[ HEALTH ]
The Ever-Evolving Health Care Debate
IT ’ S OPEN ENROLLMENT TIME : IS MEDICARE FOR ALL REALISTIC ?
BY DR . MICHAEL BRANT-ZAWADZKI
Getting all those fliers from Medicare , Blue Cross , et al .? Careful . Everything about your coverage can change — premiums , deductibles , out-of-pocket maximums , provider networks , pharmacy networks — even though it ’ s the same plan name . Makes you wonder , why can ’ t we just have Medicare for all , and be done with the annual hassle of choosing a health plan ? Some politicians ran with such promises . As the respected Stanford economist Thomas Sowell wrote :
“ The first lesson of economics is scarcity : There is never enough of anything to satisfy all those who want it .” He went on to state : “ The first lesson of politics is to disregard the first lesson of economics . Politics deals with the same problem by making promises that cannot be kept , or which can be kept only by creating other problems that cannot be acknowledged when the promises are made .”
If everyone had “ free ” health insurance , access to those who provide health care would be limited . Scarcity of assets preclude healthcare on demand to all those that want it . Starting with clinical experts , doctors are increasingly scarce . The American Association of Medical Colleges reports that – assuming equal usage across socioeconomic demographics – the US would be short between 102,400 and 180,400 physicians in ten years . It can take fifteen or more years of post-high school education to produce a specialized physician . The cost of an MD degree leaves many six figures in debt . The highly competitive and daunting path , the intense workload and shrinking compensation contribute to a growing shortage of physicians , despite the importing of foreign MDs now representing over twenty five percent of physician work force .
Insurers increasingly direct which doctors patients can see , and how much they will pay . Increasing governmental regulations , tort lawyers further erode the professional authority , job satisfaction and dedication of physicians , while their practice expenses have grown with inflation . Independent docs are disappearing , most new ones now becoming employees . Commoditization of the profession is here , and physician burnout is a hot topic . Scarcity of expertise will grow .
Nurses , physician assistants and other MD “ extenders ” are filling the gap , but their capabilities only go so far . “ Quality health care ” is being redefined , and expertise may be sacrificed at the altar of access , and cost reduction .
Facilities and advanced technology dedicated to health care were abundant in the halcyon days of robust reimbursement built on the back of generous employer and government insurance plans . Such prior investments have created the world ’ s most advanced health care for treating complex conditions like cancer and heart disease , attracting patients from around the world . However , inflating capital and operational costs , a growing senior population ( ten thousand turn 65 daily ) which uses health resources three fold over those younger , and expanding underinsured and undocumented populations impact the supply and demand equation . Hospital charges have grown disproportionally for private insurance plans , to make up for the continual cram down of payments from Medicare and Medicaid .
As an example , Medicare has proposed an approximately 8 % reduction of what it pays physicians for 2023 , in the face of an inflation rate of approximately 8 %. Hospitals were forced to increase non MD salaries by approximately 8 % in 2022 , due to pandemic-related inflation , staff shortages and burnout . This led even major systems like Kaiser and Mayo to book hundreds of millions in losses in 2022 . One in three Californians ( over 13 million people ) are now insured by Medi-Cal which reimburses approximately 30-40 % of the Medicare dollar . Many physicians refuse to contract with Medi-Cal . Most that do limit the available slots in their practice for such patients . Not surprisingly , first responders tell us that 911 calls have dramatically increased for non-critical conditions such as headaches and belly aches , bringing patients to the emergency department where access is mandated .
The spike in the utilization of emergency departments since the expansion of Medicaid is well-documented , and new legislation in California mandates free services be provided by hospitals to the homeless . Overcrowding emergency departments leads to periodic bypass status . The mental health tsunami exacerbates their limited capacity . Whereas access for emergency conditions such as heart attack and stroke must be a right , scarcity may get in the way .
Thus , expanding insurance coverage to all , although desirable , does not necessarily increase access when scarcity is inevitably built into the system , and accentuated by unbridled demand . Health care may be a right , but only when properly utilized , or – God forbid – properly rationed . This is where an individual ’ s perception of their right meets societal boundaries . The utilitarian notion of the greatest good for the greatest number should not be conflated with the promise of health care on demand for everyone . Health care is not free . Rents , salaries , equipment cost money .
Healthcare consumed over $ 4 Trillion - almost 20 % of US spending in 2022 , and was projected to grow by 4 % over the next three years , prior to the onset of the current inflationary spike .
Eventually , those 40 % of US taxpayers who still pay income taxes footing the bill for governmental healthcare will be unable to pay it . As Margaret Thatcher once observed about socialism , eventually we run out of other people ’ s money . That ’ s why Medicare for all is a challenge . Medicare Advantage for seniors is a bargain but restricts who and where seniors can seek care from . Good to know our local hospital and its MD specialists are world-class , if Medicare advantage is what one chooses . For those under 65 , choose wisely , health care is not free and your choice can limit access .
ROBERTINDIANA / SHUTTERSTOCK . COM
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