Ask the Medicare Specialist

QUESTION:

I would like to read your response/analysis to the very relevant question regarding this country possible shifting to a “single payer, “Medicare for all,” or “socialized medicine” system and how it may affect those already on Medicare.

ANSWER:

Let me start by stating that single payer and socialized medicine are not one in the same. According to Verywell Health, a partner of the Cleveland Clinic, “in a socialized medicine system, the government not only pays for the healthcare but operates the hospitals and employs the medical staff. In the United States, the Veterans Administration (VA) is an example of socialized medicine.”

Canada has a hybrid health care system of single payer/ socialized medicine where hospitals are funded by the Federal Government, but generally run by non-profits. Each hospital is given a set amount of funds to operate for the year and they must make their resources last the entire budget cycle. According to the University of British Columbia Health Services and Policy Research, this can have disadvantages such as, “to stay within budget, a hospital may restrict services to patients or be more selective in terms of the patients to whom it provides services.” I believe this is the biggest concern people have about going to a socialized or single payer system, the possibility of long wait times for appointments and the rationing of care.

My chiropractor recently diagnosed me with a torn meniscus. I called my insurance company’s member services, told the representative my issue, and that I preferred to be seen at the UPMC Center for Sports Medicine. She set me up an appointment while we were on the phone for the following week. In fact, I could have gone the next day. During my visit, I was in and out of the facility, including getting multiple X-Rays, seeing the doctor, and setting up a follow up MRI in less than an hour. I’m confident I will have the surgery and start physical therapy by the end of March. I’m an active person who likes to ride my bike, golf, kayak, etc. I wouldn’t want to miss out on a summer of doing the things I love, while being in pain, because I had to wait weeks or months to see a doctor, get a surgery, etc.

That being said, our current health care system is very flawed in my opinion. The cost of insurance has skyrocketed since 2014 and the middle class have not been spared. A 60-year old who retires pre-65 now pays $525-$650 per month for a plan with a $7,900 deductible. It’s $770 to $1,000 for a plan with a $900 deductible that has a $5,200 Maximum Out of Pocket (MOOP). That’s for one person! Double it for a married couple! Another injustice is the cost of brand name medications in the United States compared to every other industrialized country in the world. For example, Novolog pens, one of the most common forms of insulin used today, on average, retails for $575 for a month’s supply here in the US. In Canada, the same medication, produced in the same facilities, retails for $90. I feel the laws and regulations on the industry are made to protect Big Pharma, not consumers. It’s also my opinion Big Pharma’s money and influence on politicians is the reason price gouging continues. There has been discussion of laws to keep costs down and even a bill introduced in the House, which I researched and found to have no teeth. I honestly have very little faith Congress will introduce or approve any bill that would limit Big Pharma’s profits.

For example, back in 2010 it was announced that the Part D prescription drug “Doughnut Hole” would be closed by 2020. Drug manufactures were going to discount medications by 75% to those who found themselves in it. It sure sounded great at the time, but here’s what happened. Prices were increased by as much as 500%. The Novolog that now retails for almost $600 was $150 in 2010. So, not only did senior citizens get no break due to price increases, hundreds of thousands more are falling into the Doughnut Hole than ever before. And the socalled closing of the Doughnut Hole? It didn’t happen. We were lied to. In fact, it actually costs seniors more to get out of it in 2020 that it has in previous years.

Another very serious flaw in our health care system is the lack of transparency when it comes to pricing. It’s the only product or service I’ve ever heard of where you have no idea what the cost is until after it’s been delivered. Imagine taking your car to a mechanic for brakes and not knowing what you owed until you picked it up! If we knew what a quadruple bypass, chemotherapy, radiation, knee replacement, MRI’s, etc., cost, we could buy just enough insurance to cover those services and decide what others we would pay on our own. This would be a huge step in bringing health insurance costs down. Unfortunately, common sense doesn’t often prevail in these matters and we get programs like the bulky Affordable Care Act. It was great in the fact it helped those who previously couldn’t afford health insurance while eliminating the practice of denying coverage for pre-existing conditions, which was long overdue. However, it did nothing to control costs of medical services or medications, and premiums for individual health insurance have tripled since 2013 while employer plans are again on the rise.

With all these issues, I understand the calls by many for Medicare for All, socialized medicine, single payer, which are all taxpayer/employer funded health insurance. But like the ACA and Medicare Part D, if it doesn’t lower the costs of care and medicine, all it does is change the way Americans receive health insurance. It will merely spread the rising costs among all Americans in the form of higher taxes and possibly other goods and services if a larger burden of paying for the system falls on employers. There’s a lot I like about Medicare and the VA, but they’re not without flaws. Medicare is full of waste, fraud, and abuse and the VA tends to be top-heavy with bureaucrats and ripe for cronyism.

How would this type of change affect those already on Medicare? I can’t be sure. There’s a very good possibility that Medicare Advantage, which over 20 million seniors utilize, would go away. Medicare Part B costs $145/month today. Advantage Plans can be purchased for as little as $0 to $40. A Supplement plus Part D for a 70-year-old costs around $130. Maybe you no longer pay for those in the new system. But would your taxes be increased? Would the cost of gas, groceries, and utilities rise? Would your access to care and doctors be as good as it is today? Financially, would you be better off in the end? No one can answer that with any certainty, and this is where the fear lies.

I apologize for not being able get more in depth of what I consider to be both the pros and cons of Medicare for all/Single Payer/ Socialized medicine in the limited space of the column. However, I will be discussing these issues with guests who are in the trenches of the healthcare industry on upcoming podcasts. Follow us on Facebook for announcements of when they will be made available.