I can’t help but wonder how Donald Berwick can be so confident in making the claims he does in his piece about “Medicare For All” at USA Today:
With costs rising painfully, insurance companies denying care and nearly 30 million people still uninsured, America desperately needs an honest health policy discussion. That’s why it has been so disappointing over the past several weeks to watch multiple candidates parrot right-wing attacks on “Medicare for All,” like claiming that it will greatly increase spending on health care or ringing alarms about raising taxes on the middle class.
The truth is the opposite: Medicare for All would sharply reduce overall spending on health care. It can be thoughtfully designed to reduce total costs for the vast majority of American families, while improving the quality of the care they get.
I think it’s a lot more complicated than that and when you’re dealing with real people and real money in a real world it’s a lot different than when you’re drawing diagrams on a whiteboard. And “thoughtfully designed” sounds uncomfortably like “no true Scotsman” to me.
It all depends on your assumptions.
I’ve already pointed out that providers don’t have the excess capacity to provide 6% of 10% more care than they do know without changing how care is provided. What will it take to accomplish that? How long? How much will it cost?
What will providers be paid? That they will be paid at Medicare rates is an assumption in which I don’t have the slightest confidence. If “Medicare For All” were actually enacted into law, I can say with metaphysical certainty that there would be a furor of lobbying to increase the reimbursement rates beyond present Medicare reimbursement rates. The failure of lawmakers year after year to hold the line on Medicare reimbursement rates (remember the “doc fix”?) strong suggests that they won’t hold the line with M4A.
Who is “all”? All citizens? All legal residents? All residents? Anybody passing through?
Keep in mind that all of the present Democratic presidential candidates have said they would decriminalize entering the country without approval and several have said they would abolish our present enforcement agency. Under the circumstances I have no idea how you can even predict how many people “all” might be.
What are the metric for “improving the quality of the care they get”?
If you cannot answer all of those questions and back your answers up with facts, you cannot make confident predictions.
I recognize that the idea that bringing everyone within a single system would result in lower spending with better care is an article of faith but, frankly, I doubt it. We are an enormous, diverse, complicated country that is changing at a ferocious pace. Not only do simple plans not work well here, everything the government does is more expensive here than it would be in other, simpler, smaller countries and always more expensive than planners predict.
In 2010, President Obama relaxed the criteria to get approved for VA disability. This allowed more vets to get care, but there was no increase in medical facilities an personnel.
I assume that President Obama thought he was being compassionate, but the VA problems of the last decade were caused by this compassion. I do not blame him for the problems, but good intentions can have bad consequences.
Exactly. Good intentions prove nothing other than that you have good intentions.
One thing that I wonder, is substandard care better than none at all? Should the AMA relax standards?
Steve would be better-equipped to address that question than I.
I suspect that it depends. So, for example, it might be the case that for urgent or critical care substandard care is better than none at all but for chronic care substandard care might actually be worse.
Met with another Dem congressperson with the small group I am in. Just like the other one this one also said M4A is not on the table. Maybe a public option passes.
“don’t have the excess capacity to provide 6% of 10% more care than they do know without changing how care is provided.”
Even if we dont expand we need to figure out how to do this. In the ideal, I think, we both learn how to stop doing too much so that the 6%-10% turns into 3%-5% and we learn to do that with the same number of people or fewer. I suspect that we will have to find ways to force people to change. People are very resistant to change.
“One thing that I wonder, is substandard care better than none at all?”
It often is. Just to pick an example, you can have a cataract done for X dollars. You can do a cataract and add a laser (capsulotomy) to the procedure for X + $300. You can add an ORA and then it is X + $600. (Very rough numbers.) Just doing the cataract alone might give you 90% of your improvement with the other two parts 5% each. Skip the extra two parts and you still have a lot of improvement.
Steve