Medicare-For-All (Who Want It) is a Carrot that needs a Stick.

Posted on | July 3, 2019 | Comments Off on Medicare-For-All (Who Want It) is a Carrot that needs a Stick.

Mike Magee

On June 27, 2019, Pete Buttigieg was asked whether he supported Medicare-For-All. He responded, “I support Medicare for all who want it.”

In doing so, he side-stepped America’s Achilles heel, the controversial debate over shifts of power from states to the federal government. He was suggesting that times have changed and that he might prevail with Red States nipping at his heels.

Two reality maps challenge that assumption. The first is a map produced by the Kaiser Family Foundation cataloging the status of ACA Medicaid expansion in the US. The current score card includes 36 states that have or will soon participate, and 14 hold-out’s. This latter group, as has been so well-expressed by former Ohio Gov. John Kasich in the past, has chosen to vote against its own state financial interests and the servicing of its states most vulnerable citizens in the interest of keeping the federal government out of their business.

The second map comes courtesy of the Rockefeller Institute of Government and demonstrates a footprint with significant overlaps to the KFF version. It measures the amount the states contribute to the federal government through taxpayer dollars against the amount they draw off the federal government in benefits. This lays bear the truth that Red States rejection of federal underwriting is highly selective and politicized.

As I outline in my new book, “CODE BLUE: Inside the Medical Industrial Complex”, at the close of WW II we diverged from both allies and foes and went all in on cures over care, and profit over planning. Seven decades later leaders of medicine, pharmaceuticals, insurance, hospitals, and medical research have coalesced into a Medical-Industrial Complex that has dealt everyone in – except the patient.

A status quo that favors and protects states rights maintains needless complexity – on purpose. The more complex, the less we understand, the more we pay. In addition, if you’re in the business of maintaining the status quo in American health care, it pays to be financially strong enough to simultaneously field lobbying forces in all 50 states and Washington, DC as well. It’s also helpful if your organizational structure is based on state and county societies – say, like the AMA. And if your government relations armies are willing to cross sectors and collusively plan resistance strategies, all the better.

Mayor Pete is right in suggesting that Medicare, extended to all comers, will have little difficulty competing with private plans and their purposeful complexity. But to achieve the desired outcome of high quality, low variability and efficiency, our nation requires an empowered majority that clearly expresses “enough is enough.” Otherwise the self proclaimed “Grim Reaper” Senate Majority leader will continue to determine all of our futures.

“Medicare-for-all (who want it)” can not stand alone. It must be anchored in shared principles including:

1. Less is more. Insurance Simplicity = Savings and Improved Quality and Performance. .

2. Health = Full Human Potential (not the elimination of disease). Innovative research is great, but it is no substitute for national health planning and public health programming.

3. The Public Option must reinsert appropriate checks and balances. The integrated career ladder that currently entangles academic medicine, pharma, insurers, hospitals and government regulators is a cesspool of conflicts of interest and no longer deserves safe haven.