Challenging decisions on the future of health care

This article, which touts a “Medicare for all” approach, notes that 20 percent of the population account for 80 percent of total health care spending, “most of this coming from Medicare and Medicaid.” Therefore, any meaningful attempt to control health care costs must address the massive costs in these programs. The article fails to address Medicaid reform but does propose a reasonable “fix” to Medicare — allowing the government to negotiate drug costs. Do the authors believe this one action will control health care costs for the “sickest” 20 percent of the populace?

The article cites a study which states that about one-third of health care costs can be attributed to fraud waste and abuse, and later concludes that “improved Medicare ... will dramatically reduce waste, fraud and abuse.” How?

Ultimately, health care systems must answer two questions: who pays for the sick people (the 20 percent referenced in the article); and who says “no” and when. The latter point concerns the reality that our society does not have infinite resources to pay for every medical procedure that every person might someday need.

A “Medicare for all” program could provide coverage to the “sick people,” but without some kind of ultimate limits on care, an inability to say “no” would economically doom it. This in turn requires tough decisions that are challenging (to put it kindly) in a highly politicized world.