By Patricia Downs Berger, M.D.
Wicked Local Brookline (Mass.), Aug. 4, 2015
July 30 was the 50th anniversary of Medicare being signed into law by President Johnson. Fifty years of a national health program guaranteeing health coverage for all seniors is a cause for celebration! Medicare has saved millions of lives, provided quality medical care for our parents and older relatives, and significantly reduced the financial burden on younger family members caring for their parents. Medicare has provided dignity and peace of mind to our seniors, who no longer worry that they will be unable to pay for needed medical care.
Alas, this wonderful program is being threatened, and we need first of all to protect it, then improve it, and finally, we need to expand our incredible Medicare to cover everyone.
We have heard the cry, “Hands off my Medicare,” and there is a reason. There are forces trying to destroy it. Republican candidates for president and the Republican congressional leadership are saying they want to change Medicare from guaranteed medical coverage to a voucher program, leaving seniors to search for an appropriate private health insurance plan and pay for it with the voucher money allotted to them. With health costs rising, it is clear that vouchers will not keep up with the cost of private insurance, a disastrous outcome for seniors.
A second threat to Medicare is the effort by privatization groups to increase the number of seniors choosing Medicare Advantage plans. These plans are run by private health insurers and get special subsidies from the federal government to cover more benefits than standard Medicare so that no supplemental insurance is needed. Because of the added benefits in the Medicare Advantage plans, more and more seniors are signing up for them, even though they limit the network of eligible physicians. Unless the benefits in standard Medicare are improved, in 10 years, there may be more people in the private Medicare Advantage plans than in standard Medicare. In order to protect Medicare from privatization, we need to improve it so it can effectively compete with Medicare Advantage plans.
The most important improvement to Medicare would be to give it the power to negotiation with the drug companies for lower prices on medications the same way the Veterans Administration and Medicaid are able to. Medicare drug prices are 78 percent higher, on average, than prices for the same drugs for Medicaid, and 80 percent higher than for the VA. Most of the developed countries across the world have government-run health care systems that negotiate drug prices that are about half of Medicare’s. This negotiating power is especially important, since the trend is for drug companies to raise drug prices, in some instances to astronomical levels.
Another necessary improvement to Medicare is to cover the services that fall into the “gap” in standard Medicare plans so that “Medi-Gap” insurance would not be needed, and they could compete effectively with Medicare Advantage plans.
Finally, we need to expand an improved Medicare to cover everyone. Our present system under the Affordable Care Act is a market-based system where all the stakeholders in the system — hospitals, doctors, pharmaceutical companies, health insurers and medical device manufacturers — are looking for their opportunity to make a big profit. It is a profit-driven system, but lacks the power to control costs that are determined by the major stakeholders.
And who pays the bills? We, the patients, are the ones footing the bills! Patients only obtain medical care if they can pay the premiums and the out-of-pocket costs that include deductibles, co-pays and co-insurance. A new trend in our market-based system called “consumer-driven” health care is shifting responsibility for paying health care costs from insurers and employers to patients, making even “covered” visits to the doctor more difficult for patients to afford.
The rising cost of health care for the average patients perfectly exemplifies the simple truth that market-based economic policies do not work in health care. Medical care is not a commodity that can be bought and sold. When we are sick, we cannot spend time looking for the best quality doctor for the lowest price; we need a physician who knows us and is someone we trust. We need a health care system that puts the patient first and is not based on whether you have the money to pay. That is why we need an equitable system where everyone pays according to their means through fair taxation. The money that is raised goes to a government entity, like expanded Medicare for All, that will guarantee health coverage to everyone from cradle to grave.
We should celebrate Medicare’s 50th birthday by joining millions of Americans who will protect Medicare from privatization, improve its coverage, and finally expand it to cover everyone. Everybody in, nobody out!
Dr. Patricia Downs Berger is co-chair of Mass-Care, the organization leading the campaign for single-payer health care for Massachusetts. She lives on Heath Street.