Should We Support Medicare for All?

Those of us on the left end of the political spectrum are hearing some of our prospective 2020 candidates talk about ‘Medicare for All”. I think that’s a mistake.

Not because I think ‘universal health care’ is a bad idea, but calling it ‘Medicare for All’ carries with it the implication of a massive government bureaucracy run by someone like Rick Scott, our former governor and now US Senator for the State of Florida. Talk about a travesty set up to line the pockets of a few.

I endorsed the introduction of the Affordable Care Act (ACA), also known as ObamaCare, when it surfaced about a decade ago. As someone who got their start in financial services selling health insurance policies almost 45 years ago, I can lay claim to having some understanding of the health care system in this country.

Apart from the ACA, there are five principal stakeholders in our health care delivery system. They are the insurance industry, pharmaceutical companies, the hospital industry, the medical profession, and lastly, we, the consuming public.

All five have vested interests they want to grow and preserve. All five have legitimate claims against the other four. None of them can bring to bear enough leverage by themselves to either correct or make the health care delivery system better for Americans.

My reason for welcoming the introduction of the ACA was because it created another vested stakeholder. Done properly, it could put the other five in subordinate roles and slowly cause remedies to surface with the ultimate goal of a better healthcare outcome for all of us.

But it was flawed from the start. And politically, it was denied the necessary leverage to fix the flaws. So here we are several years later, everyone is still pissed off, many of us living longer and longer, and when compared to other industrialized countries around the world, we rank close to the bottom in terms of life expectancy and what we pay to maintain our health.

The one redeeming idea from the past decade is that there is an increasing acceptance in society that universal access to health care has social and economic benefits. Some of you will decry this as being another step down a slippery slope away from capitalism. To which I say bulls**t.

My wife and I are both covered by Medicare, supplemented by private insurance policies that make up for the percentage not paid my Medicare. There is no longer any reluctance to seek professional medical care if and when issues surface that suggest a visit to one or more of our doctors. There is a profound acceptance of our ability to deal with such issues in a timely manner with no regard to what it might cost. Talk about freedom and peace of mind. If that alone makes me a socialist, then I suggest you get over it.

I can tell you that for the past 45 years, I’ve watched both insurance premiums and the cost of health care ratchet up annually at close to 10% per year. At what point will that trajectory consume 100% of our annual GDP? Since that cannot happen, something has to give. In the meantime, I welcomed an annual 10% increase in my group health policy commissions.

Since no one on the GOP side seems willing to talk about this, it falls to the Democrats to find a solution. The problem is everyone insists on patching up a rickety, malfunctioning model. It’s one driven by the insurance industry.

Efforts by the other stakeholders, primarily the medical profession, made inroads here and there starting early in the 20th century. But they operated under the insurance company model, which means physicians were, and are, compensated on a fee-for-service basis. Care became over provided, costs quickly escalated, and there is no end in sight.

It can also be said that early leaders of the American Medical Association saw things like union welfare plans and prepaid physician groups as a threat. Many of them sat on state licensing boards and were quick to revoke the licenses of physicians who joined these ‘alternative’ plans. And I suspect, a few hospital admitting privileges were revoked.

The same folks also saw government intervention as a threat. Even so, some 70 years ago President Harry Truman proposed a universal health care system. Those same AMA people figured the best way to remove the threat was a private sector model, the one we have today. The insurance company model.

It was only when private interests failed to cover a significant percentage of the elderly did Congress step in to create Medicare in 1965. As a result, the demand for health care services increased dramatically and ever since, medical costs have been in crisis mode. And lest it not be forgotten, our friend, Senator Rick Scott became a very wealthy man by rigging the system in his favor at our expense.

So how will all this play out? One thing that has to happen is to allow and encourage market innovation outside the insurance company model. That there is now the beginning of a national discussion about all this is a good thing. I want something to happen soon, not because I have a problem with Medicare, but because my children and grandchildren are at risk.

Tony Kendzior \ July 5, 2019

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