?
Finally, American providers are hugely different. The Mass General is not the same as St. Joseph’s in Spokane! Nor is the Mayo Clinic the same thing as The Bastyr Naturopathic Clinic. Is M4All going to pay the same to every provider?
The British NIH and Canadian system are on both sides of the economic model. The supply side and the demand side. This does mean health care costs are about half of what they are here, and if you are rich well you can have your own pet doctor or nurse and pay for that out of your pocket. Probably none of this of the very rich moving into a hospital at an advanced age. Happens here and is usually done on the down low and may actually end up letting the hospital help some poor folks.
We do have a system that doctors do far more testing than is done in many other cultures, but this is in part our litigious nature, and demands from Dr’s insurance that they not do anything that could be construed as mal practice while still providing the very best care, even when the emergency room is full and the patient is blue in the face and not breathing and something must be done, just what is the Dr to do. He or she may actually know, but by golly don’t be wrong so run the test and cross your fingers the patient does not turn very white.
It will mean hospitals will all become much more the same. Hopefully the Mayo Clinic model is followed.
One big problem in our system is that Dr’s are paid like apple pickers. The more apples a picker picks the more money he or she makes. The more procedures or things done for a patient the more the Dr/hospital makes. Which is why an aspirin costs so much in the system and is also why there is so much of an overhead. Whereas if the patient needs an aspirin as in the military health system where the Dr’s and nurses make the same as any other Captain, Major, Col, ect th aspirin is dispensed. Yes Nancy the US already has socialized medicine and the government has done it for over a century. It is not cheap, but it can give you a good idea what to expect if we go to a system like the Canadians and expect it to work. Of course we will have the advantage that the Dr’s we eventually train will stay here unless China adopts our current model.