Saturday, May 18, 2019

Medicare For All? The Need for Competing Plans

When I see something about Medicare and Medicaid policies that don't make sense, I wonder about Medicare For All.  I believe that there should be universal access to medical care, and that taxes should be used for payment.  But does that mean only one payer, Medicare?

When Managed Care Medicare was rolled out here in CA, each county had to have at least two competing plans that patients and clinicians could sign up with, so they competed against one another.  I think the same should apply if there is to be MFA, and hopefully more than 2 plans competing.  That way, we would have a better chance of getting good policies.  Nothing is quite so intransigent as a large governmental agency to which people have no alternative.

For physicians, imagine, for instance, one of the plans in an area with the policy: "We Don't Claw Back."  Or one plan that had an effective physician advisory board. 
For patients, imagine that one of the plans had an effective feedback program, where physician failures of patient-friendly procedures had a ready conduit for complaints to be processed and published.  Or the opposite - imagine a way for the word to get out about how effective and thoughtful certain doctors, clinics, or hospital services were, in a thoughtful and informed way that a plan could handle but Yelp cannot.

Imagine a communication program among doctors, hospitals and patients mounted by one of the plans, that enabled all participants to make progress together.

Large, bureaucratic organizations cannot and will not behave this way unless prodded, and even then, smallness is most often better.  Medicare would be fine for collecting the money, bargaining with pharma, setting basic standards, and monitoring comparative results.  But when it comes to specific policies, details and nuance matter, and details and nuance are beyond the capabilities of large bureaucracies.

I believe in competition and alternatives, supported by open information.  Regional and local competition is essential.

Budd Shenkin

1 comment:

  1. Medicare for All is better than the status quo but 100% not the best system both financially and assessing by outcome. We should be only talking about the French and German systems as our models. Oh, of course they both have major issues (this healthcare stuff is hard, right?) but we don't need to reinvent the wheel and certainly should not replace our missing wheel with a flat tire. Sitting right over here are high performance tires that have been road tested. Just being an interested physician who cares about systems and not an economist etc, I actually can not believe someone would argue Medicare for All or single payer is superior to the German or French systems. Although, it is becoming dated the book, "The Healing of America" does a fantastic job outlining the world's leading healthcare systems. Compare for yourself! Read this book or similar books. Healthcare policy is extremely hard to get right, the details are so complex with some many unintended consequences, however, deciding on the goals of the system should be easy. If you do that academic exercise, then Medicare for All simply does not make sense.