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A single-payer healthcare system is still being proposed on Capitol Hill. Several proposals are pushing for hospitals and physicians to be paid through some expansion of Medicare or Medicaid. However, such plans, if implemented, could significantly degrade quality of care, critics say.
Sen. Bernie Sanders (I-VT) has his “Medicare for All” plan that calls for moving to a single-payer health system, while Sens. Michael Bennet (D-CO) and Tim Kaine (D-VA) have a bill supporting their “Medicare X” plan, which would greatly expand Medicare availability.
Sens. Chris Murphy (D-CT) and Jeff Merkley (D-OR) have a new Medicare buy-in plan called the Choose Medicare Act, and the Center for American Progress proposes “Medicare Extra for All.”
Sen. Brian Schatz (D-HI) and Rep. Ben Ray Luján (D-NM) have proposed the State Public Option Act, which would expand access to Medicaid, not Medicare.
The Sanders plan is the most far-reaching, but the senator says it will cost roughly $6 trillion less than the current healthcare system over the next decade.
“The United States currently spends $3 trillion on health care each year — nearly $10,000 per person. Reforming our health care system, simplifying our payment structure, and incentivizing new ways to make sure patients are actually getting better health care will generate massive savings,” the Sanders plan says. The plan is available online at https://bit.ly/2f2H3y7.
Sanders says the typical middle class family would save more than $5,000 with a conversion to single-payer Medicare, and that businesses would save over $9,400 a year in healthcare costs for the average employee. The plan has been estimated to cost $1.38 trillion per year.
Passage of any of these bills would threaten the quality of healthcare in the country, says James D. Schutzer, vice president of JDM Benefits, a company based in White Plains, NY, that provides assistance with insurance and claims.
He notes that incorporating a public option has been the goal all along for some politicians. An attempt was made during the Affordable Care Act negotiations, but the public option ultimately didn’t make it through.
There is no negotiation for prices with Medicare rates, unlike the private market, where one of the competing factors between the insurance carriers is the size of their network.
“Therefore, they are forced into paying a much higher percentage of the Medicare fee schedule to keep the providers in network. Contrarily, these same providers rely on the private market payers to balance their income statement,” he says.
“Therefore, none of these Medicare expansion bills really does anything to address the rising cost of healthcare. It simply is piling more Americans onto Medicare, which pays providers lower reimbursement rates. This is not real reform. It is just a transferring of the risk to a lower payer.”
Medicare rates are so much lower than private reimbursement that hospitals will be hard-pressed to provide the same level of care they currently provide, Schutzer says.
Schutzer was speaking recently with a hospital executive about recent state-level efforts to adopt “Medicare for all” in New York. The hospital leader told him that depending solely on Medicare would dramatically change the way his hospital operates.
“He told me they lose money on government programs and balance their books with people who have private insurance. So if reimbursement rates are all based on a federal or state figure, the quality of care could suffer because healthcare is a business and there is a cost to providing good care,” he says.
“And if this is a system with few restrictions on where you can go for treatment and no co-pays, are we going to see an increase in demand at the same time hospitals are paid less?”
Quality has to suffer in that scenario, he says.
“It’s going to be unprofitable for hospitals, so they will have to look at where they can cut costs. They can’t just go on providing the same care they provide now and receive substantially less revenue,” he says.
“That might mean not buying the latest MRI machine or investing in the latest technology for the OR, and in some cases it might mean closing hospitals.”
Hospitals are already reporting lower profits, so reduced payments would have to affect hospitals and the quality of care they provide, he says. The effect on doctors would ripple to the hospitals, and doctors already are shying away from Medicare rates, Schutzer says.
“It’s not uncommon to hear stories about doctors dropping out of Medicare,” he says.
“Maybe this is currently a geographical issue, for instance in New York City, but it can have the potential to become more widespread where you, once again, create a two-tiered system — one that only uses Medicare and another that uses Medicare with the ability to pay privately for non-participating doctors.”
Financial Disclosure: Author Greg Freeman, Editor Jesse Saffron, Editor Jill Drachenberg, Nurse Planner Jill Winkler, Editorial Group Manager Terrey L. Hatcher, and Consulting Editor Patrice Spath report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.