I want to highlight two really good comments from yesterday’s post on Medicare for All as a means or as an end in and of itself:
First from Barbara:
What people like about Medicare is its “thereness.” You have it no matter what. That’s what it’s like in other countries. You just show the card and questions about insurance cease. That is a combination of eligibility plus the government’s ability to impose rules that private payers cannot by themselves. These include limits on balance billing and a significant weighting against providers for performing noncovered services without notice to the beneficiary (called the ABN rules).
What people who are not covered by Medicare don’t see, often enough: fragmentation, unlimited cost sharing, incentives to overutilize care for people who are unlikely to question the need for procedures, the need to get supplemental coverage and a separate prescription drug plan, both at additional cost, what seems like incessant arbitraging of reimbursement rules by providers to extract money from the system regardless of benefit to patient, and, importantly, almost no push back by the payer (Medicare program) to rein in these tactics.
There is great value in knowing that something will be taken care of. I see that, I acknowledge that, I value that. But here it is a question of means or ends. In my mind, the end is the knowledge that something will be taken care of, the “thereness”. I love this phrasing and insight. It just is, and problems are addressed. Barbara also points out how oddly designed Medicare is for people who have to deal with it for living or a living. Medicare FFS at the Centers for Medicare and Medicaid Services (CMS) level is a minimally involved payer. Once a claim meets minimum standards, it is going through quickly without systemic management or analysis of a case.
in order for us to see the cost savings Medicare for All can bring (spending more like 12-14% of GDP on healthcare rather than 18-19% now), we’d have to use it like a hammer to cram down on providers. Doctors. Hospitals. Nursing homes & other outpatient facilities. Medical device manufacturers. Pharma. All of them. Those groups of people are not without political power. They’ll fight.
Systemic waste is someone’s mortgage payment.
The most important thing to remember in health policy is that doctors and nurses are the most trusted professions in America while hospitals are often the largest employers in a district. On the other hand, insurers and Congress routinely strive to stay above chlamydia in the popularity rankings.