My mother-in-law suffers from a severe case of Multiple Sclerosis and has fought many health battles, overcoming a life threatening bout of pneumonia just last week. As she was recovering and was ready to go home, she found she had difficulty swallowing. Unfortunately, Medicare would only pay for her tube feedings at home if she first failed a swallowing study in the hospital. The test was equivocal, and it took several days before the feeds were approved by Medicare for home use.
I wish I thought it unusual that Medicare would spend thousands of dollars for extra days of hospitalization rather than hundreds of dollars for home tube feeds. Unfortunately, this rigid and unyielding bureaucracy is what I’ve come to expect as a physician working with it on a daily basis. And that’s why I don’t want to see Medicare expanded, especially at the expense of the far more functional employer-based private health-care system.
There is an ongoing debate among the top Democratic contenders for the presidential nomination about how to reform America’s health care system, with Sens. Bernie Sanders, Kamala Harris, Cory Booker and Elizabeth Warren all backing Medicare for All, which would destroy the private system and replace it completely with government-run, single-payer coverage, while former Vice President Joe Biden is leading the relatively lonely charge for adding a public option for those who lack insurance (currently about 27 million people) while bolstering and extending Obamacare.
A Kaiser Family Foundation poll released this past week revealed that a majority of Democratic voters favor a buy in option to Medicare or Medicaid as opposed to destroying the current system (including coverage that more than 170 million people receive from their employers) and instituting a single payer alternative.
A buy-in to Medicare won’t cost the $30 trillion in transition costs that Medicare-for-all will, but it will still be quite expensive and wasteful.
A more cost-effective government option that none of these candidates are proposing would be a catastrophic-plus policy to cover sudden and severe illness. Keep in mind that we already have a health-care safety net in the U.S., with clinics (Federally Qualified Health Centers) providing care for more than 20 million people whether they have health insurance or not. And most emergency rooms across the country are not allowed to turn anyone away by law.
I am also in favor of offering more choice of private insurance options, as the Trump administration has already started to do with national association plans and so-called skinny plans. Millions of healthy young individuals who chose to pay the Obamacare tax penalty, rather than submit to an expensive narrow network high-deductible Obamacare policy when the individual mandate was in place, may now finally choose to be insured if there is a better option available. Many don’t need a Medicare buy-in, which they would rarely use, but they do need something.
Medicare for All or even a greatly expanded Medicare is a heavy stone that will sink any candidate for president. Politically, it won’t play well in a swing state like Ohio, Wisconsin, Minnesota or Michigan, where millions of workers already have health insurance coverage from their employer which also provides for their family. Most workers wouldn’t want to trade this coverage in for higher taxes and a rigid less inclusive coverage which rations elective treatments while paying doctors and hospitals less to do more.
More important, it’s just bad policy.
Don’t get me wrong, Medicare helped save my mother-in-law’s life, and for that I will always be grateful. But the way it went about it doesn’t bode well for a colossus version as an effective solution to cover the health care needs of our entire society.
Siegel is a professor of medicine and medical director of Doctor Radio at NYU Langone Health, and a Fox News medical correspondent.