Should we want Medicare for all?

I recently retired. Before I did, my husband and I were covered by health insurance provided by my employer. Some money was deducted from each paycheck, and I received excellent health care.

After I retired, we switched to Medicare. Although I had worked as a health-care executive, I found it difficult to navigate the various supplemental plans that were offered, especially the plans for drug coverage. After trying to do this on my own, I wound up using an agent. We were shocked to discover that our monthly premiums for part B physician coverage and part D drug coverage were considerably higher than we had anticipated.

There has been much talk in this political season about Medicare for All. What does this mean, and is it something we should support? Basically, it is single-payer national health insurance that would be managed by a government agency, possibly with assistance from private companies. Everyone would be covered for most medical services. The delivery of care would remain in the hands of those private doctors and hospitals that choose to participate.

Under some proposals for Medicare for All, private insurance companies would disappear. This could result in considerable savings in administrative costs. But, these same insurance companies would certainly fight to maintain their preeminent position in health care, and the industry is politically powerful.

To finance Medicare for All, personal and business taxes would have to be raised. There might also be increased wait times for some elective non-emergency procedures (e.g. hernia repair) and specialty services (e.g. colonoscopy), but this occurs today. How often have you had to wait months to see a physician for a routine evaluation or to schedule a routine procedure?

Of course, there will be physicians who choose to operate outside of this system and see private patients on a fee-for-service basis. This would undoubtedly create a two-tiered system, but, again, this occurs today.

For me, rather than immediately taking reform all the way with Medicare for All, the first step should be more modest. I would start with reducing medication expenses by having the government act as a single purchaser. Imagine the clout the government would have with the pharmaceutical industry in negotiating prices. The quality of health care would also improve because many patients who cannot currently afford medications would be able to do so.

So, my recommendation is that we begin with incremental changes. Direct government price negotiation for prescription drugs could significantly and rapidly reduce our health care costs and greatly improve quality. Once this is implemented, we can begin to use the savings to take the next step: increasing health care coverage for all.

Paula L. Stillman, MD, was director of community engagement at the Institute of Emerging Health Professions, Jefferson University.