Medicare is the key to healthcare reform
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Unlike many conservative pundits and commentators, I seem to have been absent the day they passed out Obama’s magic mind-meld helmet, so I don’t really know for certain what actions he’s going to take and what the focus of the new administration will be. What I do know is that on the campaign trail a lot of words have been spent discussing how to address our nation’s ailing health care system, and how to approach the goal of universal coverage. Obama, McCain, and Clinton all had their own ideas. And while some face time was given to Medicare, to my mind it was not nearly enough.
Medicare is our red-headed step child. Much effort and political capital was spent by the Bush administration pushing to “fix” Social Security. Compared to the estimated liabilities of Medicare though, Social Security’s future looks rosy. I understand some Democrats’ reluctance to confront the flaws in one of the pillars of our social safety net, but the need is most definitely there. Not only for the sake of the program, but for the larger impact on our health care system as a whole. In the discussion of the best road towards universal health coverage, the phrase “single-payer” has become anathema to many. And why not, when our limited experiment with single payer (Medicare) has such problems? Why should we vote ourselves into a program that appears to have issues just dealing with its current subscribers? This is why Medicare is so central to the debate on health care, especially for Democrats. Any movement towards an increased governmental role in health care will be regarded with skepticism so long as the problems in Medicare go unaddressed. And as for where to start, may I recommend to President-Elect Obama’s staff that they discuss with Senator McCain some of the proposals he suggested on the stump - cutting fraud, increasing adoption of technologies (like EMR systems), innovative care solutions (like PACE), and reforming payment methodologies (some progress was just made on this).
I personally believe that true universal coverage will only be achieved with a radical redesign of our health care system, and the likely adoption of a single payer system, though not necessarily on the Medicare model. Some of the ideas of Ezekiel Emanuel (Rahm Emanuel’s brother) and Victor Fuchs as presented in this TNR article and their book Healthcare, Guaranteed look very promising. But until the government can demonstrate that it can efficiently and effectively operate Medicare, the move towards such a system would be a true leap of faith.
Jeremy,
Thanks for the thoughtful post.
Certainly healthcare is a huge entitlement program that needs to be looked at. Between Social Security and Medicare, our national debt continues to spiral out of control.
The reality is the current system is, indeed, broken.
The question is, how much of your private, personal healthcare is it the responsibility of the federal government to manage?
Having been on Medicare for 14 years (due to disability), I can tell you it doesn’t work well. It’s adequate for medical, but covers neither vision (I wear glasses) nor dental. Both I have to pay for out of pocket.
So, no way is Medicare a model for a single-payer system.
I agree Henry. Medicare, at least as its currently implemented, should not be the model. Of course, i would challenge most people to say they actually like their health care coverage (presuming they’ve ever had to actually use it beyond preventative care). Not their provider(s), but their coverage. In the last 6 years, we’ve been through HMOs, PPOs, POSs, and HSA/HDHP plans trying to find one which best suites my families medical needs, and found all lacking in one way or another.
Why is it that we think a “single payer” system will cost less?
If it does, what else can be “single payer?” How about food? We need it to live, don’t we? Why can’t government buy all the food we need and then sell it to us a controlled prices?
How about housing? Why can’t government be the “single payer” of land and housing?
Everything about free-market economics tells us that costs are controlled with competitive markets and informed choices, neither of which we have today. People don’t choose their health care coverage. Employers do. People don’t shop for medical services, because they don’t pay more than a co-pay.
Under “single payer,” what changes? Government can dictate everything and impose price controls. What’s that gonna do to health care?
Someone needs to explain to me why a government single payer plan is a good plan.
A few things to consider. Medicare is generally more efficient than private healthcare - the private medicare plus programs are costing the government 20-50% more per covered American than these individuals were costing the government under traditional medicare - even though these private insurers are able to eliminate those with pre-existing conditions and charge co-pays.
On the issue of the free-market. The free-market has a role to play, but the field needs to be leveled. Obama is on the right path with eliminating pre-existing conditions as a bar. Fact is, no insurer wants to cover anyone who has ever had anything actually wrong with them - cuts into profits. Ask any American who has survived a bout with cancer about their insurance prospects if you are looking for an education.
Finally, if the government does get involved with insurance it will take some of the weight off of big industry - so much of their costs go into their healthcare bills. On the small business front, I was speaking with my brother last night who owns a small business, he told me that he and his entreprenuer friends are all excited about the prospect of a government healthcare program because the insurance system simply doesn’t work. He can’t afford to cover the majority of his employees and even paying his own insurance is a burden.
The goal should be to get everyone covered (it’s the right thing to do morally - and, it reduces some costs - think preventative medicine) and get everyone to participate in paying (spreads the burden across the entire population). It’s Econ 101.
Universal coverage doesn’t lower costs without competition. I’m required to have auto insurance, but If government was the only place I’d be able to buy it, I’m sure it would either cost more or cover less.
I agree that if everyone was forced to have health insurance, the cost “per person” would go down, but not the cost of service. The medical industry is one of the most inefficient, paper-laden, bloated, legal-fearing industries left in the world.
If health care solutions aren’t about higher quality at lower costs. Single payer makes health care providers accountable to the payer of the bills - government - and not the users of the care - the people.
There are single payer models that include market competition, like the aforementioned Healthcare, Guaranteed proposal. As to accountability, in such a system the health care provider (for processes covered by the service) is accountable to both the recipient (the taxpayer), and the insurer (the direct payer), as is the case now. The insurer is accountable to the govt, but also the taxpayer as reflected in the marketplace.