Blog | Thursday, July 25, 2019

Medicare for all as a moral imperative


Brace yourselves. Over the coming months and longer, you will be hearing presidential candidates and their acolytes proclaiming the moral imperative of a Medicare for All program. Is this just an electioneering slogan or is this really the Holy Grail of health care reform?

Nearly all Whistleblower posts are stand-alone essays. This Medicare for All entry, will be a rare departure from this tradition and will be a two-parter. If you like Part I today, then you will have strong incentive to visit this site next week. And, if you find today's post to be disappointing, then I invite you back next week with the hope that you will find the conclusion to be more captivating and riveting than this post. How's my salesmanship?

Let's try to agree on one thing before we disagree over everything else. Conceptually, we all support any health care system that provides high quality medical care, with reasonable access into the health care arena and is cost effective. We do not have these three pillars uniformly presently today. More accurately, these three pillars are in place for many of us, but this is not a universal phenomenon. Obamacare promised progress on all three of these fronts, but most of us agree that it did not deliver. We all are aware of the ‘if you like your doctor, you can keep your doctor’ falsehood. Additionally, most of us have not found that Obamacare has resulted in better or cheaper health care. I agree that Obamacare did increase access, mostly with Medicaid expansion in various states, but the access improvement is less than you might think. Prior to Obamacare, about 15% of us lacked medical insurance and now it is closer to about 10%. Yes, this is real improvement, but it represented incremental improvement. Seems like it is costing the nation years of turmoil and division for insuring another 5% or 6% of us.

Medicare for All proponents offer these arguments.
• Health care for all is a human right and a moral imperative.
• We are the only industrialized nation that does not provide this benefit to its people.
• We need to cut down Big Pharma and the Insurance Companies who are gouging all of us.
• We need a standardized benefit package across the board so no one is left behind.
• We will save a fortune by cutting administrative costs.
• We will enjoy better health by emphasizing preventive care and treating active medical issues sooner.
• Current spending at about 18% of our GDP and is not sustainable.

These arguments seem meritorious. Don't be swayed yet. There's a reason in our system of jurisprudence and debate that judgement is reserved until the other side has been heard.

Next week, if you will kindly return, I'll offer some ripostes to the Medicare for All arguments.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.