The Medicare for All Act of 2019

What would it really mean for patients in the U.S.?

Medicare for All Rally, Los Angeles — Feb 2017. (photo: Molly Adams)

The Medicare for All Act of 2019, and those who desire the U.S. to adopt a Universal Health Care, single-payer model, got their hearing before the Ways and Means Committee on Capitol Hill today.

Republicans were unimpressed if somewhat eager to point out the deficiencies of such a plan.

“While our American health-care system does have real problems, we should focus on improving what’s working and fix what’s broken, rather than starting over with a massive socialized medicine scheme that will leave many families worse off.” — Texas Republican Rep. Kevin Brady, ranking member of the Ways and Means Committee

House Speaker Nancy Pelosi, showing her usual non-reactionary approach to hot-button issues, was careful to emphasize the different views on healthcare that exist within the Democratic Party and the U.S. electorate.

“When most people say they’re for Medicare for All, I think they mean health care for all. Let’s see what that means. A lot of people love having their employer-based insurance and the Affordable Care Act gave them better benefits.” — House Speaker Nancy Pelosi

Pelosi is right to be cautious about the Medicare for All Act of 2019.

Rationing or a Blank Check?

The central issue of the Medicare for All Act boils down to one question:

Do American patients want financial caps and rationing, or no financial caps and no rationing, but also no limit on how much Medicare for All would cost U.S. taxpayers?

There really isn’t any other choice. If financial caps are imposed on doctor visits, hospital services, medical devices, pharmaceutical drugs, then it follows that a finite amount of these goods will be available and therefore will need be rationed.

The implications are somewhat scary. Especially if you are very old, very young, have only a slim chance of surviving surgery, suffer from a drug or alcohol addiction, or are likely to only live two more years after a lung transplant verses someone who might live another 20.

Modern medicine already has a model for what this looks like in practice.

Organ Transplants

Doctors, hospitals, surgeons, and medical boards, already have to make these decisions all the time. There are a very finite number of transplantable lungs, for instance. There are far more people waiting for a life-saving lung transplant than will ever live to receive one.

As such, it follows that the qualification and approval process for a lung transplant is long and arduous.

In order to qualify for a lung transplant, you have to undergo intensive counseling: Psychiatric counseling (Are you likely to become depressed during the long and intense physical therapy required for rehabilitation? Are you strong enough mentally for the experience?); Marriage counseling (Will your spouse or partner be supportive?) Financial counseling (Can you afford the surgery itself and the regimen of anti-rejection drugs you will have to take for the rest of your life?); Medical counseling (Will your lifestyle support organ transplant?)

Who gets the lungs? It’s complicated. But the long answer is usually the person most likely to derive the maximum benefit from the donated organ, with considerations based on how long the potential recipient has been waiting for a transplant, how life-threatening their situation is, and so on.

The decision is further complicated by another, more nebulous factor:

Why does the person need a new lung in the first place?

Let’s say one person needs a new lung because they smoked four packs of menthols every day for 20+ years, and one person needs the lung due to a congenital birth defect.

Surgeons are standing by, with one precious lung some blessed individual was kind enough to bequeath when they weren’t using it anymore.

Who gets the lung?

It still depends. If the menthol smoker has repented his nicotine saturated ways, completely changed his lifestyle habits to support the transplant, and demonstrated the mental grit he will need to see him through the process, he might get it. Even though, arguably, his need arose out of his own negligence.

The menthol smoker might get another leg up if the person with the congenital birth defect needing a lung also has a history of heroin addiction, financial insolvency, and suicide attempts.

Very sticky. But the finite resource of organs available for transplant necessitates these life or death decisions, which on the surface may seem like moralizing by the medical profession.

It isn’t.

Doctors and hospital administrators sitting on a medical board, evaluating candidates for transplants aren’t engaging in moral judgments. They aren’t passing death sentences based on concepts of good and evil.

For those dedicated medical professionals, the only immorality to be avoided at all cost is that of wastefulness. They are oddsmakers, on par with the best in Las Vegas or Monte Carlo.

Their only question: Will this precious resource be wasted on this person?

It isn’t ‘Who is deserving enough?’ but ‘Who is dedicated enough?’. Who will survive? These aren’t easy decisions. Even the best medical professionals gamble sometimes and lose, only to watch an organ-transplant recipient stop taking his anti-rejection drugs and die of a fentanyl overdose two months after receiving a transplant.

Now, imagine if all medical treatments were just as finite as a lung transplant.

This is what financial caps and their incumbent rationing might mean for American patients.

Finite diabetes medication would soon have government medical boards asking questions like: Who is willing to change their lifestyle? Who is willing to lose weight? Who is exercising?

There is also the question of competency.

Can a U.S. government body that routinely shuts down, subsequently doesn’t pay its employees for weeks on end, and grinds to a screeching halt due to political impasse be trusted with administering health care to 330 million people?

Critics of the Medicare for All Act have their doubts.

The alternative to financial caps and rationing, is of course no financial caps, and no rationing. Unfortunately, that also means no limits on how much universal health care will ultimately cost taxpayers.

If you don’t really know how much a massive undertaking like Medicare for All will cost, is your plan really all that good?

Giving legislators a blank check with regards to completely overhauling, reorganizing and administrating healthcare in the U.S. isn’t something the average American taxpayer will relish, whatever promises politicians may make during a contentious campaign season dominated, on the left anyway, by a race to the progressive.

Conservative and liberal think tanks estimate the Medicare for All Act will cost U.S. taxpayers at least 32 trillion over 10 years.

Critics fear that the Medicare for All Act would amount to a government takeover that will eliminate consumer choice, reduce the quality of U.S. healthcare, and force a one-size-fits-all plan onto 158 million Americans who are happy with their current insurance.

U.S. taxpayers deserve to know how much the Medicare for All Act will really cost. And they deserve to know how the authors of the Act plan to ensure healthcare rationing doesn’t cost American patients much more than money.

(contributing writer, Brooke Bell)