Medicare for all, whatever that means …

“Medicare for all” is not a program. It’s a slogan. We don’t know what it means until somebody defines it.

By itself, it is not a solution to America’s health care needs.

Medicare for all was hotly debated during the recent Democratic presidential debate and will continue to be a major topic during the presidential primary season.

New Mexicans may want to consider what the effect would be in our state, especially since more than half of our population is covered by Medicare or Medicaid or both.

The version advocated by Senator Bernie Sanders, as expressed in legislation he has already introduced, would make medical care free to everybody and would add services now not covered, such as dental and vision care.

With this version, Americans would no longer pay insurance premiums but would pay for health care through taxes.

TV commentators occasionally try to play “gotcha” with Sanders by asking him to “admit” that his proposal would cause a tax increase. Of course it would. We would be paying for health coverage through taxes rather than insurance premiums. The presumed tax increase would be a saving – perhaps a big one — compared to the cost of insurance. I have found Sanders to be remarkably inept in trying to explain this very simple concept.

The first obvious problem that Medicare does not solve is that it does not pay healthcare providers enough. Providers commonly say they couldn’t keep their doors open if Medicare were their only source of compensation. The system now is kept afloat by the much higher reimbursement rates paid by private insurers, which act as a form of subsidy for both Medicare and Medicaid.

If private payers are eliminated, the reimbursement rates will have to be increased. New Mexico’s reimbursement is lower than many other states based on a cost-of-living formula is not helpful to us. New Mexico policymakers should be ready to raise that issue.

Medicare does not help us to have enough doctors or facilities or access. That low reimbursement rate is one of the reasons. One recent study ranked New Mexico 48th in access to physicians.

A counterbalance is New Mexico’s malpractice law. Our state has a very low cap for malpractice awards to wronged patients. That helps providers to have relatively low malpractice insurance costs, which is good for everybody except victims of malpractice and their lawyers.

It was not surprising that legislation was introduced this year to increase the maximum malpractice award to $25 million. It was also not surprising that the legislation didn’t get very far. But it will surely be back.

Solving the problem of access to health care requires not just more doctors. It also requires more innovation and creative solutions. New Mexico is on the front lines of such innovation with Project Echo, a program created at the University of New Mexico that now has global reach, where specialists and experts teleconference with providers wherever they are. Using a different strategy, the recently enacted dental therapy law is an example of how lower paid providers with limited licenses can be used to dramatically stretch resources.

Medicare for all also does not by itself address the outrageous cost of pharmaceuticals. That’s a major cost driver in health care, and it will take separate legislation and perhaps a change in the lobbying laws to get prices down to the relatively reasonable levels of other countries.

My best guess is that national support will swing to one of the more centrist presidential candidates and a policy that moves gradually toward a single national coverage plan.

The Democratic Party is currently the only “big tent” party, with candidates and ideas ranging from center to left. We’re likely to hear those ideas debated vigorously over the next several months. Let’s not prejudge, but examine them against the template of what works for New Mexico.

Triple Spaced Again, © New Mexico News Services 2019

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