Photo: Antoni Shkraba -- Pexels
Guest: Eric Halvorson, an Asheville plastic surgeon
Topic: How Medicare for All might improve health and reduce costs and hassles by eliminating the role of health insurance companies
Challenge: Health insurance companies pass the cost of care to consumers and create unnecessary expenses and hassles for clinicians and consumers.
The debate
Medicare for All would reduce healthcare costs for society because of price controls and the cost of maintaining the health insurance industry would significantly drop.
A minority of people drive the costs and even use the system in the first place. Why should everyone else pay for their care through higher taxes?
Core Question
Would paying premiums through taxes lead to better outcomes and satisfaction at lower costs to Americans?
Medicare for All would expand Medicare coverage for senior citizens to all Americans.
We would pay a tax in return for healthcare services with much lower out-of-pocket expenses.
The Centers for Medicare and Medicaid Services (CMS) would set prices
Prices would still vary by region to account for differences in population, physician availability, cost of living and other factors.
The process health insurers use to determine whether to cover a drug or service, which often delays and even prevents certain types of care, would be scaled back.
A fixed fee schedule would benefit patients but many physician specialists would likely take a pay cut.
Examples that Medicare for All makes sense
Other countries have some form of tex-funded, national health system and experience better outcomes than we do in the United States
The Veterans Administration cares for military veterans
Our taxes pay for the police, fire, military, all of which provide safety and security, like the healthcare system is supposed to
How healthcare pricing works today
Hospitals have not set a cash prices for each service they offer (so someone has to set them)
Prices significantly vary by service, procedure and region because 1) costs are different in depending on where you are in the country and 2) each provider has a different contract with each insurance company for anything from visits, to surgeries, to supplies.
Rates are based on bargaining power:
Payers “win” negotiations when they have enough members to guide patients from the health system — prices drop or slowly rise.
Providers “win” negotiation when they can offer unique services or have little competition in a local areas — prices may increase faster.
The health insurance industry value proposition
They call you to ensure you visit the doctor and take your meds based on your diagnosis.
The process of figuring out what is covered and how much it will cost is not always clear,
The authorization process for approving care and medications can delay care.
The only choice people really have is which doctor to go to, but we are often referred to a physician we have never met and meet only infrequently after the episode of treatment.
Most Americans who are not eligible for Medicare or on Medicaid get health care insurance through their employer, so our insurance is only as good as what they pay for.
Americans pay insurance companies a premium and then for care itself until we reach our deductibles and out-of-pocket maximums.
High-deductible plans were designed to prompt people to live healthier lifestyles and get regular check-ups to prevent diseases or slow their progression.
Premiums, deductibles and out-of-pocket maximums, and prices for drugs and care all continue to rise.
Healthcare providers may increase rates to offset costs they incur because they must hire office staff to manage the different forms and requirements of all the different insurance companies, which also means they have less time to spend with patients, making the overall health care experience worse.
Consequences
We decide to use the healthcare system based on whether we can afford it and its degree of urgency
If you can afford the out-of-pocket expenses, you will use the health care system
More and more people put off health care and wind up in the emergency room or postponing it until they turn 65.
The top cause of personal bankruptcy is due to inability too pay medical expenses
People use GoFundMe campaigns to pay for needed care.
People are unhappy but stuck with their job, potentially less productive and less satisfied with employers and politicians
We stay in jobs they don’t like, potentially limiting productivity, and increasing their unhappiness with the American way to life and the government responsible for it.
Food for Thought
Is health care a public good like police, fire and military protection and so should be paid for with taxes?
If not, why should some people get it because they can afford it when they often don’t lead a healthier lifestyle than someone who can’t afford care?
If so, then we ought to ensure everyone can use it, which means driving down prices and reducing administrative costs that are associated with the health insurance industry.
If we replaced health insurance companies with CMS, how would it ensure that health care providers do not simply raise prices as high as they could?
Actions
Take a position. Rising prices for health care and medication won’t wait for you.
Young people! Get involved in changing the health care system. Just because you don’t use it doesn’t mean you shouldn’t get involved.
Call and email politicians. If they don’t respond, that’s a different issue we need to address.
Resources
Medicare for All You should be able to find a local chapter
Physicians for a National Health Plan (PNHP). Most members are not physicians Find a local chapter
Fixit Health Care: A series of documentaries about problems in the United States’ health care system anyhow to address them.
There are various efforts underway to reduce costs and improve quality. It’s not clear they are working
Price Transparency: CMS passed a law requiring health care providers to publish their prices so consumers can shop for the best deal. Enforcement is spotty and it does not address that prices will still be negotiated based on who has bargaining power in the payer/provider relationship.
Value-based care is designed to shift payment to care providers from being based on the price and volume of services provided to being based on their ability to reduce costs and improve outcomes. It’s expensive to implement. Some are arguing that it’s just creating a market for consultants and more administrative costs, and not reducing costs or improving health.