MEDICAID FOR ALL; WHAT SINGLE-PAYER REALLY LOOKS LIKE
Americans have single-payer health care insurance now, and no, it’s not Medicare. Medicare is the health insurance coverage funded by a combination of surtaxes, funding from the U.S. government and payroll taxes withdrawn from your paycheck during your working years. Medicare is primarily designated for patients who are 65 years and older. Seniors typically carry a supplemental health insurance policy to cover charges left uncovered since Medicare covers about half of patient expenses. Otherwise, Medicare patients must cover those costs out of pocket.
So, when you hear the discussion about single-payer insurance, don’t allow proponents to argue that Medicare is the exemplar. Instead, single-payer health insurance will be like the insurance program for the poor, Medicaid, or TennCare in Tennessee.
The government will ultimately pay for all services and make all decisions about formularies — the lists of drugs approved for use, types of approved care and even make some decisions that override a physician’s preference. Don’t believe me?
The “TennCare Quick Guide” is a “listing of covered and non-covered services, products, and supplies” with a pretty clear disclaimer about benefits that are considered “cost effective alternatives” or CEAs. Each of the insurance companies contracted by Tennessee to administer those insurance plans “has the sole discretion to authorize CEAs, as approved by the Centers for Medicare and Medicaid Services (CMS), to provide appropriate, medically necessary care.”
Those substitutions are frequently inconsequential. However, many times, they’re not.
Recently, data is proving that patients with Medicaid health insurance still have restricted access to physicians and, in many cases, are receiving substandard care with outcomes no better than the uninsured.
Limited access to desired physicians or a network of specialists is driven by lower reimbursement rates when the government is the payer, coupled with the bureaucratic web characteristic of delayed payments for services rendered, denials, restrictive prior authorizations and other barriers. So, no, you can’t keep your doctor.
Most compelling is the analysis of data about health outcomes of Medicaid patients. The Journal of Heart and Lung studied more than 11,385 patients undergoing lung transplants. Medicaid patients were 8.1 percent less likely to survive than the uninsured after a decade. You read that right, the uninsured.
Obamacare architect Jonathan Gruber coauthored a study in Oregon in 2013 comparing uninsured patients to those randomly assigned to Medicaid for patient outcomes and mortality for patients treated for elevated blood pressure, high cholesterol and diabetes. While an increase in utilization of health care services was reported, “Medicaid coverage had no significant effect” on the prevalence of these ailments nor improvements.
In a 2014 Journal of Pediatric Health Care study, the findings published compared Medicaid versus private plans, showing “patients with Medicaid plans had 20 percent more inpatient hospitalizations, 48 percent increased odds of emergency department visits and 42 percent fewer outpatient visits compared with those who had a private plan.”
Government insurance means government decisions and control. Expanding Medicaid via Obamacare added about 11 million able-bodied adults without dependents to a program created to serve the poor, especially women and children.
We need reforms to drive down costs of health services, not just insurance premiums, so that our insurance functions as it should: to prevent financial calamity instead of dictating services rendered and driving up costs. Clearly, having health insurance does not equate to health.
Robin Smith, a former chairwoman of the Tennessee Republican Party, owns Rivers Edge Alliance.