By Ray Bellamy, M.D.
Tallahassee Democrat, July 18, 2015
In 1963 or so, a group of us UF second year medical students tramped upstairs to listen to some of a spirited discussion among Gainesville-area physicians along with UF faculty regarding providing nearly universal health coverage to seniors. I remember little of the discussion other than some inflammatory rhetoric about “government overreach and what it would do to or for Granny.”
Most folks now are not aware that in those days, the AMA had only recently come off its traditional opposition to group medical practice. (Yes, they felt all physicians should be working solo.) So now, on July 30, we will herald arguably one of this country’s most successful social programs ever — the establishment of Medicare. We should also acknowledge the role Medicare played in speeding the integration of hospitals.
There is much one can complain about Medicare — that it will begin running a deficit in 17 years, that some providers are not reimbursed adequately to cover expenses, that the first day of inpatient care costs a thousand dollars out of pocket. However, with a strong approval among seniors — 92-percent satisfaction, a low overhead of about 2.5-percent, and the benefit of safety net coverage for a part of the population which is stressed to pay bills (elderly women average a third of their income for medical expenses), the goal of sharing risk broadly over a large population has been been met. Note that the sickest 20 percent of this group accounts for 80 percent of the cost.
Presidential candidate Vermont Senator Bernie Sanders is advocating for an improved Medicare for All, properly funded, as he has for decades. Since the simplicity of everyone having the same comprehensive plan and a Smart Card to swipe at the physician’s office or pharmacy would save several hundred billion dollars a year in reduced overhead, it is easy to understand how most developed nations use some version of a single payer system. Because prevention is often less expensive than treatment, but the payoff may take years to realize, enrollees in private insurance who tend to stay with one plan for only a short time are unlikely to see this cost reduction passed to them.
But we muddle on, and costs in health care keep rising, inflammatory opposition rhetoric about “death panels” and “socialized medicine” gets bandied about, and our overall healthcare non-system struggles from day to day.
So here we are with Medicare at 50, struggling with proposals for vouchers, the higher costs of Advantage plans, the need to more adequately fund the trust fund. The latest assault comes from a “bribe” to help passage of the TPP Fast Track international deal. It would take $700 million from Medicare and use those funds to support job retraining and assistance for workers who lose their jobs due to offshoring, etc.
And with our political paralysis, along with suspicion of all things government does, even when government has demonstrated it can do many tasks better than the private sector, stay tuned.
Ray Bellamy, MD, is a long time Tallahassee physician.