Medicare for All Pondered by Lawmakers

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Original story posted on: May 8, 2019

Meanwhile, the House of Representatives holds a hearing on the topic.

Although the U.S. House of Representatives has seemed preoccupied with other issues in Washington D.C., it also recently held a hearing on H.R. 1384, the “Medicare for All Act of 2019.”

This bill was introduced by Rep. Pramila Jayapal (D-Wash.) and Rep. James P. McGovern (D-Mass.), and over 100 House members have signed on as cosponsors. It is similar to the bill previously sponsored by Bernie Sanders. This marked the first time Congress has ever held a hearing on “Medicare for All.”

On April 30, the House Committee on Rules listened as multiple witnesses supported, derided, or explained Medicare for All (M4A). Testimony at the hearing underscored the political challenges associated with the proposed overhaul of the nation's healthcare system.

Congresswoman Jayapal noted that “even with passage of the (Patient Protection and) Affordable Care Act (PPACA), there are more than 70 million people either without coverage or (with) coverage that leaves them still unable to access medical care due to prohibitively high out-of-pocket costs,” adding that “the health outcomes and barriers to care in America are the worst of any industrialized nation.”   

Among the supporters of M4A was Doris Browne, M.D., immediate past president of the National Medical Association (NMA), the largest national organization of its kind, representing the interests of more than 30,000 African-American physicians and the patients they serve. In supporting the bill, Dr. Browne stated that the inequitable health system in the United States impacts a disproportionate number of minorities. “Whether you call it universal coverage, single payer, Medicare for all, or some other label, the label is not the most important point,” she said. “What is important is that the care must be of high quality, accessible, affordable, comprehensive, and coordinated.”

An emergency medicine doctor at NYU Langone Health provided jarring real-life examples of tragedies that illustrate the impact of inaccessible or unaffordable healthcare. Dr. Farzon Nahvi related the case of a young lady who came into his ED for an overdose on fish antibiotics. The patient had had a fever but felt that she could not afford an ER visit. She went to a local pet store to buy fish antibiotics as self-prescribed medication for her symptoms. She accidentally overdosed, and the side effects ended up affecting her brain, causing her to fall down a flight of stairs. 

Another patient opted for antibiotics for treatment of acute appendicitis instead of an appendectomy because of the expense. When told about the possibility of a perforation of her bowels, an abscess formation, sepsis from her infection, and even death, the patient stated that she would have to take her chances.

Dr. Nahvi concluded, “all I want is to practice medicine in a world where I no longer have to watch a patient walk out of the ER without medical care that could save their life because they are worried about going bankrupt. All I want is to never see another patient who thinks their best option for medical care is to go to their local pet store.”

Accentuating the financial realities of the concept, Charles Blahous, Senior Research Strategist at George Mason University’s Mercatus Center, spoke about the costs of M4A, estimations for which he suggested were overly optimistic.

Mr. Blahous had based his analysis of M4A costs on the previously introduced bill from Sen. Bernie Sanders. Cost estimates for the Jayapal/McGovern bill are expected to be higher due to their additions of long-term care benefits.

Mr. Blahous stated that the additional $38.8 trillion cost to the federal government over the next 10 years could not be covered, even if all federal individual and corporate income taxes were doubled.

“Finally, the plan’s requirement that no cost-sharing, including deductibles, coinsurance, copayments, or similar charges, be imposed on an individual, would also significantly increase healthcare utilization,” he said. “Providing this first-dollar coverage is estimated to induce 11 percent additional demand for those currently covered by private insurance, and 16 percent for those now in traditional Medicare without supplemental coverage.”

The most significant variable affecting M4A cost projections is that of provider payment rates. Cost estimates of M4A are based on all providers being paid Medicare rates, which are roughly 40 percent lower than private insurance rates.

“We do not know how providers would respond to payment reductions of this magnitude for treatments now covered by private insurance, concurrent with a simultaneous increase in patient demand for health services under M4A,” Blahous said. “It is likely that there would be some disruptions in the availability, timeliness, and quality of healthcare services, but no one can say what they would be.”

Ady Barkan, a universal health coverage advocate and founder of the Be A Hero PAC, remained steadfast in his support for M4A.

“This country, the wealthiest in the history of human civilization, (does) not have an effective or fair or rational system for delivering (medical) care ... (and) any proposal that maintains financial barriers to care – any proposal that continues to charge patients exorbitant copays, deductibles, and premiums – will necessarily leave people out,” he said. “Any proposal that maintains the for-profit health insurance system will require that some people don’t get the healthcare they need.”

While the House Democratic leadership continues to prioritize efforts to strengthen the PPACA before advancing broader reforms, additional hearings on Medicare for All could be held soon, including in the House Ways and Means Committee and House Budget Committee. It seems that we will learn a lot about our national priorities during those hearings.


Programming Note:

Join Dennis Jones today as he co-hosts Talk Ten Tuesday with Dr. Erica Remer beginning at 10 a.m. ET.

Dennis Jones

Dennis Jones is the administrator of patient financial services at Montefiore Nyack Hospital. Dennis is an experienced healthcare leader with broad and detailed knowledge of the revenue cycle, compliance issues, denials management, process and workflow, and uncompensated care. Well known in the northeast region for his active leadership and diversified areas of expertise, Dennis is a past president of the New Jersey Chapter of AAHAM. He is a popular guest panelist on Talk Ten Tuesdays and Monitor Mondays.

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