By Margaret Flowers, M.D.
There is a lot of discussion about the Medicare buy-in. Since the federal legislation does not include a public option and the single-payer movement talks about expanding Medicare, people wonder if the bill introduced by Rep. Alan Grayson, D-Fla., is a step forward.
The answer, however, is no. Unfortunately, the Grayson proposal does not advance us towards single payer and serves as a distraction, much like the public option was, that takes energy away from working for single payer at a time when we need focus and a clear demand.
When single-payer advocates talk about “Improved Medicare for All,” we are not actually saying that we would simply expand the current Medicare to everybody. We are talking about creating a national health program that is similar to Medicare in that it is publicly funded and accountable, guaranteed, provides choice of provider and removes the insurance middlemen from making decisions about treatment.
The system would be universal; have proven cost controls such as global budgeting, simplified administration and negotiation for physician fees and the bulk purchasing of drugs and medical devices; and would create a framework for a health system so that we can address the many other areas that need to be addressed such as having enough providers, getting resources more evenly distributed, looking at how we deliver care and improve the health of our population. Simply allowing people to buy into Medicare will not place us on the path to creating this system.
The biggest obstacle to the success of a Medicare buy-in is that it keeps the private insurance companies, and so the fragmentation of our risk pools, in place. The only way that we as a nation can afford to pay for the health needs of everybody is by creating a single risk pool.
It is by doing this that we eliminate the waste of the hundreds of millions of dollars that are required to market and administer these hundreds of different plans. Not only are these dollars required by the insurers to process their claims, but they are spent by businesses, individuals, doctors, hospitals and health providers to submit and track claims to the many insurers. It is the expense of dealing with the many different insurers that is driving some medical practices, especially primary care, out of business. This would not change with a Medicare buy-in.
Most likely all that a Medicare buy-in would do is attract the sickest patients as usually happens in this situation in this country. The reason this happens is that the majority of people who are healthy are able to work and so get their insurance through their employer. Those who are not able to work or who do not have insurance offered at work must buy through the individual market. Health insurers don’t really want to insure those that have health needs because they are too expensive to treat, so they offer policies with high premiums to those who need care. This forces that part of the population to look elsewhere, which means they would probably be the ones buying Medicare.
This would relieve the private insurers of having to cover the sicker population (which they would like) and would place further financial strain on Medicare (caring for the sickest without the healthy contributing). And a simple Medicare buy-in would not create the improved Medicare that we need which would cover all medically necessary care including dental, mental, vision and prescriptions without co-pays.
It is possible to get a national improved Medicare-for-All health system, but the first and smallest increment of change that we must have in order to do this is to create a single public health fund. There is much more to do after that but this will be the step that will provide sufficient funds and a framework in which to take the next steps.
There will be many distractions and temptations to look for an easier way to get to single payer, but each of these takes us off the path to single payer. It is important that we stay together and focused on our goal. To paraphrase Gandhi, you cannot compromise on fundamentals, and single payer is the fundamental step that will end health care as a commodity and place us on the path of health care as a human right.
Dr. Flowers is congressional fellow for Physicians for a National Health Program.
Adapted from original post on Backbone Campaign.
