Is Medicare a Good Model for National Health Care?

It is a rhetorical technique to state a debatable issue as if it were fact. It puts opponents at the disadvantage of having to play defense, and those who may be less well informed will have a tendency to assume your statement is true.

I keep hearing proponents of a government option in health care use Medicare as an example of how well it will work. The President did this Wednesday night. So, just how well does Medicare work?

Many doctors will not take new Medicare patients because the program underpays so severely as to make it impossible to earn a living if they see too many patients. Not impossible to earn a good living. Impossible to earn a living. Some Medicare reimbursements are so low that, depending on the doctor's overhead, each patient visit can be a few dollars either side of break even. It requires those of us with the kind of insurance that the administration and some in congress are villainizing to pay our doctors enough for our visits that they are able to afford to see Medicare patients at all.


Medicare is due to start bleeding money faster than it is taking in money in just a few years.


The President thinks there is so much "waste and abuse" in Medicare and Medicaid that cutting it out will fund nearly all of his new plan. If there is that much "waste and abuse" in Medicare, why not cut it out now?

Part of the reason is that in any bureaucracy there will be waste and abuse. The larger the bureaucracy, the more waste and abuse there will be. That is just the nature of the beast. Nothing runs perfectly and the larger and more complex the organization, the less perfectly it will run. It is fantasy to think you will eliminate waste and abuse any more than you can eliminate gravity. In order to get money out of Medicare he is going to have to cut payments in a system that already underpays to the extent that health care is now being rationed to the elderly by virtue of doctors not accepting new patients.

The President promised that a government run plan will be self-funding. That is the way the Postal Service works.

How long did you have to stand in line the last time you went to the post office? Postage rates have been increasing annually for the last few years and still the Postal Service is losing money. Rather than resolving the problems by being more competitive and customer friendly, they are talking about cutting delivery services to 5 days a week and closing some post offices. This is what happens when the government runs something. There are no competitive forces at play to compel creative thinking. It doesn't become a matter of providing better services to the customer. Do we really want to replace what is arguably a good health care system in need of improvement with a government monopoly similar to the Postal Service or Medicare?

We Aren't Enemies

I was debating politics with my step-father several years ago, when part of his argument rolled around to the fact that Barry Goldwater had opposed Medicare. This was meant to be an indictment to prove that Senator Goldwater was opposed to providing medical care for the elderly. The fact of the matter was that the senator from Arizona was in favor of another bill that he believed did the job in a better way.

Recently another relative asked me how families were supposed to afford health insurance if not by the passing of the healthcare bill now before congress. So I gave her a list of things that could be done without gutting and undermining our current system.

In an effort to win votes and support for their side, politicians and interest groups often paint their solution as the only solution to a problem. The corollary is that if you oppose their solution you are opposed to solving the problem. Don't let this hocus pocus fool you. Many, if not most, politicians and Americans want to address inequities in our society. They want to protect us from terrorists, and preserve our civil rights. They want to encourage prosperity for all and provide for a social safety net. The arguments, for the most part, revolve around the methods of resolving problems and ranking priorities. The demagoguery comes into play once a proposal is made by one side or the other and then both sides begin a game of deceit and gamesmanship in order to preserve power and prestige for their party or ideology.

We forget that we are all on the same side. Remember the mood of the country on September 12, 2001? You can argue about some of the decisions that came out of that mood, but we recognized that more important than whether we were Republicans or Democrats, labor or management. we were Americans & there were real enemies out there whose quarrel with us wasn't the methods of achieving our goals, but the goals themselves.

When somebody holds up a banner that says "Healthcare for All", we can all agree with that goal. Just don't get confused and begin to think that if we oppose the present legislation we don't want anything done. That is just a ploy to scare you into supporting something that you may not understand, or with which you may not agree. It is an effort to make you believe that those who oppose this bill are against quality healthcare for all Americans. Be assured, that isn't the case.

Do We Want Government In the Healthcare Business?

Where do people go to obtain cutting edge, state of the art healthcare? More than any other country, the answer is the United States. That healthcare is expensive. Not everybody can afford the most sophisticated care or the newest drugs. That makes some of the rest of us feel that we are being treated unfairly. But the medical care and medicine we get today was cutting edge & state of the art several years ago. Where would we be if those technologies & drugs had never been developed?

There will always be inequities in the world. Some of us will always have less and some of us will always have more. That isn't fair, but that is life. The trick is to address the needs of those who need help without inhibiting the system that develops the kind of medical treatment people come from around the world to get.

The biggest thing you can do to inhibit that innovation is to make the government an insurer. As Lord Acton said, "power tends to corrupt, and absolute power corrupts absolutely". Making government both the rule maker and the provider in the medical care arena, gives government all the power with little opportunity to check it. With government in the game as an insurer, private insurance will, over time, be crowded out of the market. That would leave you and me with only the government as our insurance company. When the government is in charge they will have a conflict of interest. On the one hand, they will be providing benefits for the country's healthcare, on the other hand, they will be responsible for all the costs. We are already doing this with Medicare, and Medicare underpays to the extent that many doctors will not take on any new Medicare patients. I heard one doctor recently say that his net profit on each Medicare patient is $4 per visit. that kind of profit will not permit the innovation that will cure cancer or diabetes.

There is much in the healthcare system that needs fixing. But the current bill before the House is not the only way to fix it. Don't let anybody convince you that it is their way or the highway. We can fix healthcare without a government option.