Sen. Bernie Sanders’ “Medicare for All” bill — onto which just about every Democrat aspiring for the 2020 presidential nomination has signed on — is a serious attempt to fix the American health care system.
That is not to say that the proposal, in its present form, warrants our support. In fact, I will tell you exactly why it should not be supported without significant changes. But Berniecare goes vastly farther than either Obamacare or recent Republican health care plans, and therefore, ought to be considered the real starting point of an in-depth conversation about how we can finally fix American health care.
I’m a family doctor, and from my vantage point, the American health care system is defined by four main problems. First and foremost, too many people lack access to care. Second, health care costs too much – both for individuals, and for the nation as a whole. Third, American health care is low-quality care. And fourth, American health care is a bureaucratic and administrative nightmare for both patients and providers alike. Any serious proposal must address all of these issues.
Obamacare increased access to care for some, but it did not seriously address cost issues. Republican reform proposals may cut costs, but they do so at the expense of access to care for millions of Americans. Therefore, neither is the solution we need.
Berniecare, on the other hand, provides access to all. And for patients, the cost issue is solved. One fee, an income tax, pays for everything. So the two biggest issues in American health care are ostensibly fixed. That should be enough to get everyone to give this proposal serious consideration.
But criticisms of single payer are relevant, and must be taken seriously. In fact, how these issues are addressed makes or breaks the plan.
Many question whether our government, which has a hard time managing complex problems, is capable of properly administering such a system. This is a legitimate issue. Any practicing physician or nurse will tell you that excessive and unnecessary government bureaucracy has contributed as much as any other single factor to the destruction of American health care.
Billing for Medicare patients in the current system may actually be more complicated than providing their medical care.
An average appointment for a Medicare patient that I see pays about $75, but the amount of effort it takes my small office to collect that amount is incredible. At one point a few years ago, all of our Medicare payments were stopped for months because Medicare officials could not decide which credentialing form we needed to fill out, the 855I or the 855R.
We were not paid a penny the entire time. We were forced to draw from our line of credit to pay our staff.
This barely begins to scratch the surface of the administrative overkill that plagues health care professionals every day. The government’s mandatory Meaningful Use program doomed a generation of modern physicians to purchase expensive and essentially unusable electronic health record programs. Compliance with such programs is so complicated that I now spend as much time today trying to figure that out as I do reading medical journals.
The worst may be yet to come. The government’s complicated new “value-based payment” program (best-known by its abbreviation, MACRA) uses clinical, computer use, and cost data to determine physicians’ Medicare pay rates. It increases physicians’ administrative burdens substantially, and will actually penalize doctors who see the oldest, sickest, and poorest patients, who tend to generate the worst data.
Even more frustrating is the fact that the American health care system holds back genuine value at almost every step. The other day, one Medicare patient, who happens to have diabetes, had prescriptions for insulin and glucose testing supplies rejected four times because we could not successfully figure out all of the coding and authorization requirements. Misguided programs like MACRA will encourage physicians to stop taking care of the most difficult patients.
What this means is that it is not unrealistic to fear that out-of-control government bureaucracy could ruin a single-payer health care system. In fact, recent history, as evidenced by these examples, argues that without significant reform it would do just that.
Does this mean that we should reject “Medicare for All”? I don’t think so. But we need to give a good deal of thought to developing more efficient, less invasive ways to regulate health care.
In fact, let’s consider striking a grand bargain: Guarantee health insurance for all, in exchange for a major deregulation of the day-to-day decisions of most doctors.
Hahn, M.D., is author of “Distracted: How Regulations Are Destroying the Practice of Medicine, and Preventing True Health-Care Reform.”
