Why ‘Medicare for all’ is the best deal Trump can make

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Despite the rhetoric, the seven years of chest puffing, Republicans could not deliver on repeal and replace of Obamacare.

They had not used those seven years wisely to look at the issues with the Affordable Care Act (ACA) to come up with a replacement that would actually work. Yes, healthcare is complicated. It does not need to be as complicated as we are making it.

{mosads}The government already pays for the majority of medical care in the country between Medicare, Medicaid, Tricare and the various Federal employee benefits. The simplest, most cost effective, fiscally conservative step we could take is to expand Medicare by simply increasing the Medicare employment tax by 3.5 percent.


That translates to about $59 for every $20,000 earned. This would cover everyone. Yes it really is that simple.

 As to what we would cover with single payer healthcare, we can debate that. As a Family Medicine physician I would include the essential health benefits that we have already decided on prior to the passage of the ACA. Preventive care, including immunizations, maternity care, emergency care, pediatric care, screening tests such as colonoscopy, mammography, mental health, substance abuse treatment and rehabilitative services. 

Insurance companies could then compete nationwide for the coinsurance (Medicare covers 80 percent of the bill) and people could opt to purchase it or not. Plans could range from just covering the coinsurance of essential benefits to being more extensive – a true, free market could develop. 

This would allow creativity in the insurance market. At this point allowing plans to cross state lines would be more attractive and  that has eluded the market until now.

The United States could finally join the rest of the developed nations of the world in having comprehensive healthcare for all its citizens. Frankly I would relish having one set of guidelines to follow. 

My endless days dealing with each insurance company’s phone operators making medical decisions could end.  Phone operators who lack any sort of degree let alone a doctorate in medicine. The frustrations of trying to understand why a generic medication is being denied by insurer X today but was not last week. The endless hours of administrative nonsense that have sucked the joy out of medicine for so many of us could be tempered.

Looking at where costs have risen in medicine it is the exponential rise of administration. If we are serious about controlling healthcare costs it is not by hurting those of us providing the care it is by eliminating the unnecessary plague of architecture we have created.

This behemoth is choking us – financially and literally. We rank last in developed nations on access to care, efficiency of care, and equity of care. The  more spent on administration as opposed to actual care the worse the experience for both physicians and patients.

What has been buried in this whole discussion of healthcare and the tremendous cost shifting to patients while insurers profit and worry about their CEO salaries, shareholder returns is that physicians are burning out. It costs a tremendous amount to train a physician – not just in terms of the tuition each of us pays – Medicare dollars also go towards training physicians.

As physicians burnout, dropout, commit suicide that toll is larger. It becomes more important to solve this now.  We already have a shortage of primary care physicians, losing more is not an option. Simplifying the administrative burden physicians face daily comes up on every single survey of physician dissatisfaction that exists and yet Washington has been tone deaf on that issue.

Without physicians you do not have healthcare. Simplifying the process solves payment issues solves administrative issues so it is truly remarkable that our elected officials are not debating this option.

The system that could deliver on promises of cheaper comprehensive care for all is Medicare for all.

This would be a good plan. 

This would be the art of the deal. 

Dr. Cathleen London is physician based in Maine who developed a cost-effective alternative to the standard EpiPen in response to skyrocketing prices. London has been an on-air contributor on Fox News and local television stations around the nation. Her healthcare innovations have been featured in the New York Times.

The views expressed by contributors are their own and are not the views of The Hill.





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