By Ed Weisbart, M.D.
St. Louis Post-Dispatch, Feb. 7, 2019
I am a capitalist and physician who believes competition within a market can drive up quality and drive down cost. That’s why I believe single-payer Medicare for All is an improved market solution and the best road forward for American health care.
Think about it. The market today pits doctors like me against other doctors, each in search of the most lucrative insurance contracts we can get. After all, by necessity, we’re running a de facto retail business, and if we can sign on with an insurer that pays us a few bucks more for the same amount of work, it’s pretty hard to turn down.
From time to time, you may have seen those little notices in your doctor’s office listing insurance networks with which your doctor no longer participates. You quickly scan that list, see that your insurance company isn’t on it, and forget about it. After all, you don’t think it really affects you. It does.
What that notice actually means is that your physician’s practice has signed a contract with a new insurer that pays more than some of their other insurers do, and that new contract promises an influx of better-paying patients. To make room for these new patients, we doctors leave networks that aren’t as economically advantageous. We’re just responding to the ever-changing market and making business decisions.
This is an unfair and inhumane use of the market. It makes me sick that someone’s economic value determines whether physicians take care of them. This is a terrible side effect of the for-profit health care market.
It’s also incredibly wasteful. A recent study from Milliman showed that the average American physician spends $99,000 per year just dealing with insurance companies. That’s money that must be made up, and it eventually comes back to you and your employer in higher premiums.
Imagine, instead, that you live in a country where every person is worth the same economic value to any physician. Imagine that you could go to any doctor you choose and the payment automatically follows you. Imagine that you never have to check to see if your doctor is “in network” and that no one can tell you have to change doctors. Imagine that you — and only you — control your own health care decisions.
In other words, imagine you live in a country with single-payer, improved Medicare for All. Instead of hundreds of insurance companies, imagine the United States has one single payer — Medicare — and it includes coverage for prescription drugs, dentistry, eyeglasses and more — all without any co-pays or deductibles.
That’s precisely the country we would have with the Medicare for All Act of 2019, which Rep. Pramila Jayapal, D-Wash., is currently proposing.
Intuitively, one automatically assumes the costs of such a pipe-dream solution would be prohibitive, but the counterintuitive facts say the opposite: Single-payer, improved Medicare for All would cost less than the current, wasteful system. Twenty-eight independent economic analyses have come to the same conclusion: Medicare for All would reduce what our nation spends on health care.
Most of the studies predict dramatic savings — at a minimum, enough to eliminate the need for co-pays and deductibles, while adding coverage for dentistry, eyeglasses and hearing aids, and giving us access to virtually every doctor. Even a Koch-brothers-funded study a few months ago concluded that Medicare for All would save the nation trillions of dollars over 10 years.
A 2018 analysis from the University of Massachusetts estimated a 12 percent increase in overall utilization of health care services but a 9 percent drop in total administrative costs, a 40 percent drop in the 15 percent we spend on pharmaceuticals, a 2.8 percent drop created by developing uniform rates, and a 1 percent drop by reducing fraud and other waste. Overall, the 12 percent increase is more than balanced by a 19 percent cost savings, dropping our 2017 health care spending from $3.24 trillion to $2.93 trillion.
In a nation that shut down a government over a $5.7 billion wall proposal, saving $331 billion in health care is huge.
I support Rep. Jayapal’s Medicare for All Act of 2019 because it applies the free market to the delivery side of health care — in favor of patients — because doctors should be competing for patients, not for insurance contracts.
Medicare for All is pragmatic, doable and necessary — because our current system is broken. It stands to reason that if we can find a way to pay for health care that’s far too expensive, then we can certainly afford health care that’s less expensive.
Dr. Ed Weisbart is a family physician in Olivette, Mo. and chairs the Missouri chapter of Physicians for a National Health Program.
