Medicare for All – What Does It Really Mean?

Last week, one of our senior physicians told me a patient care story that made me cringe. He had spent 45 minutes filling out a preauthorization form for an insurance company to try to get coverage for a patient’s surgery that he knew she absolutely needed. The surgery was booked, but it could not happen until the insurance company – that was completely uninvolved in her care – approved the procedure.

Unfortunately, the approval did not come through in time, and the surgery was canceled. Eventually, the authorization was approved, and the patient did get the surgery she needed, but only after the physician’s time and his team’s time was wasted, along with the lost operating room time from the cancellation – not to mention the stress and inconvenience experienced by the patient and her family.

Do you want to know why physicians are burning out at an unprecedented rate? Do you want to know why health care costs so much in the United States? Look no further than the administrative burden associated with preauthorizations, excessive documentation requirements and payment denials. And these things do not improve patient care.

We have patients in the hospital who need to go to rehab so they can continue healing, but instead are stuck in a hospital bed because we cannot get the appropriate referral for rehabilitation services. We have patients who show up at pharmacies to fill their prescriptions only to find that more paperwork needs to be filled out by the provider to accommodate the insurance company before they can get the medicine they need. All of this adds to the cost of health care and reduces the quality of care Americans receive.

Can “Medicare for All” fix this? Maybe.

Medicare for All is a hot topic right now as Democratic candidates for President put forward their health care policies. I think those of us in health care have a responsibility to be a part of this national conversation and closely evaluate the candidates’ proposals. In fact, I’ve recently engaged in this conversation with Sen. Elizabeth Warren and was featured in a recent Boston Globe article and in the Worcester Telegram & Gazette.

So, what does “Medicare for All” really mean? Are we talking about a single payer system? Are commercial payors (insurance companies like Blue Cross and Blue Shield) going away? No more Medicaid? That depends on whose plan you’re talking about.

Although I am not yet ready to endorse a Medicare for All plan or any other plan presented by any of the presidential candidates to date, I do believe the current system is unsustainable and must change. We need health care reform – real health care reform. Here are the five changes that I believe should be a part of any health care reform bill.

  1. We need basic health insurance coverage for everyone. Health care services should be like fire, safety and emergency response. If you have a fire in your home, you call the fire department and they come to your aid, regardless of who you are, where you live, what you do or how much money you make.
  2. We need a fair system that levels the playing field between safety net health care systems like ours and wealthier institutions with more favorable payer mixes. It is unfair that we get paid less than other similar systems because we care for a higher percentage of the poor and underserved.
  3. We need to control the sky-rocketing costs of health care caused by out-of-control pharmaceutical costs.
  4. A reformed health care system needs to pay more for care coordination, behavioral health services and primary care.
  5. We need administrative simplification to reduce the administrative burden on physicians and other providers. Studies show that a major cause of provider burnout is the administrative burdens like the examples I’ve given here. Our providers are spending way too much time dealing with hundreds of different forms and processes that take them away from their patients. By its nature, caring for patients will always be a busy and sometimes stressful endeavor. But the negative impact of unnecessary fights with insurance companies upon the administrative burden, schedules, workload, energy and morale of our caregivers is truly incalculable. And the resulting delays and disruption in providing care to our patients is unforgiveable. This has to stop.

I think a well-planned Medicare for All program has the potential to address these issues, assuming we redesign the existing Medicare program that is loaded with administrative waste. However, there may be other options we should consider. For now, I am keeping an open mind as I review the individual candidates’ proposals and trying to get the candidates to focus on addressing the five issues highlighted above.

I think we all can agree that our current system is broken, which means there is ample opportunity for process improvement. I would love to hear your opinions on Medicare for All – do you think this concept could work? You can send a note to me at Eric.Dickson.System.CEO@umassmemorial.org or use the link below.

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