Improve health care by building on Medicare’s success

By Erica Heiman, M.D.
The Sacramento Bee, July 31, 2014

Lately, I have been diagnosing a lot of high blood pressure and diabetes. Patients who have never received medical care are now pouring into the county-funded Sacramento Primary Care Clinic, which provides care to low-income and other underserved patients.

The Affordable Care Act has expanded access to 8 million more Americans. Although Sacramento County has always tried to ensure high-quality care to indigent patients, Obamacare has opened our doors even wider.

Often, these new patients are unaware they have a condition that requires treatment because it has never caused them any trouble. But these conditions, if untreated, lead to increased risk of heart attack, stroke and other serious complications.

In short, it’s important for everyone to have a doctor. If hypertension and high cholesterol are detected early and treated, the risks down the road are dramatically reduced. That’s why I love primary care; it may be difficult to see the benefits from day to day, but in the long run, they are vast.

Medicare entered its 50th year on Wednesday. Signed into law by Lyndon B. Johnson in 1965, its goal was to alleviate “the threat of financial doom” faced by aging Americans and their families. Since the 1960s, Medicare has steadily expanded, currently providing coverage to more than 50 million elderly and disabled Americans. Medicare is far from perfect – but it has succeeded in reducing poverty among its beneficiaries and in reducing health disparities.

Opponents often assert that Medicare is wasteful and should be cut. Aside from the political infeasibility of this, given how popular it is, it’s actually inaccurate: Medicare’s operational costs are estimated at about 2 percent, far below that of most private insurance companies. According to recent studies, Medicare’s growth rate is actually lower than projected and lower than cost increases in the private sector.

Proposed changes to Medicare have recently focused on granting vouchers for Medicare-like insurance plans run by the private sector. These plans receive lower approval ratings from their beneficiaries than traditional Medicare. Other proposals would increase the age of eligibility for Medicare, which may save the federal government money in the short term, but would result in higher costs to employers, individuals and Medicaid. In the longer term, this would be much more likely to look nice on a written budget projection than to provide meaningful benefit to the American people.

To rein in skyrocketing costs in health care, the answer isn’t cutting Medicare. It’s expanding and reforming it to create an improved “Medicare for All.”

Eliminating private insurance companies would eliminate their high overhead costs and the hefty salaries their CEOs earn. It would allow more bargaining on pharmaceutical prices so patients would have more affordable choices. Health care delivery would still be done by private-sector hospitals and clinics, and the number of options would likely expand for the average American, as current insurance plans restrict to “in-plan providers” who can be difficult to find and hard to schedule with.

I’m appreciative of the expansion in coverage that the ACA has allowed, but we still have a ways to go. There are still 13 percent of Americans without health insurance. Many of my patients who just enrolled in Medi-Cal are having trouble getting specialty care because their plans have not negotiated contracts with specialists in their areas. This is frustrating for the patients – who have to spend anxious days, weeks and months waiting for a call from the orthopedist’s office – and for primary care clinicians like me, who would like nothing more than to know that our patients will be well cared for without the efforts of an army of case managers.

The answer to health care costs that are 2.5 times higher than the industrial nation average (and yet fail to produce higher-quality care and more favorable morbidity and mortality indicators) is Medicare for All.

As I celebrate Medicare’s birthday and its successes, I look forward to the day when every American will access the same high-quality care that those over 65 now enjoy.

Erica Heiman is a resident physician at the University of California, Davis, Medical Center and a member of Physicians for a National Health Program.