The following text contains the remarks of Olveen Carrasquillo, M.D., at a congressional briefing titled “An analysis of proposed changes to Medicare before the Deficit Commission and a better alternative: Improved Medicare for all” held in Washington on Sept. 23.
Madam chairperson, members of Congress, legislative aides, colleagues and friends,
Thank you so much for assembling this critically important session on the need to preserve and strengthen our nation’s best and highest quality health insurance system, namely Medicare.
As data released last week by the Census Bureau shows, the need to enhance our health insurance systems is now more critical than ever.
The numbers show that in 2009 in the nation’s uninsured reached the highest levels since the Bureau has been keeping records – 50.7 million without health coverage. That represents 17 percent of the U.S. population. If you add the other 60 million people who are underinsured to that number, we see that we have no choice but to act.
Buried in those numbers is the disproportionate impact this crisis has had on the Latino population. In 2009, 32 percent of our Latinos in this country lacked health insurance, i.e. 16 million Latinos were living in the U.S. without health coverage.
This is an issue that affects both U.S.-born and immigrant Latinos. Nearly a quarter of U.S.-born Latinos lacked health coverage. But of course the impact is much worse among immigrant Latinos living in the U.S., with 50 percent of those persons lacking health coverage last year.
Thus, the problem must be addressed. Of course, there are aspects of the president’s health reform that may not please everybody. The fact that it does nothing for the 10-12 million Latinos who lack formal documentation in the U.S. and the fact the legal immigrants must wait five years for coverage are among my own irritations with the new law.
And of course the fact that we could have done this at much lower cost (about $1 trillion less) and provided truly universal coverage with Medicare for all – through a publicly funded but privately delivered health care system – is a real travesty.
That said, it is clear that a few million uninsured Latinos will benefit from the enacted health reform, and something is definitely better than nothing.
At the same time, it is ironic that after our nation’s brave steps to improve coverage, proposals have rapidly emerged that would weaken that coverage by undermining our nation’s best health care insurance system, namely Medicare. It makes no sense.
Here we pass a plan to potentially insure 32 million persons, and now we are seriously considering barring million of seniors from coverage by upping the Medicare eligibility age to 67 or even 70.
As a provider, I see firsthand what happens when people reach the “magic” age of 65. Suddenly all those health conditions they had been waiting to take care of because they were uninsured or underinsured can now be addressed: the poorly controlled hypertension and cholesterol, or preventive measures like colonoscopy that had been deferred because they couldn’t afford it.
Indeed, if we are truly interested in bettering the health of our country and potentially saving money, I would argue the exact opposite of those who advocate upping the eligibility age. Let’s extend coverage downward to age 60 or even better to age 50, when we can catch those conditions early and treat them.
Treating that high blood pressure or cholesterol early, or removing that pre-cancerous polyp in the colon early, is much more pound-wise than the penny-foolish notion that we can save money by allowing these conditions to fester until the person turns 67, when the patient may now face a $20,000 coronary stent procedure or colorectal surgery and chemotherapy.
You want save money? Reduce the Medicare eligibility age. Want to spend more? Let people get sicker from preventable conditions to the point where it will cost them and us exorbitantly.
Another terrible idea is increasing co-payments and deductibles. Every study shows that doing this will decrease costs, but much of that savings is achieved by reducing necessary health services.
Do we really want that diabetic not to see me three to four times a years because of co-payments? Do we want him to cut down on the average of five medicines he needs to take? Do we want him not to get the needed tests and screening he needs? Do we really want to let him end up on dialysis due to uncontrolled diabetes, or end up on disability because of an amputation, or end up blind because we tried to save a few dollars by increasing his co-payments and deductibles?
Equally terrible is the idea of substituting private vouchers for Medicare. We know that private insurers cannot compete on an equal footing with Medicare. The needs of their stockholders, outrageous administrative overhead, and CEOs making tens and sometimes even hundreds of millions of dollars mean they are much less efficient than Medicare.
From my end, I see the private insurers’ outrageous paperwork demands, pre-approvals for anything I want to do for my patients, limited participating sub-specialists, automatic denials.
I am so happy when a patient has straight Medicare. I know the hassles to get them the care they need will be minimal. This and Medicare’s provider payment structure makes many private plans quite unattractive to physicians like myself, and explain why my practice accepts so few of these of these privately managed Medicare plans.
So now some members of the Deficit Commission and others around it are proposing to move all of our seniors into highly bureaucratic, expensive and inefficient private plans to save us money. Come again?
Last is the idea of means testing, like we do for Medicaid. Yes Medicaid is better than nothing, but look at Medicaid. The administrative hassles created through means testing means millions of children who are eligible for the program don’t enroll in it. Millions more children are kicked off the rolls every year because they could not gather all the documents required to prove they still qualified for the program.
Most notably, as a program for the poor, Medicaid is chronically underfunded and often pays providers less than half of what Medicare pays – which is why less than half of all doctors in this country don’t even consider taking Medicaid patients. This means these patients are often segregated and have to get care at community clinics and public hospitals. So if you really want to dismantle Medicare, new means testing would be an extremely effective mechanism to do this.
Granted, we need to save money in Medicare. But the question is how do we do it? We certainly don’t need ill-informed, retrograde ideas that will destroy the health of our elders and likely save us little money or, even worse, end up costing us more.
Well, I am from south Florida and I can give you some stories about Medicare fraud and abuse. So yes, there is some fat there. Increased surveillance and enforcement, which the new health law calls for, will definitely help a little.
Second, as noted, we overpay private Medicare Advantage plans for the inefficient and burdensome care they deliver. We should build on the steps that have already been taken and compel these plans to meet the same efficiency criteria as Medicare. Of course their CEOs and stockholders may not like the fact that we are ending their outrageous welfare-like subsidies, but if the goal is to improve care and reduce costs, taking this kind of action is a no-brainer.
But here is an even bolder idea. Rather than dismantling Medicare, why don’t we improve Medicare and extend
it all persons living in the United States? Why don’t we eliminate the bureaucratic, private-insurance middlemen?
Doing so would save us money. Every health economist will tell you that a Medicare-for-all system would the most efficient mechanism to reduce our national health expenditures. Savings estimates are in the $200 billion to $400 billion range. In fact, estimates are that we may be able to cover the entire U.S. population without even increasing our annual health expenditures with a Medicare-for-all system.
This of course would mean angering very well-connected constituencies, namely the medical insurance and pharmaceutical industries. But that’s what is called for.
I hope for the day when Congress will realize that their job here in Washington is here to help the American people and not to enrich private corporations.
Until Congress gets enough courage to do the right thing, we have to hold briefings like this one to dissuade Congress from undermining our best health insurance system, Medicare. As a start, let’s dismiss the harmful ideas for weakening the Medicare program floating around the National Commission for Fiscal Responsibility and Reform.
Thank you.
Dr. Carrasquillo is a national authority on health disparities, minority health, health services research, health policy, access to care and national health insurance. He is presently chief of the Division of General Internal Medicine in the Department of Medicine at the Miller School of the University of Miami and a board member of Physicians for a National Health Program (www.pnhp.org).