Comment by Ray Bellamy, MD
Prescriptions Blog
New York Times
September 20, 2009
Katharine Q. Seelye really got it all wrong with her analysis of the finances of Medicare for All. Some of the reasons for Medicare’s financial difficulties come readily to mind:
1. Bad Risk Pool of the elderly (think end of life care), and the disabled (think sick).
2. Financing has not changed since 1985. How can funding for healthcare for the sickest of our population be sustained over 24 years of increasing healthcare costs without raising the Medicare tax?
3. Political interference. Effectiveness recommendations have been blocked by Congress, who have mandated coverage for treatments of dubious benefit such as chiropractic and complementary medicine to please constituents. Providers, one who bilked Medicare and was fined over a million dollars twice, are still providers due to political interference. The savings of Medicare for All would be 380 billion dollars or more a year, according to independent analyses, and this is enough to easily extend comprehensive coverage to ALL of the uninsured and have money left over for reducing the deficit. The inclusion of healthy, lower cost younger folks in the risk pool of all Americans spreads the risk and cost along with massive administrative savings. There are additional huge benefits in better effectiveness data to improve quality, as well as identification of overutilization and better cost control by global budgeting and volume discounts. Congress and America would benefit by a head-to-head comparison by an independent agency such as the CBO or other comparing Single Payer with any other proposal you want to offer. Single Payer would win hands down, as the rest of the developed world has already figured out.