When Senator Elizabeth Warren released a plan to finance her hugely expensive Medicare-for-all proposal last Friday, doctors and patients everywhere knew that no matter how the numbers were crunched, adopting the health-care reforms Warren seeks would mean lower income and higher taxes across the board. There would be no sparing of the middle class, and because of its demolition of the employer-based health-care system, the 2 million jobs that Warren projects the plan would cost the health-care sector would be just the tip of the iceberg.
Inside the doctor’s office and the hospital, havoc could ensue. We would be regulated more yet paid less by the government. Doctors are already fleeing from Medicare and Medicaid in growing numbers. Warren’s plan would make that dysfunctional system the only show in town and trap us all within it.
Even more than the enormous price tag, I am concerned about the fundamental ways my practice would be irrevocably altered by Warren’s plan. For all the complaining doctors do about navigating private insurance, the current system still leaves us in the driver’s seat, and most decisions are arrived at jointly between us and our patients. Insurance can deny coverage for specific tests and treatments, but much of the time I can anticipate a denial before it happens and work around it. If a drug isn’t covered, for example, I’m usually ready with an alternative that’s just as good. By contrast, under Medicare as it’s currently constituted, specialists routinely go through diagnostic or referral gymnastics to secure approval for crucial procedures such as MR angiograms, nerve-conduction studies, and stress tests. And in single-payer Canada, doctor and patient control is completely lacking. The need for the government bureaucracy to approve doctor-patient decisions often leads to weeks or even months of delays for essential tests.
Medicare for All would come with a much higher level of government regulation and red tape than Medicare presently does. Medical practice would be restricted, and both the art and the science of medicine would be compromised. Federal bureaucrats with little insight into the day-to-day demands of practicing medicine would make an increasing number of crucial decisions.
Much attention has been paid to the close to 30 million people who remain without health insurance in the U.S., despite Obamacare. Even when the Affordable Care Act’s individual mandate was in place, millions of people every year chose to remain uninsured and pay a tax penalty rather than sign up for an unattractive high-premium, high-deductible policy. The law’s Medicaid expansion has been more successful at plugging the uninsured gap, with more than 17 million people choosing this option in states that have it. At the same time, Federally Qualified Health Centers have been expanded and now deliver care to more than 22 million people whether they have health insurance or not. And hospital emergency rooms across the country are still compelled to see patients regardless of their insurance status. These crucial pieces of our health-care safety net don’t need fixing.
What’s still missing is fallback basic health coverage for all, provided by the government to help those who need it when catastrophe or severe illness strikes. This public option, based loosely on the Nixon/Kennedy plan of the 1970s that likely would have passed into law if not for Watergate, would augment rather than destroy or dismantle or even compete with the functioning employer-based health-care system, unlike Warren’s plan.
To be sure, our unique health-care system includes waste and duplication, but it also avoids the cold rationing of the socialized medicine systems of Europe. We have some of the best medical centers, and do some of the most groundbreaking medical research, in the world. We are at the cutting edge of surgical technology, radiology, and care for cancer, heart disease, and acute emergencies, among many other things. Political solutions to the problems that ail the system should be the same as medical ones, first and foremost doing no harm. The system is complex and interwoven; it needs to be maintained and strengthened, not replaced. Warren’s plan takes the wrong approach.