Democratic Presidential candidates have a number of proposals on how to reform the health care system, including “Medicare for All” proposals. The goal of these reforms is to improve access, lower costs (both premiums and out-of-pocket) and improve quality. Achieving all these goals is not easy. Even access was improved and costs fell for patients, where will the funds for this come from?
Joe Paduda of Managed Care Matters argues that this would come from either higher taxes or lower payments to physicians, hospitals and other providers:
…the average family with one member in poor health “pays” about $23,500 for healthcare thru direct payments, insurance premiums, what their employer pays for insurance, and taxes for Medicare, Medicaid, and other government healthcare programs.
The good news is about $5,000 of that would be stripped out; that’s my best guess at how much administrative expense would be eliminated if healthcare providers and payers didn’t have tens of thousands of people on payroll fighting each other.
Oh, those tens of thousands of people will lose their jobs.
Mr. Paduda makes an important point. Even if health reform/Medicare for all were implemented in an effective way, even if expanding Medicare would maintain the quality of care, even if fraud and abuse do not increase, even if access to care/provider waiting times do not increase dramatically, there will be losers to any reform effort.
There is no free lunch.