A happy 48th to Medicare

By Laurence S. Jacobs, M.D.
Santa Fe New Mexican, July 27, 2013

On Tuesday, Medicare will be 48 years old. It covers more than 50 million Americans — those older than 65 and the disabled. It has improved financial security for the elderly and disabled and reduced health disparities related to race and socioeconomic status. Medicare recipients go to the doctor and the hospital of their choice, not to a restricted panel of caregivers. Medicare operates on an overhead of about 2 percent, compared with private insurers’ overheads from 12 percent to more than 20 percent. Medicare does have its flaws: It doesn’t cover vision or hearing problems, and the drug program (Part D) has the insane congressional restriction that it cannot negotiate with pharmaceutical manufacturers over medication costs, the way Veterans Affairs can. That’s why the VA spends 40 percent less for the same drugs.

An improved Medicare for all would make terrific sense. Low overhead, a single set of approved forms (not a separate one for each insurer, as is now the case), no outrageous CEO salaries, no marketing or advertising costs, first dollar coverage without copayments or deductibles, no restrictions on choice of doctor or hospital. All medically approved tests and treatments would be covered, and there would be no issue of physicians refusing to see certain classes of patients because of poorly paying insurance. Funding, from progressive taxes, would cost individuals less than they now pay in premium, copay, deductible and out-of-pocket expenses. Finally, Medicare as the only payer would be able to negotiate robustly over prices of drugs, medical devices and hospital bills.

Medicare recipients are happier with their health insurance, have fewer problems with access to care and delays in payment, and are more likely to have a medical home with a primary care provider who knows them well than are people with private health insurance.

Severe illness has extraordinary consequences in the U.S. Some 62 percent of personal bankruptcies are largely due to medical expenses, and three-quarters of those bankrupted had health insurance in place prior to illness. Those policies did not offer financial protection, which is one of the main purposes of insurance. Many low-income people go without insurance because of its high cost. The consequences are awful; it’s been estimated that approximately 45,000 people die in this country annually because of lack of insurance, associated with delay or deferral of needed care. An improved Medicare for all would eliminate these consequences.

So why don’t we have Medicare for all? Because insurers, drug companies and associated entrenched interests lobby our Congress intensely to preserve their huge profits, and because of ideologues’ lies about government intrusion into health care. Actually, it’s the private insurance companies that intrude into medical decision-making and deny expensive coverages, not for medical reasons but to maximize profits and restrict access to care by contracting with ever-smaller panels of physicians.

Medicare for all would simply be a payment mechanism. Ask current Medicare recipients whether the program interferes with their care in any way.

We need to eliminate our crazy patchwork of insurance coverages, which leads to the estimated $400 billion in administrative overhead we now annually waste, and, like every other developed nation, we need to find a way to offer comprehensive health insurance to all our residents. The best way to accomplish this goal is to improve and expand our Medicare program, by making its coverage truly comprehensive medical and by enrolling everyone. That would make the birthday of Medicare a truly happy one for our entire population.

Dr. Laurence S. Jacobs, an emeritus professor of medicine at the University of Rochester School of Medicine and Dentistry and a member of Physicians for a National Health Program, calls Santa Fe home part of the year.