Time will Tell

I posted most of yesterday's blog on facebook, which I rarely do anymore.  I tweaked it a little when I realized that I had been looking at Elizabeth Warren's "Medicare for All" plan from her perspective as a politician, of which I'm not.  Since the politicians generally make their decisions based on the calculus of how many votes it will get them, I thought that this was an important approach to take.  I'm even more certain of this today.  At the same time, it's also clear to me that even if Warren becomes President, and even if Democrats manage to get a majority in the Senate, the likelihood of her enacting "Medicare for All" is nil.  From that perspective, it's an aspirational approach, and I can respect that.  It would be nice if she acknowledged that fact, but I have to defer to her and her advisors as to whether that makes political sense.  A colleague of mine pointed out that such a dramatic change to a program that constitutes 20% of all health care expenditures could potentially devastate the marketplace.  I'll go one step further.  While Medicare accounts for 20% of the health care market, its influence affects the entire market.  Many insurers utilize Medicare rates, or some variation of them, for their reimbursement methodology.  If we mess with Medicare, we could cause the whole system to collapse.

On the other hand, Medicare is working. It's a functional healthcare model that most of the people who are on it are satisfied with.  It even has shifted to allow for free-market approaches, as I mentioned yesterday in relation to Medicare Advantage plans.  Is it a given that "Medicare for All" will harm the existing Medicare program?  I'm not so sure.  The existing program is working.  "Medicare for All" would be a new program.  The devil is in the details of how it would be enacted.  Would it stand alone from traditional Medicare?  Would it be incorporated into traditional Medicare? Everyone is making assumptions at this point.  While I initially questioned the sanity of the Warren campaign putting this proposal out there, only time will tell.  Can she adequately describe what the proposal really does?  Can she connect with the American people in regards to how it will impact them as individuals?  Only time will tell.

One last thought.  I've said the Medicare is "working."  I say that from the perspective of most people who use the program.  I've also argued in the past that since it's founding in 1965, Medicare has corrupted free-market forces in healthcare.  It starts with subsidies for graduate medical education, and continues with how it can make or break varying healthcare delivery models.  In future blogs, I'll discuss some of the areas that Medicare has failed us.  The concern would be how that translates to a system that provides "Medicare for All."