Medicare for Everyone?


NEJM Editorial

 Medicare for Everyone?


 JC Smith, MA, DC

 I enjoy reading The New England Journal of Medicine for its timely and interesting commentaries about healthcare issues. While their medical perspective is often very slanted to their interests, it does make for good reading to learn their party line.


For instance, after David Eisenberg’s two studies about patients’ usage of different types of doctors were completed, the editor of the NEJM, Marcia Angell, MD, spit up her milk in her weekly commentary and on NPR radio that same day. I’ll never forget her comment on radio, “Why are Americans going to non-MDs for natural remedies when they have all these wonderful drugs to chose from?” She just doesn’t get it, does she?


Dr. Angell’s recent editorial, “Patients’ Rights Bills and Other Futile Gestures,” revealed her underlying disbelief that present legislation will improve the dire straights of managed health care.


She states that “…most important politically—middle-class voters are getting fed up with the abuses of managed care. They are frustrated by shorter hospital stays, restricted choices of doctors, arbitrary denials of coverage, increasing deductibles and copayments, and all the other methods by which the industry resists actually providing services to sick people.”


While these barriers and hurdles may be new to the sanctimonious world of medicine, we chiropractors have had to deal with these problems forever. I guess slummin’ with the chiropractors has finally made Dr. Angell mad as hell, and she’s not taking it anymore.


“What we should instead conclude is that the private managed-care market has been a miserable failure at delivering health care. It has creamed off ever larger percentages of health care premiums in bloated administrative and marketing costs and profits, it has rewarded health plans that cherry-pick the health and avoid the sick, and it has resisted at every turn providing adequate services to those unfortunate enough to need them.”


Well, Dr. Angell is certainly right about that, but she left off a few concerns of mine, such as patients have no choice or informed consent to their options/alternatives to medical care, second opinions are generally another medical opinion, no emphasis on the ounces of prevention, no free market competition to lower health care costs by offering more services, hospital and insurance boycott of chiropractic care that drives up costs and unnecessary surgical failures, just to name a few problems she failed to mention.


Dr. Angell doesn’t stop with her gripes: “What needs to change is the system itself. Contrary to conventional wisdom, incremental changes, such as patients’ rights legislation, will not work.” Apparently she’s wanting to throw the baby out with the bath water.


She continues by suggesting three changes:

1)     “First, employers should get out of the health care business altogether…they have a clear conflict of interest since they have a strong incentive to keep premiums as low as possible.

2)     “Second, just as employers are not good proxies for their workers, so investor-owned managed-care companies are not good proxies for doctors. They, too, have a conflict of interest. They have obligations to their investors as well as to their enrollees. That the former often take precedence is evident from all the ways in which the industry limits medical services even while maintaining high profits and executive salaries. In my view, there is no place for these businesses in a good health care system.

3)     “Finally, health care insurance should not be optional, as it is in our employment-based system. Just as everyone over the age of 65 is covered by Medicare, so should everyone under that age be covered…. In 1993…I called for a universal, single-payer system and suggested that we could attain that goal by extending Medicare to all Americans….Those who worry that such a reform would increase taxes should remember that we all pay for health care anyway—through our paychecks, deductibles and copayments, and the prices of goods and services—and that Medicare is far more efficient than the market-based part of our health care system.”


Wow, what a radical idea—Medicare for everyone. Bypass the indulgences of the fat-cats in the insurance world altogether and have the government administer health care. I can only imagine the rancor that will bring from the insurance lobbyists and legislators who make plenty of money from these folks. While it’s one thing for leftists to suggest a government-based health care system like the rest of the entire world has had to do, but when the editor of the NEJM suggests it, something’s amiss.


In other articles I’ve read in the past in the NEJM, they constantly suggest that free enterprise in health care just can’t work. They cite more medical mistakes in for-profit hospitals, higher administrative costs, more restrictions, etc. What they don’t admit is that a true free enterprise system doesn’t exist in healthcare today. Instead, we have a brand of quasi-socialism with government subsidies and control along with a medical monopoly that refuses to play on a level playing field with all other types of providers.


I daresay that another option to Medicare for all is to have an open marketplace where anyone with a license to practice anything can play. Imagine if every back pain, MSD or NMS impaired patient had access to chiropractic care, or every vascular-impaired patient had access to chelation therapy, or herbal remedies were available as options to drugs, or homeopathic remedies instead of vaccines, etc. Just imagine if patients had a choice in their own health care matters, which they often don’t have nowadays.


Unfortunately, the medical mindset of Marcia Angell would never consider that option. To her, either give the medics their former carte blanche credit card spending where anything done to any patient is paid if full with no questions asked, or cave-in to a single-payer system like Medicare. Why she didn’t suggest a true free enterprise marketplace is hard to imagine except for the fact that the medical world would still have their monopoly in a Medicare type system. Apparently, these medical monopolists are so spiteful they would rather succumb to socialism than compete on a level playing field with non-MDs. Perhaps Dr. Eisenberg’s studies still ring loudly in her ears.


While in chiropractic college during the 1970s, I recall reading a book by Sen. Ted Kennedy about the medical mess in America. The one comment I recall to this day is his assertion that the basic problem with American health care is the fact that the federal government turned the healthcare delivery system over to the AMA to run. That was the primordial stamp of approval by the feds to let the AMA begin its monopolistic control of the entire healthcare system. They had little idea that decades later it would lead to this quagmire of outlandish costs, insurance industry profiteering, hospital mistakes and abuses, and a Health Care Reform movement.


So, what do you think? Is Dr. Angell right in suggesting a single-payer system like Medicare for everyone? Or is free enterprise the answer? I’m all ears to hear your comments.