The “no free health care” tax: We all pay when the ‘undeserving’ have to grovel for treatment
Posted Feb. 20, 2014, at 12:55 p.m.
How much tax would you be willing to pay to make sure somebody who can’t afford health care has to grovel to get it?
I have watched the fight about whether to expand Maine’s Medicaid program (sometimes referred to as “welfare”) going on in Augusta during the past year or so with increasing bewilderment. Many Mainers, including Gov. LePage, seem to be really angry at the idea that “those people” (you know who they are) may get something they don’t “deserve” at taxpayer expense. Yet these angry people seem unwilling to take the step that would really save money by just letting those who can’t pay for medical care die.
Why? I suspect it’s because the overwhelming majority of us still value human life. But they don’t seem to mind making “undeserving welfare takers” grovel.
We all end up paying the bill for their care one way or another anyway, in higher health insurance premiums and hospital and doctors’ charges. That bill is much higher than it needs to be.
Adding it all up, the price of unnecessary administration, avoidable illness, and lack of more effective control of costs that are avoided in the Medicare-for-all-like systems in other countries easily amount to 20 percent of our total health-care spending.
Many people are unwilling to believe you can cover everybody for less than the cost of covering just some, and probably can’t be persuaded otherwise. But it’s still worth trying.
Deciding who is or is not “worthy” of dignified health care turns out to be very expensive. It’s been persuasively shown in dozens of other countries that it costs far less to cover everybody than to spend lots of money, energy and political capital deciding who the “undeserving” are, and then figuring out how not to cover them.
For example, doctors in Maine, required to deal with scores of health insurance plans, spend about three times as much on administration as Canadian doctors with their much simpler single-payer financing system.
Hospitals spend even more, requiring large billing departments, often with hundreds of employees. Insurance companies have large underwriting departments in order to create dozens or hundreds of “risk pools.”
Credible estimates of the money wasted on such unnecessary administration run to about $1,500 per year for every person in the state.
Then there’s the cost of avoidable illness. It’s a well-known fact that people without health insurance often delay seeing a doctor if they think they can’t afford it. This results in many delayed diagnoses that then end up requiring treatments that are far more difficult and expensive than need be.
Uninsured people tend to use emergency rooms that do their best to stabilize patients, but cannot prevent illnesses and injuries from happening in the first place and are not required or equipped to provide adequate follow-up care. Such pent-up demand is most likely what underlies the recent finding that the use of ERs surged among newly insured Medicaid enrollees, who are less likely to have a regular doctor. I expect that it will level off as they begin to receive regular care.
A single pool of funds is much easier to control than our current fragmented system of financing health care. Constraining the flow of money into our current system is like trying to control the flow of a river by building a dam in its delta rather than upstream.
As governments and employers try to restrain their payments into the health-care system, the latest rivulet to expand is direct out-of-pocket payments (co-pays and deductibles) by patients. They too will soon become a flood.
Out-of-control health care costs are eroding our ability to do lots of other important things in both public and private sectors. The complexity of the Affordable Care Act will only make these unnecessary administrative costs grow even more. The tax just went up.
Is it really worth $1,500 every year and rising — to you and every member of your family — to make sure some “undeserving” person doesn’t get “free” medical care?
That’s something worth thinking about.
How much tax would you be willing to pay to make sure somebody who can’t afford health care has to grovel to get it?
I have watched the fight about whether to expand Maine’s Medicaid program (sometimes referred to as “welfare”) going on in Augusta during the past year or so with increasing bewilderment. Many Mainers, including Gov. LePage, seem to be really angry at the idea that “those people” (you know who they are) may get something they don’t “deserve” at taxpayer expense. Yet these angry people seem unwilling to take the step that would really save money by just letting those who can’t pay for medical care die.
Why? I suspect it’s because the overwhelming majority of us still value human life. But they don’t seem to mind making “undeserving welfare takers” grovel.
We all end up paying the bill for their care one way or another anyway, in higher health insurance premiums and hospital and doctors’ charges. That bill is much higher than it needs to be.
Adding it all up, the price of unnecessary administration, avoidable illness, and lack of more effective control of costs that are avoided in the Medicare-for-all-like systems in other countries easily amount to 20 percent of our total health-care spending.
Many people are unwilling to believe you can cover everybody for less than the cost of covering just some, and probably can’t be persuaded otherwise. But it’s still worth trying.
Deciding who is or is not “worthy” of dignified health care turns out to be very expensive. It’s been persuasively shown in dozens of other countries that it costs far less to cover everybody than to spend lots of money, energy and political capital deciding who the “undeserving” are, and then figuring out how not to cover them.
For example, doctors in Maine, required to deal with scores of health insurance plans, spend about three times as much on administration as Canadian doctors with their much simpler single-payer financing system.
Hospitals spend even more, requiring large billing departments, often with hundreds of employees. Insurance companies have large underwriting departments in order to create dozens or hundreds of “risk pools.”
Credible estimates of the money wasted on such unnecessary administration run to about $1,500 per year for every person in the state.
Then there’s the cost of avoidable illness. It’s a well-known fact that people without health insurance often delay seeing a doctor if they think they can’t afford it. This results in many delayed diagnoses that then end up requiring treatments that are far more difficult and expensive than need be.
Uninsured people tend to use emergency rooms that do their best to stabilize patients, but cannot prevent illnesses and injuries from happening in the first place and are not required or equipped to provide adequate follow-up care. Such pent-up demand is most likely what underlies the recent finding that the use of ERs surged among newly insured Medicaid enrollees, who are less likely to have a regular doctor. I expect that it will level off as they begin to receive regular care.
A single pool of funds is much easier to control than our current fragmented system of financing health care. Constraining the flow of money into our current system is like trying to control the flow of a river by building a dam in its delta rather than upstream.
As governments and employers try to restrain their payments into the health-care system, the latest rivulet to expand is direct out-of-pocket payments (co-pays and deductibles) by patients. They too will soon become a flood.
Out-of-control health care costs are eroding our ability to do lots of other important things in both public and private sectors. The complexity of the Affordable Care Act will only make these unnecessary administrative costs grow even more. The tax just went up.
Is it really worth $1,500 every year and rising — to you and every member of your family — to make sure some “undeserving” person doesn’t get “free” medical care?
That’s something worth thinking about.
True Free Market Proponents Should Support Private-Public Competition
The debate is often presented as between people who like the government and people who like the market. It isn't
One of the initiatives President Obama announced in his State of the Union Address was the "MyRA," an IRA that workers could sign up for at their workplace. The MyRA would be invested in government bonds and provide a modest guaranteed rate of return.
The MyRA has several useful features. It's simple, it has low administrative costs, workers can have money deducted directly from their paychecks, and it has no risk. It also has the great advantage that President Obama can make MyRAs available to workers without seeking congressional approval.
"This fear of government competition presumably stems from the fact that they would lose business and profits to the government because it could provide the service at a lower cost."
However there was one very notable downside to the MyRA. Workers could not accumulate more than $15,000 in these accounts, at which point they would be required to fold their MyRA into an IRA run by the financial industry. People who commented on this requirement all assumed that this was a sop to the industry.
When the accounts are small, the industry wouldn't make any money on them anyhow. Once they get to be a decent size the government will require savers to park their money with a bank or brokerage house. This is nothing but good news for the industry.
Everyone understands the power of the financial industry, so perhaps Obama had to include a $15,000 cap in order to avoid its wrath, but that doesn't mean the rest of us shouldn't be asking the obvious question. If the private financial industry is more efficient than the government, then why do we have to force people to use it? What's wrong with giving people the option of keeping their money in a MyRA?
This is not the only context in which this question arises. The Postal Service recently put forward a proposal to start offering basic banking services to take advantage of its retail infrastructure. This should be an obvious win-win.
There are tens of millions of low and moderate income people who are poorly served by the banking system. The Postal Service would be able to offer them checking accounts and other services at a lower cost than private competitors by taking advantage of underutilized facilities. This will extend banking services to the unbanked population and potentially be an important source of revenue to the Postal Service.
This is not a new idea. The Postal Service used to offer banking services and many countries still have postal banks. So there is good reason to believe that this effort could succeed.
The other notable area in which there has been interest in public competition with the private sector is healthcare insurance. During his campaign, President Obama had promised there would be a public Medicare-type option as part of his healthcare plan. There was much support for a public option in Congress and across the nation, but the insurance industry was powerful enough to keep it out of the final bill.
In these and other cases key industries use their political clout to avoid having to compete with the government. This fear of government competition presumably stems from the fact that they would lose business and profits to the government because it could provide the service at a lower cost.
The Lies That Doctors and Patients Tell
By SANDEEP JAUHAR, M.D.
The doctor-patient relationship is ideally an intimate partnership where information is exchanged openly and honestly. That is seldom the reality, however. Deception in the doctor-patient relationship is more common than we’d like to believe.
Deception is a charged word. It encapsulates precisely what we dread most in a doctor-patient relationship, and yet it is there in medicine, and it often runs both ways.
I once took care of a young woman who told me she suffered from a rare blood disorder that caused clots to develop in her heart and lungs. She’d had multiple surgeries, as evidenced by the scars on her back and abdomen. However, when we called her grandmother to get more information about her illness, she told us that her granddaughter was just fine — physically. It turned out she suffered from Munchausen syndrome, a psychiatric disorder in which patients intentionally produce or distort symptoms because of a need to be seen as ill or injured. They will undergo painful tests or diagnostic procedures if necessary to maintain the lie.
Physicians sometimes deceive, too. We don’t always reveal when we make mistakes. Too often we order unnecessary tests, to bolster revenue or to protect against lawsuits. We sometimes mislead patients that our therapies have more value, more evidence behind them, than they actually do — whether it was placebo injections from my grandfather’s era, for example, or much of the spinal surgery or angioplasty that’s done today.
Perhaps the most powerful deceptions in medicine are the ones we direct at ourselves — at our patients’ expense. Many physicians still espouse the patriotic (but deeply misconceived) notion that the American medical system is the best in the world. We deny the sickness in our system, and the role we as a profession have played in creating that sickness. We obsessively push ourselves to do more and more tests, scans and treatments for reasons that we sometimes hide from ourselves.
The doctor-patient relationship is ideally an intimate partnership where information is exchanged openly and honestly. That is seldom the reality, however. Deception in the doctor-patient relationship is more common than we’d like to believe.
Deception is a charged word. It encapsulates precisely what we dread most in a doctor-patient relationship, and yet it is there in medicine, and it often runs both ways.
I once took care of a young woman who told me she suffered from a rare blood disorder that caused clots to develop in her heart and lungs. She’d had multiple surgeries, as evidenced by the scars on her back and abdomen. However, when we called her grandmother to get more information about her illness, she told us that her granddaughter was just fine — physically. It turned out she suffered from Munchausen syndrome, a psychiatric disorder in which patients intentionally produce or distort symptoms because of a need to be seen as ill or injured. They will undergo painful tests or diagnostic procedures if necessary to maintain the lie.
Physicians sometimes deceive, too. We don’t always reveal when we make mistakes. Too often we order unnecessary tests, to bolster revenue or to protect against lawsuits. We sometimes mislead patients that our therapies have more value, more evidence behind them, than they actually do — whether it was placebo injections from my grandfather’s era, for example, or much of the spinal surgery or angioplasty that’s done today.
Perhaps the most powerful deceptions in medicine are the ones we direct at ourselves — at our patients’ expense. Many physicians still espouse the patriotic (but deeply misconceived) notion that the American medical system is the best in the world. We deny the sickness in our system, and the role we as a profession have played in creating that sickness. We obsessively push ourselves to do more and more tests, scans and treatments for reasons that we sometimes hide from ourselves.
Loophole in healthcare law may put Medi-Cal patients' assets at risk
A provision in the Affordable Care Act may leave the financial assets of some Medi-Cal enrollees vulnerable to federal collection.
Luis Rios, who lost his job at a filling station in December at the age of 56, is newly eligible for Medicaid, the healthcare program for the poor.
Following the advice of state-trained medical insurance enrollment workers, he filled out the paperwork required to get coverage — but has a nagging fear that he may have put his family's financial assets at risk.
That's because, in certain cases, Medi-Cal, California's version of Medicaid, will be able to collect repayment for healthcare services from the estate after a recipient dies, including placing government liens on property.
"I don't want to run the risk of losing my house," Rios said. "I want to leave it for my daughter."
Despite government assurances that the vast majority of Medi-Cal patients needn't worry about the state trying to claim their assets, growing numbers of new enrollees under Obamacare are voicing concerns after reading warnings on healthcare notices that after their deaths the state "must seek repayment of Medi-Cal benefits" for services provided once they turn 55.
Some advocates for the elderly say the "estate recovery provisions" of Medi-Cal could threaten family finances and discourage people from signing up for health insurance.
"If you really want healthcare reform to be successful, don't subject people to this," said Patricia McGinnis, executive director of California Advocates for Nursing Home Reform, an advocacy organization for elders and persons with disabilities that opposes a cost recovery program for new Medi-Cal enrollees.
Established in 1993, the federal government's estate recovery program was chiefly intended to recoup outlays for lengthy nursing home stays and skilled nursing care, which are among its biggest expenses.
But California and other states have exercised an option in limited instances to recover payment for medical services, from doctor visits and surgeries to managed care payments and drugs.
Norman Williams, a spokesman for the state Department of Health Care Services in Sacramento, says only a tiny fraction of the 9 million patients using Medi-Cal will be affected by cost recovery actions against their estates. Less than a quarter of a percent of the more than $600 billion the state spent on Medi-Cal over the past 20 years has been recovered, he said.
Only costs incurred for patients 55 to 64 years old are involved, he noted. And collection efforts will not begin while there is a living spouse, minor children or surviving dependents with disabilities. Families also may apply for hardship exemptions.
State officials are hoping those kinds of collection restrictions will allay fears about applying for medical coverage.
However, Medicaid expansion, a key part of the federal Affordable Care Act, is expected to add as many as 2 million people to Medi-Cal by the end of this year. Because eligibility under the expanded program is based on income not assets, a larger portion of new participants may own homes, cars or investments that could pass into their estates, McGinnis said.
Betsy Imholz, special projects director at Consumers Union in San Francisco, said exposing a family's assets to government claims is an unintended consequence of healthcare reform that can be corrected with additional legislation. "People just didn't think about it," she said
Posted Feb. 21, 2014, at 12:16 p.m.
The Alexander Group delivered a deeply flawed report last month examining the feasibility of expanding Medicaid in Maine. In fact, the consulting group hired by Gov. Paul LePage’s administration didn’t deliver a feasibility study at all. It delivered a political document disguised as impartial analysis created at taxpayers’ expense.
Taxpayers were cheated out of $108,000 — the feasibility study portion of a $925,000 no-bid contract.
The report fell so far short of actually determining the feasibility of expanding Medicaid in Maine that the Alexander Group’s analysts should be embarrassed. The team calculated only the cost of expansion — in a methodologically suspect way that inflated the final number — without considering any effects, either direct or indirect, that offset the cost. Its calculations were so methodologically suspect an independent analysis conducted for the AARP determined one of the Alexander Group’s cost estimates was $575 million too high.
Now, the Alexander Group report has been so thoroughly discredited and become so much of a liability, the LePage administration is trying to de-emphasize it and divert attention from it.
It’s natural for Democratic leaders in the Legislature to want to do something to right this wrong. Democratic leaders on the Health and Human Services Committee said recently they’ll propose legislation to cancel the Alexander Group contract.
As much as we think the Alexander Group deserves to lose its contract and as much as we agree the contract represents a misuse of taxpayer funds, we would recommend the Legislature resist intervening in this way.
By proposing to cancel an individual contract signed by the executive branch, the Legislature risks setting a dangerous precedent. If the Legislature feels it’s appropriate to nullify this contract, what’s to stop future lawmakers from seeing it fit to nullify a contract awarded following a competitive bidding process? Or what about no-bid contracts awarded to qualified entities?
We have warned the Legislature against micromanagement when it comes to a different contract this winter. Senate Majority Leader Troy Jackson, D-Allagash, is sponsoring a bill to cancel a state contract with a Medicaid transportation broker that has failed to fulfill its responsibilities. Jackson’s bill is dangerous because it cancels a contract without suggesting a backup plan for managing a crucial program on which thousands of Medicaid recipients depend.
It’s the Legislature’s role to, in partnership with the executive branch, set policy direction. It’s the responsibility of the executive branch to carry it out. It’s the Legislature’s responsibility to hold the executive branch accountable. It’s not the Legislature’s duty to micromanage. The consequences of micromanagement can sometimes be real and dangerous.
With the Alexander Group contract, that line of thinking still leaves Maine taxpayers on the hook for paying $108,000 for a report steeped in ideology and faulty logic that only helps LePage (or perhaps it doesn’t) to prove a political point. It doesn’t come close to accomplishing what it should: offering a comprehensive, reliable, nonpartisan analysis that informs a debate about the costs and benefits of expanding Medicaid.
Posted Feb. 21, 2014, at 12:37 p.m.
The residents of Maine’s nursing homes have some of the most intensive health needs of any nursing home residents in the U.S. Maine’s nursing homes require some of the highest staff-to-resident ratios of any state, and are among the fullest anywhere in the U.S.
And they haven’t effectively gotten a raise in six years to reflect the rising costs of providing care.
The financial challenges of Maine’s 107 nursing homes will take center stage at the State House in the coming weeks as lawmakers consider a bill that proposes raising the rates homes are paid through MaineCare, Maine’s version of Medicaid.
The discussion about nursing home payments will take place as the number of nursing homes and residents slips nationwide and as states, including Maine, try to design long-term care systems for elderly residents that move away from a reliance on nursing home care.
High need, low deficiency
Maine’s 107 nursing homes are generally smaller than their counterparts elsewhere in the country. About 48 percent have between 50 and 99 residents, according to the federal Centers for Medicare and Medicaid Services, or CMS; nationally, the most common size is 100-199 residents.
And Maine’s nursing home residents receive some of the highest levels of staff attention. According to the Kaiser Family Foundation, Maine’s nursing home residents see 4½ hours of staff time each day, compared with a national average of four hours. Maine’s level is the fourth highest in the nation.
That’s a result of higher-than-average state requirements for staff attention to nursing home residents. The extra attention helps the state’s nursing homes take care of a population with greater health needs than most other states.
In 2010, Maine’s nursing homes ranked first for the percentage of residents with dementia — 55 percent, compared with 46 percent nationally. In 2011, Maine was one of 10 states where more than 65 percent of nursing home residents had four or five conditions that impaired their ability to perform everyday tasks.
The high staffing levels are directly connected to the quality of care Maine’s nursing homes provide, said Brenda Gallant, executive director of the Maine Long-Term Care Ombudsman Program, which pushed for the higher staffing requirements in the 1990s.
“We staff higher, and it shows in our care,” she said. “That’s really critical. There are just numerous studies that show the significance of staffing.”
In 2011, inspections of Maine’s nursing homes turned up an average of 4.6 deficiencies per facility, the 10th lowest rate nationally, and lower than the national average of 6.1. Maine’s deficiency rate has improved over time; it was 8.8 in 2007, according to CMS.
The viability challenge
Higher staffing also costs more. A year of nursing home care in Maine cost $98,550 in 2013 for a resident in a semiprivate room; nationally, the average cost is $75,405, according to Genworth Financial’s annual survey of long-term care costs.
While Maine’s nursing homes have higher staffing and provide better care, they’re not receiving better pay. MaineCare pays the bills for 68 percent of current nursing home residents, according to the Maine Health Care Association, which represents the state’s nursing homes.
Yet MaineCare bases its payment rates on the homes’ audited costs from 2005, and the rates have been based on those costs since 2008. Since 2008, nursing homes have received just one rate bump — a 1.5 percent raise in 2012.
Over time, those payments haven’t kept pace with the costs of operating a nursing home. Combined, the state’s nursing homes were underpaid $29.4 million by MaineCare in 2011, according to the Maine Health Care Association. The state’s portion of that sum is about $11 million; the federal government would pay the balance.
The bill pending before the Legislature this winter, LD 1776, would give nursing homes a raise by basing payment rates on audited costs from 2011. Nursing homes where MaineCare pays the bills for more than 70 percent of residents would receive a supplemental payment for each MaineCare resident. And rates would be adjusted every two years to keep pace with costs.
The Maine Health Care Association estimates the adjustments would cost the state about $12 million annually. The federal government currently matches every dollar Maine spends on Medicaid with about $1.60.
This year’s legislation pays the additional cost for the first year with proceeds the state expects to realize from no longer overpaying assisted living facilities, which offer a level of care less intensive than nursing home care. The state plans to recover those overpayments by improving the state’s Medicaid claims system. A state auditor’s report last year found it was overpaying up to $29 million annually.
Closure threat
Doctor favors a single-payer health care system
By Ed Weisbart, M.D.
The Lawton (Okla.) Constitution, Feb. 2, 2014
I am a proudly patriotic, fiscally prudent, family physician. For those three reasons, I support a national health insurance program.
Patriots like me prefer to think that America leads the world. Unfortunately, statistics show that we lag far behind in health care. Our diabetics are more likely to get an amputation, our maternal and infant mortality rates are among the worst, and our life expectancy ranks 51st in the world.
We have many of the world’s best doctors and hospitals. So how do we explain our poor health outcomes?
It’s our deeply flawed way of paying for care.
We should demand an explanation for why we continue to spend double any other nation per person on health care, despite our dreadful results.
Nearly two-thirds of that spending comes from our tax dollars. Our public funds for health care are already higher than the total health spending in any other nation. We’re paying more than enough for universal comprehensive health care, but we’re not getting it.
Even more striking, 31 percent of what we spend on health care has nothing to do with actual care. That 31 percent goes to the paperwork and administration inherent in an insurance model designed to be confusing to patients and profitable for big insurance companies.
In contrast, all other nations spend less than 10 percent on overhead. Our own Medicare program has overhead of roughly 2-5 percent.
Thirty-one percent. That means that of my $1,300 monthly premium, $403 dollars is squandered every month just to prop up the bureaucracy inflicted on us by the health insurance industry.
As a practicing physician, I see the ravages of living with inadequate insurance. I’ve seen my diabetics take their insulin every other day, my hypertensives choosing between prescription and eviction, and my 64-year-old stroke patients choosing to wait until they turn 65, get Medicare, and can afford what they need to stay alive.
This is not the United States I was brought up to believe in.
Yes, we have emergency rooms as a last resort. But patients often defer or forgo care, sometimes with fatal consequences. Further, by limiting universal access to the ER means that we pay the $48,000 average cost of a stroke, but we refuse to pay for a $4 bottle of pills to prevent that stroke. This is both terrible health care and fiscal imprudence. It is inconsistent with our nation’s alleged culture of life.
The good news is that there is a solution, hiding in plain sight. Most seniors love their Medicare program, despite its limitations. Many seniors purchase a wrap or supplement to fill Medicare’s gaps. We could simply embed those supplements into the Medicare program and provide that to all Americans, not just seniors.
Every serious economic analysis shows that the savings from an “improved Medicare for all,” otherwise known as single-payer national health insurance, would more than outstrip its new expenses.
By slashing the administrative waste and redirecting that money to care, and by eliminating premiums, copays and deductibles, 95 percent of Americans would spend less, not more, on health care.
http://www.pnhp.org/print/news/2014/february/doctor-favors-a-single-payer-health-care-system
The Lawton (Okla.) Constitution, Feb. 2, 2014
I am a proudly patriotic, fiscally prudent, family physician. For those three reasons, I support a national health insurance program.
Patriots like me prefer to think that America leads the world. Unfortunately, statistics show that we lag far behind in health care. Our diabetics are more likely to get an amputation, our maternal and infant mortality rates are among the worst, and our life expectancy ranks 51st in the world.
We have many of the world’s best doctors and hospitals. So how do we explain our poor health outcomes?
It’s our deeply flawed way of paying for care.
We should demand an explanation for why we continue to spend double any other nation per person on health care, despite our dreadful results.
Nearly two-thirds of that spending comes from our tax dollars. Our public funds for health care are already higher than the total health spending in any other nation. We’re paying more than enough for universal comprehensive health care, but we’re not getting it.
Even more striking, 31 percent of what we spend on health care has nothing to do with actual care. That 31 percent goes to the paperwork and administration inherent in an insurance model designed to be confusing to patients and profitable for big insurance companies.
In contrast, all other nations spend less than 10 percent on overhead. Our own Medicare program has overhead of roughly 2-5 percent.
Thirty-one percent. That means that of my $1,300 monthly premium, $403 dollars is squandered every month just to prop up the bureaucracy inflicted on us by the health insurance industry.
As a practicing physician, I see the ravages of living with inadequate insurance. I’ve seen my diabetics take their insulin every other day, my hypertensives choosing between prescription and eviction, and my 64-year-old stroke patients choosing to wait until they turn 65, get Medicare, and can afford what they need to stay alive.
This is not the United States I was brought up to believe in.
Yes, we have emergency rooms as a last resort. But patients often defer or forgo care, sometimes with fatal consequences. Further, by limiting universal access to the ER means that we pay the $48,000 average cost of a stroke, but we refuse to pay for a $4 bottle of pills to prevent that stroke. This is both terrible health care and fiscal imprudence. It is inconsistent with our nation’s alleged culture of life.
The good news is that there is a solution, hiding in plain sight. Most seniors love their Medicare program, despite its limitations. Many seniors purchase a wrap or supplement to fill Medicare’s gaps. We could simply embed those supplements into the Medicare program and provide that to all Americans, not just seniors.
Every serious economic analysis shows that the savings from an “improved Medicare for all,” otherwise known as single-payer national health insurance, would more than outstrip its new expenses.
By slashing the administrative waste and redirecting that money to care, and by eliminating premiums, copays and deductibles, 95 percent of Americans would spend less, not more, on health care.
http://www.pnhp.org/print/news/2014/february/doctor-favors-a-single-payer-health-care-system
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