April 21, 2019
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We need equality in health care. Will Medicare for all deliver it?

George Danby | BDN
George Danby | BDN

Credit Vermont Sen. Bernie Sanders with the vision to see universal health care as a public issue whose time has come, and for the bumper sticker slogan, Medicare-for-All. As income inequality widens, equality in health care takes on a new urgency.

We have excellent technological breakthroughs in medicine. In my 23 years as a registered nurse we have gone from X-rays with leaded vests to non-invasive 3D Echo, an ultrasound imaging done at bedside and producing three-dimensional pictures a grade schooler could interpret. Laboratory diagnostic provide fast and amazing analyses of blood, tissue and other fluids. With laser and laparoscopy surgery, 12-inch incisions and two-week recoveries are a thing of the past.

The problem we face is how to distribute this bounty fairly, which is not so simple when good health itself is not equally distributed, and individual perception of medical necessity covers a wide spectrum. Working in the emergency room, we were always aware that, in the far corner of the waiting room, beyond the sprained ankles and stomach aches, there might be a stoic Scandinavian suffering with a silent heart attack. Most busy ERs have built-in triage protocols to pierce the veil of drama and appearances.

Back to Sanders and his bill S. 1804, co-sponsored, apparently without being read, by a slew of Democratic presidential candidates. I say that only because one of them, Kamala Harris, the dynamo from California, casually blew by an important provision in the small print in the Sanders’ Medicare-for-All Bill that does away with Medicare Advantage, Part D insurance, employer-sponsored cafeteria plans and any other private transactions — think liposuction, dermatology, elective knee replacements and other procedures not considered life-threatening. The press piled on, and Harris walked it back. The other candidates will now have to pour over the 96-page piece of legislation and dress down their staff for lack of due diligence. On Capitol Hill, letting your principal twist in the wind is a capital offense, no pun intended.

S. 1804 is more akin to the National Health Service in Great Britain than anything we have in America. (The exception would be the Veterans Administration — a self-contained single-payer, single-provider that includes eye, ear and dental care for 8 million veterans, a hard-earned privilege exempted from S. 1804.)

Think of S. 1804 as a Rolls Royce, fully loaded: hospital stays, surgeries, office visits, rehab, ambulance transport, unlimited ER services, free prescription drugs and, best of all, no co-pays. Oh yeah, and dental, eyeglasses and hearing aids included.

With a stiff upper lip, the Brits put up with long waiting lines for procedures not considered life-threatening. They mutely abide by decisions by a government panel ( The National Institute for Health and Care Excellence) to decide on whether a requested a treatment is appropriate. Their healthcare is free and the most popular social program in Britain, and even Conservatives, when in office, treat any changes to it as stepping on a third rail.

Generally speaking our Medicare is quite different. Think of it as a Buick.

Since 1965 — and thanks to Lyndon Johnson — Medicare covers more than 50 million elders (and about 9 million disabled individuals). It comes in two models: traditional and Medicare Advantage plans. About 20 million Medicare beneficiaries have opted for Medicare Advantage. Many private insurers offer plans that may include dental, eye care, home health and prescription drug packages. The tradeoff is that for elective surgeries, tiresome justification can be called for and the plan usually reserves the right to refuse expensive non-essential surgeries. Nonetheless, many folks are obviously pleased with the bargain. Traditional Medicare offers hospital stays and surgeries based on a physician’s referral, rehab, emergency room care, lab work and other diagnostics. You are on your own to pay for prescription drugs unless you sign up for Medicare Part D insurance at added expense. In my 23 years of nursing practice I have rarely heard a complaint about Medicare.

Medicare costs the US government an average of about $11,000 per enrollee per year, according to the most recent statistics. By comparison, the Affordable Care Act comes in at an average cost of $6,300 per enrollee per year, with steep co-pays.

We still await the list price of the Rolls Royce.

Tom Deegan of Orono is a former registered nurse and author of the ebook “ Healthcare: A View from the Trenches.”

 



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