By Jane M. Orient, M.D.
(12-17-19) Democrat presidential candidates are sparring over how much to expand Medicare. Should it be Medicare for all, for people over 50 and children, or for “all who want it”? Does “all” include veterans, Native Americans, and military dependents, who now have their own government program? Does it include everybody who happens to be in the country, legally or illegally? And do the benefits include just what today’s Medicare beneficiaries get, or everything the candidate can think of-dental, eyeglasses, hearing aids, mental health treatment, addiction treatment, “sex-change” surgery, etc.? Does it even include long-term care, which the Affordable Care Act had to discard because it was unaffordable?
Who wouldn’t want that?
In 1965, a lot of seniors did not want Medicare. They were happy with their private coverage, which nearly half of them had. They did not trust government. To assure the success of “his” program, President Lyndon Johnson took away their private coverage. Insurers could not, under contract law, cancel an individual’s policy, say because they got sick, but they could cancel everybody’s coverage-and they did. This was a precedent for the Affordable Care Act (ACA), which outlawed the coverage many people had unless it could meet stringent “grandfather” requirements.
“If you like your plan, you can keep your plan” was an acknowledged “four-Pinocchios” lie. Elizabeth Warren doesn’t worry about that because she thinks nobody likes insurance. Possibly true, but that doesn’t mean people would choose the government alternative.
With rare exceptions such as a continuation of policies from employers, seniors do not have and cannot get a private plan that duplicates Medicare coverage. They can only get “Medigap” policies to cover deductibles and things Medicare does not cover.
After a huge percentage of the population got “covered” by the government, did things get better? People did get more treatment. Great advances in medical technology occurred-likely unrelated to Medicare. But toxic, unrelenting cost-price inflation began abruptly after 1965 for the first time in 90 years, leading to massive government interventions to put a lid on them. Administrative demands burgeoned-there are now at least ten times as many administrators as doctors. And government eroded the value of people’s savings by inflating the dollar. If you had put $10 in a mattress in 1965, it would be worth only $1.24 today.
Did evil, greedy private insurers go away? No, they competed for government contracts to administer Medicare. As one whistleblower discovered, carriers can get away with $200 million in fraud without even triggering an investigation. Or they went into the Medigap business. AARP, which purports to represent seniors, has received more than $4 billion in “royalties” from UnitedHealth since the passage of ACA. According to a lawsuit Krukas v. AARP, AARP effectively acts as an unlicensed insurance agent that collects what amount to illegal kickbacks.
Medicare Advantage plans are widely touted for offering extra services such as gym memberships. But there’s a dirty little secret: once in, if you get sick your costs soar and it can be very expensive to get out. Also, about a third of such plans have a very narrow network of physicians.
But in traditional Medicare, you get worry-free treatment, right? Not exactly. Government controls are constantly tightening. The ironically named Protecting Access to Medicare Act of 2014 provides that clinicians must refer to “appropriate use criteria” (AUC) when ordering advanced imaging studies like CT scans or MRIs. We’re supposedly in a “testing period” during which payment won’t be denied. However, physicians are already receiving notices from their hospital that they now MUST use AUC when ordering out-patient studies.
If you are admitted to hospital, you will be greeted by a worker checking on advance directives that will enable the hospital to withhold treatment. If your care is expected to cost a lot, and the Prospective Payment System allowed charge won’t cover it, the hospital has every incentive to shunt you off to hospice. This also averts the possibility of a penalty for re-admitting a patient. Hospice is a one-way transfer.
Medicare for All means government-directed, corporate-managed care. The managed-care “insurance” cartel, giant hospital chains, and private-equity-owned medical practices will make sure that you get your flu shot (likely mandatory), your anti-tobacco lecture, your silver sneakers, your 15 profitable “preventative” drugs, cross-sex hormones, abortion on demand-and eventually your terminal sedation.
Beyond that, you’re on your own-if there are any private options left and if you still have any after-tax money.
Is that what Americans want?
Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. She completed an internal medicine residency at Parkland Memorial Hospital and University of Arizona Affiliated Hospitals and then became an Instructor at the University of Arizona College of Medicine and a staff physician at the Tucson Veterans Administration Hospital. She has been in solo private practice since 1981 and has served as Executive Director of the Association of American Physicians and Surgeons (AAPS) since 1989. She is currently president of Doctors for Disaster Preparedness. She is the author of YOUR Doctor Is Not In: Healthy Skepticism about National Healthcare, and the second through fifth editions of Sapira’s Art and Science of Bedside Diagnosis published by Wolters Kluwer. She authored books for schoolchildren, Professor Klugimkopf’s Old-Fashioned English Grammar and Professor Klugimkopf’s Spelling Method, published by Robinson Books, and coauthored two novels published as Kindle books, Neomorts and Moonshine. More than 100 of her papers have been published in the scientific and popular literature on a variety of subjects including risk assessment, natural and technological hazards and nonhazards, and medical economics and ethics. She is the editor of AAPS News, the Doctors for Disaster Preparedness Newsletter, and Civil Defense Perspectives, and is the managing editor of the Journal of American Physicians and Surgeons.