I love to celebrate birthdays, but this year there’s one birthday that really needs a special pie – not a cake, but a pie. Medicare turns 50 today, on July 30.
For the last 14 years, I’ve practiced primary care pediatrics at a community health center located just two miles north of the White House. I love what I do, but not necessarily how I have to do it.
I’m grateful to practice alongside colleagues who share my commitment to provide high-quality, comprehensive care to all, regardless of their ability to pay, their employment status or the language they speak.
But I am frustrated when patient after patient gets inadequate treatment – not because I’m not working hard, but because of the irrationality and cruelty of the complicated way in which we pay for care.
I am disheartened when a 15-year-old patient is asked to spend $800 so she can be seen at the concussion specialty clinic to help her recover from a lacrosse-related head injury, or when my uninsured 17-year-old patient is refused a postoperative follow-up visit with his surgeon.
The private insurers’ primary mission is to create “value” for their shareholders, not to provide care.
Growing up in Texas, I was taught to embrace words like “self-determination” and “freedom,” even if the real world didn’t always measure up to those ideals. But something sunk in, and now I find myself wanting to be free to practice medicine without the bureaucratic shackles imposed on all of us by the private insurance companies and other for-profit players in US health care.
The private insurers’ primary mission is to create “value” for their shareholders, not to provide care. They maximize their profits by enrolling the healthy, avoiding the sick, denying claims, increasing premiums and erecting barriers to care like co-pays, high deductibles, bureaucratic thickets and narrow networks.
These private-insurer practices are good for neither patients nor physicians. Patients suffer needlessly, and doctors are afflicted by endless bureaucratic paperwork, contributing to burnout.
The Affordable Care Act hasn’t changed this picture very much.
But back to Texas. My home state is also the birthplace of Lyndon B. Johnson, who signed Medicare into law 50 years ago. Medicare has since become one of our nation’s most beloved social programs.
Traditional Medicare offers important lessons. It runs on very low overhead – around 2 percent, versus the 12 to 15 percent overhead typical of the big private insurers. It allows seniors to go to the doctor and hospital of their choice. It controls costs better than private insurers do, even though it serves the oldest and sickest segments of our population.
If only all my patients were covered by a single, simple program like Medicare. The administrative savings would be immense – more than $375 billion annually, according to a recent study. That’s more than enough money to cover everyone’s medically necessary care with no co-pays or deductibles.
In point of fact, in 1965, the authors of Medicare intended to create a social insurance fund to cover all Americans, not just seniors. We still need such a single-payer program. We have to go beyond the Affordable Care Act. Too many people are still suffering and dying prematurely.
As a patient, imagine never again having to worry about whether the doctor’s office, hospital or pharmacy takes your insurance, because there is only one insurance, improved and expanded Medicare for all, which pays all the bills.
As a provider of health care, imagine never again having to worry about being paid for the services you provide. Imagine working for yourself and having the freedom to set your hours most conducive to your lifestyle and to that of your patients. Imagine the autonomy of running your own practice, or at the very least, spending less time on paperwork hassles.
This is no pipe dream. Medicare points the way. We merely need the political will to enact legislation like H.R. 676, the Improved and Expanded Medicare for All Act, into law.
And that birthday pie I spoke about? When it comes to Medicare, the three crucial ingredients are to protect it, improve it and expand it (pie). Let’s celebrate Medicare’s birthday by extending it to all.