I am struggling with what a health care bill should look like. We need to be able to say what we want to change in the ACA and counter the Republicans and Trump with a positive vision of what would happen in health care when we get back in power.
And Medicare for all seems like a good way to go. I was excited to see three reps from my state cosponsor HB 676 which would establish Medicare for all.
But I just read a thoughtful article from a geriatrician who serves only Medicare patients. He supports universal single payor, but points out some grievous problems with Medicare that are becoming increasingly apparent.
Because payment is made on a relative value system that pays much more for procedures than for interactions, the role of a physician changes:
If you wonder why the doctor-patient relationship is not doing well right now, wonder no more. Trust takes time. Even family doctors who take Medicare have to turn their practice into a patient or low-risk procedure mill to make ends meat. Medicare will pay a physician between $70 to $80 to freeze off a wart, a procedure that takes about 2 minutes to do, and 1 minute to document in an EMR.
In contrast, I can spend an hour with an elderly patient with multiple complicated issues, addressing their concerns, reviewing and adjusting their many medications, and coming up with a plan and then having to take 30 minutes later to document what happened and get paid essentially the same amount (about $80) had I just spent 3 minutes removing a wart and sending them out the door. Is it any wonder that geriatrics is a dying field?
I know this is true. As my husband lived with heart disease and cancer for many years, we had the good fortune to find doctors who were unhurried in talking with us and answering our questions But when I saw their bills and the amount that they were paid by Medicare, I realized that they frequently made less than the plumber who came to my house. And they had to pay all of their office overhead and probably a med school loan out of the money as well.
The whole article is a good read. It reminds me that “health care is complicated” (DUH). In this time while we work to return to power, we should be turning to blue states and looking for any models that work. We should be developing standards for what universal care should look like. We should be bringing together all the players to add their expertise. We should be setting up model programs and assessing what works and what doesn’t. We should be developing a method of funding this that is sustainable and sellable. And we should be informing the public that we are following a rational, humane process to get good health care to everyone in a system that works better than what we have now.
Not asking much..
We need to do it NOW.