Medicare for All? Some Questions Legislators Need to Answer
The new state legislative session will almost certainly include some discussion of a state sponsored Medicare for All (M4A) for Massachusetts residents. Legislation to that effect was submitted last session, and the elected representatives from Hampshire county apparently already support the concept. We should ask them to consider these questions and then give the state’s citizens some specific, fact-based answers:
1. How much will it cost and how will you pay for it? At a minimum M4A would need to replace the amount currently being paid by commercial insurers plus the amount paid my Massachusetts residents in co-pays. According to the2018 Annual Report,of the Center for Health Information and Analysis (a state government agency), that amount was $22 Billion.As a point of comparison, the FY 2019 budget of our state government is $41.2 Billion
2.Vermont already passed but decided not to implement a M4A program (Green Mountain Care) .One reason was that the program would have necessitated a huge increase in taxes. The Administration of then governor Shumlin administration estimated it would need to increase payroll taxes to 11.5 percent and income tax of up to 9 percent, to be assessed on a sliding scale.
3. Over 1 million Massachusetts residents are enrolled in federally funded Medicare.
If you have it, can you keep it? If not, will the state give a tax credit of some kind to seniors who have been subject to Medicare taxes since 1965?
5.Over 4 million residents are covered by commercial heath insuranceWill they be better off financially with M4A? Will their quality of their heath care improve? If so, how? If you like your current health insurance, can you keep it? If so, are you exempt from the added taxes associated with M4A?
6. What will be the reimbursement rate for health care providers? At present, the Medicare reimbursement rate is much lower than that of commercial market insurance.
7. Will health care providers be required to accept M4A?
According to a Kaiser Family Foundation report in 2015, 21 % of respondents in their National Survey of Primary Care Physicians do not accept NEW patients covered by Medicare. For Medicaid, the figure is 22 % for new patients . In addition to that, 32% will not accept Medicaid at all.
8. Will all medical expenses be covered automatically? If not, will the limitations and restrictions be like those imposed by the commercial insurers? By Medicare? By MassHealth? If a claim is rejected, wouldn’t an M4A be like a huge insurance company in terms of customer and health care providers who want to fight their prescriptions as written (not generics), PET scans etc.?
9. What is the plan to roll private insurance, Medicare, Medicaid, federal employee health insurance, state employee insurance into one M4A program? How many new state employees will have to be hired?
10. Do proponents of M4A really expect that private employers who now provide company- financed health insurance will raise their employees wages to compensate for the increased tax burden their employees will bear?
11. If the person utilizing a medical service is not paying anything for it out of their own pocket, will they make medical appointments more frivolously? Will wait times to see a doctor or have an operation increase? Will it be necessary to recruit more doctors to practice in Massachusetts?
12. Will people residing in Massachusetts while being in the United States illegally be covered by M4A? In California, the Legislature is already considering such a proposal
13. Some proponents of M4A apparently believe that there will be billions of dollars saved from reducing provider reimbursements and funding administrative costs, lowering drug prices, reducing fraud, and reducing hospital and provider pricing calculations upon which that proposition is based?
It seems to me that any state M4A will simply shift health care insurance costs from Massachusetts residents as individuals and employers to individuals and employers as taxpayers. Health care per se will not improve and may get worse.
It may be that legislators will simply refer M4A to a Commission for study. If that happens, it will give legislators more time to do their fact- based research and give citizens their answers.