Stalin and healthcare

Yes, this is a polarizing topic.  But The Donald has a slightly liberal bend toward this concept. It is certainly nice to think about everyone being covered for “all that is medically necessary.” But this is where things get sticky. Among the compelling issues in the “Medicare for all” debate are the following:

1. Who decides what is “medically necessary”?  A czar, a panel, a group of MD bureaucrats, or just maybe YOUR physician?

2. How are doctors (or chiropractors, naturopaths, acupuncturists, etc to be paid? Do they get a lump some per month and then dish out what they fel obligated to provide or should they be paid for their services (seems to be OK with the way we pay most attorneys)?

3. Who gets taxed for this and how much? Should this be a “flatter” tax so all have skin in this game or do we just soak the “rich”? And who’s rich?

4. Do all physicians get paid the same way? Right now, under current Medicare rules, the experienced internist with 35 years of education and practice gets paid the EXACT same amount for their time as the rookie just out of training. Did you know that?  Sort of like paying the 757 captain the same amount as the new pilot of a puddle jumper. Zero pay differential for seniority or experience.

These issues are almost never addressed when such matters are debated since the simple concept of “care for all” sounds so good. This is why the sick in Canada come here if they have any money. It is why the Saudis fly to Mayo and why HMOs (now ACOs) generally have no idea what personalized care really is. Otherwise, why would presidents and governors require “special” care if it is all “equalized”?

A few days ago the group clamoring for a National Health Plan issued a statement/press release once again crying out for this. Their plea starts with this:

In a dramatic show of physician support for deeper health reform – and for making a decisive break with the private insurance model of financing medical care – 2,231 physicians called today [Thursday, May 5] for the creation of a publicly financed, single-payer national health program that would cover all Americans for all medically necessary care. (my emphasis)

Among the operating principles is this now-familar phrase:

Patients could choose to go to any doctor and hospital. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHP to cover all operating costs. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

So…you can keep your doctor again! It’s how those doctors are paid that makes the difference in terms of whether the doctor works for you or the state. It’s that simple, folks. The next time you hear about the wonders of a national health plan, remember this: unless physicians are permitted to “balance bill” beyond what the government is going to pay them, the service will be the medical equivalent of fast food, not fine dining.

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