Medicare for All

Among the agenda items of the new Socialist wing of the Democrat party is the concept of Medicare for All. Why not! As a standard Medicare beneficiary I can attest to how pleasant it is. At the time of any medical service I present my cards and it's all taken care of. So if it's this easy just extend it to everyone and our health care problems are solved. Seems pretty simple. 

Before we jump into it though there are a few little details that we should think about. 

Medicare Part A, which pays for hospital and home health, is in the red and the trust fund is expected to run out somewhere around 2026. Part B, which pays for the rest, won't go broke because, even though the recipients pay some in premiums, they only cover 25% of the cost and the general tax fund pays for all the rest. The cost is steadily increasing and continues day by day to add to the deficit. The really interesting statistic is that the unfunded liability, that is the amount that is anticipated to be needed for all present citizens when they reach eligibility but would not be funded by the present tax structure is something in the range of $50 trillion. Whoa!

More than that though, Medicare is structured something like a Ponzi scheme. The money that's paid for my medical services comes not from a fund I've saved up, but from taxes paid by present day young 'uns, thank you very much. That's one big problem because every year there are more and more of us, and less and less of them. When you think about it when everyone is on Medicare, who will be the poor suckers paying the bill? I guess all of us, but hey, if it's running us into debt now when the young majority is paying for the old minority, where are we going with that.  

No problema say the Socialistas. We save money on efficiencies and decreased administrative costs. OhKay?? How economical and efficient is the Medicare we've already got. Well for starters it's going broke and continually adding to the debt. This despite the fact that the percent of our incomes we pay to fund it have been gradually increased to anywhere from 10 to 15 times what they were when the program was started. Doesn't seem that economical to me, about what you'd expect from a government run program. What can we say about administrative costs which a single payer system is supposed to reduce. Well when Medicare started, doctors and other service providers just sent in their bills and they were paid. Now the payment systems are so complicated that doctors actually, quite literally, often take courses to learn how to do the coding that must be sent in to get paid. Why's that? Well what do you suppose happens when you're selling a service where you get guaranteed payment whatever you charge. You guessed it! So now the prices are set and documentation is required in detail that would warm the heart of any tax accountant. If you ever wondered why your doctor was typing on his computer so intently instead of listening to you this is what it's about. He's not just catching up on his emails. 

Now think about what I'm describing, folks. In the old days, when I was a young fella, you went into the doctor's office and he was it, or maybe there was a nurse or a secretary hanging around. But all the people around to check your Medicare number and do the billing and coding and reporting and the scribes and all the IT people, why they're all part of the administrative savings. 

Before Medicare poor people were treated gratis by a lot of doctors. I remember that when my mom called him to see me, my pediatrician, Dr Curtin, would always stop by to see the kids of the poor family across the street. When old folks needed the hospital but couldn't pay they went to Scranton State where they were treated by interns supervised by local doctors who went in to make rounds. Lyndon Johnson wanted to change that, and rightly so it appears, since the poor old folks opted for private care in droves. But ol' Lyndon said he wanted things the same for everybody so he arranged to put the government in change of the medical care of everyone over 65 whether they needed it or not. That worked fine for a little while because then there was plenty of money floating around for the politicians to play with. And for us beneficiaries it's still a pretty good deal. Not many restrictions and very heavily subsidized by the rest of the taxpayers and the national debt. The fit's going to hit the shan someday but, Hey, that's the future, and today's today. Personally I think 'ol Lyndon made a big boo-boo. Yes, help those who are unfortunate and can't arrange to take care of themselves, but leave the rest of us alone. 

Medicare for All? Boy does that sound good. But it can't be done without major destruction to our medical care system. I know, I know - they do it in Europe and Australia, etc so there must be some flaw in my reasoning. Our government really can run our medical care economically and with minimal bureaucracy. That's a subject for another day. All I can say is for the seniors who like Medicare the way it is - watch out!