‘Medicare for all?’ Please, no

After reading the opinion piece by Marcia Angell proposing that it’s time for everyone to be covered by Medicare all I could say was “Please No!” The more I read the more convinced I became it was time for me to respond.

I started my career in the hospital financial profession in 1976. This was only a few years after the Medicare program was established. It was set up to reimburse hospitals for the cost of the care they provided to Medicare patients. Hospitals were required to submit detailed reports used to calculate that cost. The reports were complicated and cumbersome often requiring the use of outside consultants to ensure they were properly completed. Then there was the annual Medicare audit that also took time and added to the hospital’s expense.

But soon those in Washington noticed the program was costing much more than had been projected. So they began excluding costs that they would reimburse. That made the reports and audits all the more complicated and expensive to complete. The costs were valid expenses incurred by hospitals, but Medicare chose not to reimburse for them. Most infamous of the “inappropriate” costs were the costs of telephones and televisions in patients’ rooms.

Soon the cost of the Medicare program was considered too high to remain “cost” based so they came up with a new system of reimbursement based on predetermined payments for Diagnosis Related Groups. But as they implemented the groups, they added other administrative requirements adding new costs and requirements to the hospitals. Each new change saw the Medicare program pay a smaller portion of the actual cost of caring for Medicare patients with the difference being made up by private insurance and self-pay patients.

So now, how financially viable is the Medicare program? The 10-year projections included in President Obama’s 2017 Budget are as follows: Medicare outlays are $ 7.9 trillion; and Medicare payroll tax receipts are $ 3.1 trillion; making the net cost of Medicare (to taxpayers) $ 4.8 trillion. Add to that a projected 10-year cost for Medicaid of $5 trillion, which makes the net cost of Medicare and Medicaid (to taxpayers) $ 9.8 trillion.

The projected deficit for that ten year period is only $6.1 trillion. So the Medicare and Medicaid programs are 158% of the projected deficit. And it’s getting worse each year. All this leads a Harvard faculty member to think it’s time for all individuals to be covered under Medicare?

She admits “Paying for Medicare for All would require an increase in taxes.” Paying for the current Medicare and Medicaid programs already are projected to require the taxpayers to pay $4.8 trillion additional in taxes and the Treasury Dept. to borrow $5 trillion in new debt over the next ten years. Do we really want to compound that problem by adding tens of millions to the Medicare program? And where would that leave our healthcare system when Medicare reimburses less than 50 percent of the actual cost to care for Medicare patients?

Just look at the headlines about the collapsing British healthcare system and you’ll see where it will lead!

Alan Davis is a retired health care professional living in Chillicothe.