What’s your opinion of Medicare for All?

November 14, 2019

"In an ideal world, it could work pretty well. We live in a capitalistic society, however, and insurance companies are not going to voluntarily implode in order to make it easy to implement a Medicare for All system," says one urologist.

Urology Times reached out to three urologists (selected randomly) and asked them each the following question: What’s your opinion of Medicare for All?

"Being primarily a conservative, white male-dominated field, urologists overall are probably ambivalent about Medicare for All. From my own perspective, I think there is some merit to it. In an ideal world, it could work pretty well. We live in a capitalistic society, however, and insurance companies are not going to voluntarily implode in order to make it easy to implement a Medicare for All system.

The Affordable Care Act, for all of its glitches, was probably our best shot if all the states had participated. It actually increased the number of people who were insured, took people off bad plans, and got rid of a lot of predatory plans.

If people were truly genuine about fixing health care, they could’ve made that plan work, made needed improvements, and required all states to participate. That would be the closest we could probably get in a capitalist society.

Also see: How has your management of BPH patients changed?

One issue for this country is that insurance is often tied to employment, but not all plans are portable so that’s another glitch in the system.

The whole point of insurance coverage for everybody in a country like Sweden or Norway is that it spreads out the overall risk. When people can opt out, you have an entirely high-risk pool and that’s not sustainable. When everybody pays, that mitigates risk.

The best thing would be to get people who are truly interested in making health care affordable and make the Affordable Care Act work.”

Kelvin Moses, MD / Nashville, TN

Next:"My concern is that we may not have the manpower initially to handle Medicare for All"

“It’s interesting because I’m in Oregon and Oregon did a big expansion of Medicaid to open up health care. I’m not really for or against it currently, but the most interesting thing that happened when we opened up health care to a lot of people who didn’t have access [was] we actually had difficulty just accommodating all the people who came in.

Read: What’s your biggest frustration with prior authorization?

Urology is stressed for manpower, so the first thing we noticed was an overwhelming number of patients. That was great because they were able to get treatment for their problems. But as far as access goes, my concern is that we may not have the manpower initially to handle Medicare for All. That’s no reason not to give people health care coverage, but we’d have to be sure we are prepared to deal with a large influx of patients.

I don’t really hear the manpower part discussed. It’s usually the payer system and reimbursement.

I also worry about new technologies. Urology is cutting edge; we like to keep advancing for better outcomes and results. I worry about the lag in the acceptance of payers to approve new testing or treatments, especially all the genetic stuff going on now in urology. I’m concerned if just one entity is deciding, it may hinder our growth as a specialty.

Currently, one insurer may be a quick adapter, while another stonewalls, but then other insurers come along because of competition and patient pressure on their insurance company.

Also see: What are you doing to safeguard patient information?

I guess there’s the issue of paying for it, but I try not to get involved with that part and I hope they can figure that out.”

Jeffrey Scott Palmgren, MD / Albany, OR

Next:"How does this get paid for? And who pays for it?"

“I think the reality of Medicare for All is fraught with multiple complexities that I’m not sure are well thought out, the most obvious being, how does this get paid for? And who pays for it?

The other very obvious complexity is, how does this affect my reimbursement for the services I provide?

One of the challenges for Medicare for All is, does everybody walking the earth automatically get Medicare? That’s a question I don’t think anybody has yet answered.

Does the billionaire and the single mother of five all have access to equal levels of care? That gets to the root of the discussion. Is health care a need, a right, or is it a luxury? Should each aspect of health care include seeing a specialist on demand at the time of your choosing, or just emergency care services? Are those all created equally?

Read: What do you tell male patients about men’s health clinics?

Those are complex issues with no answers, just opinions. I think the overwhelming majority of people lie in the gray area; very few people lie on the absolute extremes.

I tend to personally lie in the middle as well. Most people probably deserve some access to emergent-level care. I just don’t believe everyone deserves access to all aspects of elective care or specialist care. I truly don’t believe that.

Besides the philosophical and political questions surrounding Medicare for All, I also think there’s the practical issue. You will absolutely see reimbursements to physicians decrease a lot if it’s adopted.”

Taylor Vaughan, MD / Pensacola, FL

Tell us what you think. Send us your thoughts on Medicare for All to urology_times@mmhgroup.com