Drs. Lawrence Pareles and Christopher Flory: Why Medicare for All works

Published: 6/25/2019 8:00:17 PM

We are two physicians who each have more than 30 years of clinical experience working within our health care system. We are writing because we strongly disagree with Dr. Jay Fleitman’s recent column (“Bernie Sanders’ health care plan is not the real thing,” May 7) — we think that the right prescription to heal our broken medical care system is to pass Medicare for All to solve many of our medical insurance problems.

Compared to other developed western countries, our health care system has worse outcomes and higher costs. The Commonwealth Fund rates the U.S. 11th out of 11 developed countries. The National Academies of Sciences, Engineering, and Medicine ranks us 17th out of 17. The World Health Organization ranks American medical care 37th in the world.

Even conservative Forbes Magazine said our infant and maternal mortality rates are much too high, but they attributed this to socioeconomic factors such as poverty and teen pregnancies.

The connection between unaffordable and neglected health care and between unaffordable contraception and unwanted pregnancies was not addressed. Our present health care financing system gives us poor outcomes, despite having very high costs.

We spend nearly twice as much on health care as other developed countries — it consumes 18 percent of gross domestic product (a total of $3.65 trillion dollars in 2018). Here in Massachusetts, health care accounts for 44 percent of the total budget.

Dr. Fleitman was worried about cost control, but a Medicare for All plan can control costs better than our system does now, and still provide reasonable payment to caregivers and hospitals. Everyone knows where the tremendous waste in our system occurs— the high administrative costs of for-profit insurance companies, and unaffordable drug prices.

Private insurance companies charge us 20-25 percent in administrative overhead, while government-run Medicare does the same work with only 3-5 percent overhead (and without all the TV ads).

By law, Medicare is not allowed to negotiate lower drug prices, so we pay twice as much for medicines as most other countries (and our own VA system). The pharmaceutical industry lobby is powerful, but despite that we need to change the system so people can afford their medicines, including life-saving insulin. Drug company profits are also obscenely high.

Improved Medicare for All would provide medical coverage to the 30 million Americans who currently have no insurance, and to the additional 10 million who are under insured, and to everyone else — and actually cost less. This would not be “socialized medicine” — our government would handle the finances, but not control the hospitals, providers, or medical care.

Medical decisions would stay where they belong — between patients and their doctors. And unlike now, we could freely choose the caregivers we want to see, and the hospitals we want to use.

Currently, the federal government under Medicare and Medicaid already pays 70 percent of our health care bills, without controlling the medical decisions. Private insurance is much more intrusive, and rations our health care to increase their profits.

Caregivers could again use their precious time to provide real medical care, instead of working on unnecessary pre-approvals and paperwork from insurance companies.

Hospitals would again have their nurses provide hands-on patient care, instead of working in billing departments. Many hospitals now employ as many coders and billers as they have beds. The money saved on administrative costs would be used on patient care for everyone.

Medicare for All would eliminate copays and deductibles and still cost less. Every reputable economic analysis has found that a government-financed plan would save money. Even the Mercatus study (funded by the ultra-conservative Koch brothers) found that Medicare for All would save $2 trillion over the next 10 years compared to continuing with our present system. Other studies project even greater savings.

Changing such a large-scale system will not be easy, but we know that our profit-driven private insurance system is expensive and failing. It provides poor outcomes, cannot contain costs, and doesn’t provide care for everyone.

Our current system is estimated to be responsible for 40,000 avoidable deaths each year. America can and must do better — we deserve a system that cares for everyone with a better, more comprehensive, and more affordable system.

We really deserve Medicare for All. There are currently Medicare for All bills in both the Massachusetts Legislature and Congress. Let’s all work for their rapid passage.

Dr. Lawrence Pareles lives in Florence. Dr. Christopher Flory lives in Williamsburg.

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