The Elephant In The Room

Health care is the focus of a national debate that never seems to end. So called “experts” on health care delivery offer all kinds of suggestions and advice to solving the health care financing crisis in this country yet they won’t admit the journey towards solving the crisis will soon end.

In my circle, for example, the discussion centers around performance based medicine, reference based pricing strategies, point of service claim adjudication/payment, wellness programs, direct contracting, value based outcomes and more. But all secretly recognize there is an Elephant in The Room.

The Elephant in The Room is the inevitable coming of a single payer health care system to this country. It’s only a few elections away and we all know it. Americans are fed up with the high cost of health care. Many employers  are simply running out of money to pay for it. The American middle class who has been bearing the brunt of the cost is a vanishing, diminishing class. Hospitals and third party intermediaries continue to raise pricing, compounded year after year well beyond true inflationary pressures. Drug manufacturers are reaping record profits on drugs that sell as much as 80% – 90% less overseas.

The experts mentioned above have the answers to solving our health care crisis and the proof to go with it but few seem to be listening………….

– Bill Rusteberg

The following article is about that Elephant:

Medicare-for-all Revives Healthcare Debate, Could Threaten Providers

Gregory A. Freeman, April 25, 2018

Democrats are pushing for a Medicare program that would cover all Americans, a change that would rattle the healthcare industry. Uncertainty over how quickly to proceed may slow their efforts.

The debate over healthcare reform has died down in recent months after the Trump administration systematically dismantled some of the key components of the Affordable Care Act, but legislators are keeping the heat on with Medicare-for-all plans that would amount to a huge shake up in the healthcare industry.

The question for Democrats is when to bring them to the forefront and work for a healthcare change that would rival what happened with Obamacare.

Democrats will promise great benefits to consumers and make healthcare reform the No. 1 topic again, but if Medicare displaces private health plans an alarming number of healthcare professionals are likely to flee for early retirement or change careers, according to an industry thought leader.

There are currently four proposals with variation on the idea of making Medicare available to all Americans, the most prominent from Sen. Bernie Sanders (I-VT), which proposes Medicare for All by transitioning the country to a single-payer health system, which has the support of 15 senators.

Sens. Michael Bennet (D-CO) and Tim Kaine (D-VA) are still proposing their Medicare X plan, which calls for making Medicare available as an option but not the only payer.

The liberal Center for American Progress is proposing Medicare Extra for All, and Sens. Chris Murphy (D-CT) and Jeff Merkley (D-OR) recently offered another new Medicare buy-in plan called the Choose Medicare Act.

In addition, Sen. Brian Schatz (D-HI) and Rep. Ben Ray Luján (D-NM) are still supporting their  State Public Option Act, which would create a Medicaid-based public healthcare option on the insurance marketplace.

Democrats see opportunity

With the ACA significantly weakened but no indication that the Republicans will be able to fully repeal and replace it, Democrats are seeing the opportunity to push the single-payer system many of them favored all along, says Sally C. Pipes, president and CEO, Thomas W. Smith Fellow in Health Care Policy at Pacific Research Institute.

The variety in the bills, however, shows that Democrats aren’t sure how much they can seek a complete change in how Americans pay for healthcare.

“Some of the Democrats are concerned about pushing for full single-payer when they don’t know what it’s going to cost or how it’s going to be paid for, so they’re taking a stepping stone approach,” Pipes says. “They’re putting the public option back in, which was in the original House bill for the Affordable Care Act, before it went to the Senate.”

The likelihood of any version of Medicare-for-all passing in the next two years is dubious, Pipes says.

Major reform is unlikely to happen at the national level under the Trump administration, though there could be movement on the state level while the Democrats keep the federal legislation warm on the back burner, Pipes says.

Impact not understood

Having lived with a single-payer system in her native Canada, Pipes opposes such a wholesale change in the American system. She notes, however, that out of 1,850 adults in the U.S. who were surveyed in a recent poll, 51% supported the idea of a single-payer plan.

“My worry is that the American people don’t understand what single-payer means when the government is the only payer for your healthcare, what the tax increases would be, and the long waiting lists for healthcare,” Pipes says. “The average wait to see a specialist in Canada is 21.2 weeks, over five months, having grown from 9.3 weeks in 1993. When you look at these various bills, the same things would happen in the United States if we go that way.”

Those long waiting lists would come partly as the result of a Medicare-for-all plan driving healthcare professionals out of the business, Pipes says.

Physicians will not want to work for Medicare wages, she says, which are about 20% below what they typically get for treating private insurance patients.

Hospitals also will be stressed by the reduced revenue. That will make it difficult to pay nurses and other healthcare workers competitive wages, causing many of them to leave the industry also, Pipes says. Access to care and quality of care would suffer, she says.

“Doctors retiring early, the best and the brightest kids not going into medicine, and care being rationed because the government only has so much to spend even when they keep increasing taxes,” Pipes says. “That’s what would happen if these plans go through, especially a plan like the Sanders proposal that would go right to single-payer.”

No agreement in D.C.

Republicans, particularly Ted Cruz (R-TX), have said they are not giving up on the goal of repealing and replacing Obamacare, but Pipes is doubtful that would happen any time soon because they don’t want to stir up that debate before the midterm elections.

That leaves the Democrats an opening to push the issue to the forefront again and at least keep public interest alive until 2020 when they might have a better chance with a new administration, she says.

The fact that there are numerous Medicare-for-all bills indicates the current state of affairs with healthcare, says CEO John Baackes of L.A. Care Health Plan, which covers more than 2 million Medi-Cal members.

Legislators and consumers alike are still grasping for a way to improve a system that everyone seems to agree is not working in its current iteration.

“It is evident our policymakers are still not of one mind on how to organize and pay for healthcare. To a certain extent, these bills are the result of a growing populist movement and a natural reaction to the Republicans’ ACA repeal-and-replace efforts,” Baackes says. “One could argue they are gaining momentum, but it should not be assumed it is forward movement.”

Baackes says there is not sufficient detail from any proposal to determine the impact they would have on healthcare providers.

“I appreciate the ongoing exchange of ideas to make healthcare accessible to everyone as long as they are accompanied by a responsible plan for funding,” he says.

Gregory A. Freeman

Gregory A. Freeman is a contributing writer.


Will the single payer system solve the problem?   I don’t think so… are the 12 drivers to increasing healthcare costs I talk about every day……single payer might address one or two of these but also expands the adverse impact of most of them……we are working on practical financing solution

1.Business Practices – Marginal business practices of government, insurance companies, providers and medical vendors

2.Drug Costs – Mercenary pricing

3.Transparency – Lack of transparency with actual costs and appropriate profit margins

4.Litigation – The threat of litigation drives costs through redundant “defensive” medical practices and malpractice insurance costs

5.Wellness – Unhealthy lifestyles choices

6.Media Distortions – Promoting an entitlement mentality… “Free” is not “Free”

7.Consumer Education – Lack of informed medical consumers

8.Technology – State-of-the-art medical technology prolongs life

9.Aging Population – Baby boomer generation experiencing deteriorating health

10.Government – Cost of Compliance for ACA, EHR and additional taxes

11.Politics – Marketplace volatility driven by political uncertainty

12.Catastrophic Claims – Unlimited Lifetime Benefits Driving Cost Increases

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My dad started as a broker back in 1969.  In 1993 when I started in the business, he tried persuading me against it because he felt the gov’t would take it over in the near future.  It’s taken much longer than he forecasted.

I agree with your comments.  I feel the single payer is coming sooner than later, despite all of the common sense methods that would solve the healthcare financing crisis, to the betterment of families and medical providers. 

I hesitate making any changes.  I often wonder if I’m better off starting now to slowly migrate into a new career before the gov’t makes another mess of things.