For our closing blog in this series, we will be addressing the “Medicare for All” movement. The sheer volume of material this topic offers would allow this conversation to continue for much longer; however, there are more urgent and potentially more transformative issues in healthcare that need to be examined, therefore this will conclude this series.
In the months preceding and following the 2016 Presidential election, we wrote extensively on possible remedies or modernization to the healthcare industry in the United States; however, our view on healthcare never has been, nor will ever be, a politically-driven view. We strongly believe, based on experience dating back to the now infamous “Hillarycare” initiatives in the early 1990s that a single payer or “Medicare for All” is very unlikely to happen in our lifetime as we explain in the following paragraphs.
We think about healthcare from a broad perspective, which drives our views of the impact that a “Medicare for All” would have. We continue to remain confident of three things: first, that “Medicare for All” would crush the delivery of healthcare, due to the inadequacies of a governmental system to adequately reimburse the provider for healthcare delivery resulting in a drastic reduction in the quality and quantity of healthcare provided; second, that a bureaucratic system, comprised of medical and non-medical personnel, making life and death decisions on patient care based on age, history and socio-economic “values” is profoundly un-American and antithetical to our Constitution and culture; and third, that it would destroy what is today a fragile, costly and provider-centric (not patient-centric) healthcare delivery system in the United States. In the previous four blogs, we have provided an explanation for this “cause and effect” scenario of “Medicare for All.”
Healthcare in general, and healthcare delivery in the United States and worldwide, must eventually modernize. What we have today is not working! We now have evidence that EHRs are contributing to the fragility of the system by disconnecting doctors from patients as they are forced to interact more with the keyboards to enter information than to interact with the patient. This is contributing materially to physician fatigue and burnout at levels never before witnessed. Moreover, it is contributing to reduced enrollments in medical school to the extent that statistics are showing we are falling behind in simply replacing the physicians leaving their practice by attrition. Think of the effect this will have 10 and 15 years from now when we have a major shortage of trained physicians!
As mentioned in previous blogs, some mistakenly believe that by expanding Medicare, there will be a substantial reduction in administrative cost by eliminating the administrative and transaction costs of public and private health insurance. Such a thesis runs counter to everything that any government in history has ever undertaken – when government is involved, the bureaucracy swells, inefficiency explodes, costs skyrocket and quality tumbles. Though we believe that administrative costs at approximately 20% of total healthcare expenditure is exorbitant and must be addressed; this by far is not the only, nor most demanding or urgent problem in healthcare today. One of the biggest issues with healthcare today is the unprecedented amount of regulations and reporting throughout the entire healthcare delivery chain. Every segment is regulated from how a hospital is built to how to bill 87,000 different diagnostic codes. Nationalizing healthcare is not going to solve these administrative issues; rather it will be compounded.
We remind the reader, that except for the medical centers and hospitals under the control of the Veteran’s Administration (VA), and those operated by the U.S. military, the rest of the healthcare delivery system in the United States is operated by county, state, or private entities. These entities can be both not-for-profit for for-profit. For example, the majority of the hospitals in the United States are operated by not-for-profit organizations. Most physicians in the United States, work for themselves, small independent groups, or other for-profit entities. Though we have Medicare operated by the federal government, and Medicaid operated by the states with federal reimbursements, we also have for-profit insurance companies and nonprofit insurance companies that account for more than a third of all patient healthcare expenditures.
Again, the reader is also reminded that most of America received health insurance from their employers, and it is very likely that those beneficiaries are satisfied for the most part with the plans they have access to, and the payments made by their employer to cover generally most of the cost of the actual insurance.
Critics will correctly point out that even employer-based healthcare, including both private and public sector (local, state and federal healthcare plans), are “partially subsidized” by federal and state governments, in the form of allowing the deduction of healthcare premiums for their employees. A subsidy report in 2018 accounted for $280 billion to employers.
We have great empathy for the approximately 30 million people uninsured in the United States today and for the 44 million that are underinsured. The 30 million represents less than 10% of the U.S. population and the 44 million represent less than 15% of the U.S. population, and this issue must be addressed; however, we do not believe that healthcare is a Constitutional Right (like food and shelter) but rather it must be earned; Medicare/Medicaid were originally developed to help individuals between jobs or those with special circumstances.
Those two groups (identified above) should be addressed first, and I would advocate without disrupting the majority of Americans who believe they have good insurance, or the approximate 60 million receiving care through government-sponsored programs of Medicare, Medicaid, Well Baby Care, CHIP, WIC or other programs that will have to be materially disrupted by any “Medicare for All” plan that will leave many more millions of adults and children without access to health and medical care.
We end this blog with a parting thought that will tie to the next blog…
It was announced today in an article by Business Insider that for the first time in history, there are more people aged 65 and older than those aged 5 years and under, worldwide. This is a dynamic that is not generally factored into the healthcare discussion. In the next blog, we will discuss our views on how current and emerging technologies can provide answers to the healthcare issues; however, our premise is and always will be that we are a healthcare company bringing the right technology at the right time to solve specific issues – we are not a technology company looking for the next application of technology in healthcare!