Medicare for all Scenarios

medicare for all scenarios chart

All aspects of our current For Profit Healthcare Insurance Model would be impacted.  In the PROVIDER (FIRST PARTY) community, hospitals have a profit related concern.  Medicare’s lower rates may markedly reduce revenues and “ disrupt the delicate balance of cross-subsidization between higher commercial rates and lower government rates.[1]  What is also interesting in this NAVIGANT article are the enrollment scenarios which are included. These may serve as a prognostication for the impact of the various  potential Medicare for All variations.

  1. Voluntary Medicare buy in after age 50
  2. Medicare as a public option
  3. Medicare as a single-payer (excluding Medicaid)

I took data from the 2017 United States Population[2] and the CBO to add the NUMBER in the chart above.

Another segment of the FIRST PARTY are physicians. If we are to believe what some groups of physician PROVIDERS espouse, they are not in favor of “Medicare for All,” but apparently addressing some of the ills of the current model.  In a White Paper, these groups advocate dismantling complexity in stages. The stages?

-DRIVE DRUG PRICES DOWN AND INCREASE SUPPLY

-STRENGTHEN THE SAFETY NET FOR THE VULNERABLE

-FOSTER FRESH MODELS TO PAY FOR MEDICAL CARE

-REVERSE OUR PHYSICIAN SHORTAGE

-MAKE ACTUAL PRICES TRANSPARENT

Their Goals?

-Lowering the cost of medical care

-Restoring autonomy (choices) to patients and their physicians

-Educating lawmakers and the public about the root causes of skyrocketing costs and waste in the current American medical system

In summary:

“In this White Paper, while steadfastly opposing ‘Medicare for All,’ we avoid the polarizing call for repeal of the Affordable Care Act in its entirety. We seek neither Scylla nor Charybdis.[3] Instead, we begin with goals and ideas that are workable and that resonate very readily with most citizens and practitioners.” [4]

What about the THIRD PARTY PAYORS? If UnitedHealth CEO David Wichmann would be seen as the spokesperson for this segment of our FOR-PROFIT HEALTH CARE INSURANCE model:

“On the investor call, UnitedHealth CEO David Wichmann warned moving to a Medicare for All type system would ‘surely jeopardize the relationship people have with their doctors, destabilize the nation’s health system and limit the ability of clinicians to practice medicine at their best[5].’”

“As CEOs addressed investors during quarterly conference calls, their tone and messaging varied, but one consistent theme emerged: The private sector has a role to play in any future healthcare reform.”[6]

For now, here is what Health Care 2020 looks like as we speak today.

CBO integrated estimates of health insurance coverage

CBO: over 1 million Americans have become uninsured since 2016[7]

  • Results of the 2018 mid term elections solidified Health Care as an important topic
  • The Federal Judge ruling that the ACA is unconstitutional as well as the Justice Department now lining up behind a complete legal repeal has set the stage for Health Care’s continued importance
  • The ACA is still in place until the mandate to have insurance goes away thanks to the Tax Reform Bill of 2017
  • The Supreme Court will become involved
  • Health Care will continue to be of importance through the 2020 Presidental Election and beyond
  • The CBO has begun begun to address the issue

CBO key designs in single payer health care system

How do our politicians view this issue? Stay tuned for the next blog.

Keep an eye out for my soon to be published book:  Earthquake: How America’s Ever-changing Healthcare System Victimizes Americans

FOOTNOTES:

[1] *Goldsmith, Jeff et al., “MEDICARE EXPANSION: A PRELIMINARY ANALYSIS OF HOSPITAL FINANCIAL IMPACTS, NAVIGANT, 20 Apr 2019, www.navigant.com/-/media/www/site/insights/healthcare/2019/medicare-expansion.pdf

[2] **based on ” Resident population of the United States by sex and age as of July 1, 2017 (in millions),” STATISTICA, www.statista.com/statistics/241488/population-of-the-us-by-sex-and-age/

[3] Scylla and Charybdis were monsters from Greek mythology thought to inhabit the Straits of Messina, the narrow sea between Sicily and the Italian mainland. Preying on passing mariners, Scylla was a terrible creature with six heads and twelve feet, while Charybdis, living on the opposite side of the straits, was another monster who, over time, was transformed in the imagination of the ancients into a more rational, but no less lethal, whirlpool. Odysseus famously had to negotiate a passage through their deadly clutches in Homer’s Odyssey. from Cartwright, J., “Scylla and Charybdis,” Ancient History Encyclopedia, www.ancient.eu/Scylla_and_Charybdis/

[4] “Reducing Cost and Waste in American Medicine,” Physicians for Reform, www.physiciansforreform.org/ and Practicing Physicians of America, practicingphysician.org/ and Physicians for Patients, www.physiciansforpatients.org/home

[5] Liss, Samantha, “UnitedHealth CEO’s ‘Medicare for All’ bashing sends payer, provider shares tumbling,” HEALTHCAREDIVE, 17 Apr 2019, www.healthcaredive.com/news/unitedhealth-ceos-medicare-for-all-bashing-sends-payer-provider-shares/552943/

[6] Liss, Samantha, “Insurers’ message on ‘Medicare for All’: We’re part of the answer,” HEALTHCARE DIVE, 3 May 2019, www.healthcaredive.com/news/insurers-message-on-medicare-for-all-were-part-of-the-answer/553998/

[7] “Health Insurance Coverage for People Under Age 65: Definitions and Estimates for 2015 to 2018,” Congressional Budget Office, April 2019, www.cbo.gov/system/files/2019-04/55094-CoverageUnder65.pdf

By | 2019-05-14T14:14:14+00:00 May 28th, 2019|Categories: Healthcare|0 Comments

Leave A Comment