Can Bernie Sanders Sell MediCAID-for-All?

To reform our crumbling healthcare system, presidential hopeful Bernie Sanders advocates what he calls Medicare-for-All. The name is disingenuous, a falsehood. What he is pushing is MediCAID-for-All.

Medicare is a health savings account where you pre-pay your future medical expenses. You pay a portion of your paycheck each month for forty years. Washington holds that money in a trust. When you retire, the money you saved is used to cover your old-age medical costs. Medicare is not and never was an entitlement: you paid for it.

Medicaid is an entitlement for low-income Americans. Washington, working through the states, gives no-charge government-approved health insurance to 70 million Americans. In contrast to Medicare, Medicaid recipients pay nothing.

The Medicaid of 2016 is not the Medicaid that Congress passed in 1964. The original law was written to help those “unable to support themselves” (direct quote from original legislation.) Inability to provide for oneself was the key Medicaid eligibility factor. Now, it is simply low income.

Bernie Sanders wants to extend no-charge-to-the-patient taxpayer-supported, government-controlled, single-payer health insurance to all Americans: 70 million current Medicaid recipients; 49 million Medicare (pre-paid) enrollees; and 200 million privately insured as well as uninsured individuals.

What Sanders offers is not Medicare-for-All. He is selling MediCAID-for-All. Should we buy? No, we certainly should not. Medicaid-for-All will be a financial and medical disaster. Start with the money.

Some claim that Medicare only has a 1.5 to 2 percent overhead cost. This devious statistic implies that at least 98 percent of Medicare dollars go to patient care. If only it were so! In fact, the infamous “two percent cost” refers only to internal accounting. It ignores all the other costs associated with Washington-created BARRC: bureaucracy, administration, rules, regulations, and compliance.

The financial information we should demand is dollar efficiency -- the ratio of dollars going into a system that produce the outcomes we want. For healthcare, efficient dollars are ones that produce health care. Inefficient dollars are ones that don’t.

Medicare is just like the rest of U.S. healthcare. It is approximately 50 percent dollar efficiency, not 97 percent. Half of all Medicare spending produces care, and half does not. The 2014 Medicare budget was $618 billion, which means roughly $309 healthcare dollars for seniors were spent on something other than care. Those 300 billion dollars would have allowed much needed care if they had been made available to the providers.  

The Obama administration admits that the Medicare Trust will be insolvent within 10 years. Why would Sanders want to hasten Medicare’s trip to bankruptcy court by adding 270 million more people to an already financially unstable government program?

Mr. Sanders is honest, in contrast to President Obama. Mr. Obama promised that health insurance costs would go down by $2500 per year while he knew that our costs would go up by at least $3000 per year, in many cases to exceed $20,000 a year for a family of four. Is this what the president eant when he titled his reform “affordable?”  

Sanders concedes that his healthcare reform plan would cost trillions. So he will dramatically raise taxes. 

“But wait, there’s more,” shouts an excited TV salesman! All government-run agencies -- whether it is Medicare, Medicaid, the EPA, or the Pentagon -- allocate funds first to themselves. What is left over is made available to the people. The bureaucracy gets the first, biggest, and juiciest bite of the pie. In healthcare, We the Patients get the crumbs.

ObamaCare offers a real world demonstration. The price tag for the Affordable Care Act is $2.6 trillion. Even with 14 new taxes, with increases in existing taxes, and even adding to the deficit, there isn’t enough money to pay for the expanded bureaucracy. So, ObamaCare takes away $716 billion from care, reducing reimbursements for Medicare services.

As more money goes to bureaucrats, less is available to pay providers. Even before ObamaCare, 31 per cent of American doctors could not afford to accept Medicaid patients. What do you think ObamaCare’s further reduction in reimbursement schedules is doing to the availability of care? Now imagine what will happen if Sanders extends Medicaid to all Americans. There won't be a doctor left to care for anyone. 

There is one and only one reason for a healthcare system: to improve the health and longevity of people. Would MedicAID-for-All do that? Does Medicaid make its recipients healthier?

One study of medical outcomes shows that Medicaid-covered patients do no better than those with no insurance at all! A different study showed that Medicaid recipients actually did worse after surgery than other groups. In other words, avoid Medicaid if you want to live and if you don’t want to waste taxpayer dollars.

Successful marketers tell us to forget reality -- image is everything. Medicare, despite impending bankruptcy, has the “sweet smell of success” while Medicaid connotes failure. That is why Bernie calls his plan MediCare-for-All even though it is really MediCaid-for-All.

Sanders hopes we won’t notice his bait-and-switch. We noticed. Let’s refuse to buy what he is selling.

“Dr. Deane” Waldman MD MBA is the author of the 4.7-star reviewed, The Cancer in the American Healthcare System; and the new Amazon Bestseller, Our Allies Have Become Our Enemies. Dr. Deane is host of www.wecanfixhealthcare.info; Professor Emeritus of Pediatrics, Pathology and Decision Science; and Adjunct Scholar (Healthcare) for the Rio Grande Foundation, a public policy think tank. Dr. Deane serves as “Consumer Advocate” Director on the Board of the New Mexico Health Insurance Exchange. Opinions expressed here are solely his own and do not necessarily reflect those of the Board.

To reform our crumbling healthcare system, presidential hopeful Bernie Sanders advocates what he calls Medicare-for-All. The name is disingenuous, a falsehood. What he is pushing is MediCAID-for-All.

Medicare is a health savings account where you pre-pay your future medical expenses. You pay a portion of your paycheck each month for forty years. Washington holds that money in a trust. When you retire, the money you saved is used to cover your old-age medical costs. Medicare is not and never was an entitlement: you paid for it.

Medicaid is an entitlement for low-income Americans. Washington, working through the states, gives no-charge government-approved health insurance to 70 million Americans. In contrast to Medicare, Medicaid recipients pay nothing.

The Medicaid of 2016 is not the Medicaid that Congress passed in 1964. The original law was written to help those “unable to support themselves” (direct quote from original legislation.) Inability to provide for oneself was the key Medicaid eligibility factor. Now, it is simply low income.

Bernie Sanders wants to extend no-charge-to-the-patient taxpayer-supported, government-controlled, single-payer health insurance to all Americans: 70 million current Medicaid recipients; 49 million Medicare (pre-paid) enrollees; and 200 million privately insured as well as uninsured individuals.

What Sanders offers is not Medicare-for-All. He is selling MediCAID-for-All. Should we buy? No, we certainly should not. Medicaid-for-All will be a financial and medical disaster. Start with the money.

Some claim that Medicare only has a 1.5 to 2 percent overhead cost. This devious statistic implies that at least 98 percent of Medicare dollars go to patient care. If only it were so! In fact, the infamous “two percent cost” refers only to internal accounting. It ignores all the other costs associated with Washington-created BARRC: bureaucracy, administration, rules, regulations, and compliance.

The financial information we should demand is dollar efficiency -- the ratio of dollars going into a system that produce the outcomes we want. For healthcare, efficient dollars are ones that produce health care. Inefficient dollars are ones that don’t.

Medicare is just like the rest of U.S. healthcare. It is approximately 50 percent dollar efficiency, not 97 percent. Half of all Medicare spending produces care, and half does not. The 2014 Medicare budget was $618 billion, which means roughly $309 healthcare dollars for seniors were spent on something other than care. Those 300 billion dollars would have allowed much needed care if they had been made available to the providers.  

The Obama administration admits that the Medicare Trust will be insolvent within 10 years. Why would Sanders want to hasten Medicare’s trip to bankruptcy court by adding 270 million more people to an already financially unstable government program?

Mr. Sanders is honest, in contrast to President Obama. Mr. Obama promised that health insurance costs would go down by $2500 per year while he knew that our costs would go up by at least $3000 per year, in many cases to exceed $20,000 a year for a family of four. Is this what the president eant when he titled his reform “affordable?”  

Sanders concedes that his healthcare reform plan would cost trillions. So he will dramatically raise taxes. 

“But wait, there’s more,” shouts an excited TV salesman! All government-run agencies -- whether it is Medicare, Medicaid, the EPA, or the Pentagon -- allocate funds first to themselves. What is left over is made available to the people. The bureaucracy gets the first, biggest, and juiciest bite of the pie. In healthcare, We the Patients get the crumbs.

ObamaCare offers a real world demonstration. The price tag for the Affordable Care Act is $2.6 trillion. Even with 14 new taxes, with increases in existing taxes, and even adding to the deficit, there isn’t enough money to pay for the expanded bureaucracy. So, ObamaCare takes away $716 billion from care, reducing reimbursements for Medicare services.

As more money goes to bureaucrats, less is available to pay providers. Even before ObamaCare, 31 per cent of American doctors could not afford to accept Medicaid patients. What do you think ObamaCare’s further reduction in reimbursement schedules is doing to the availability of care? Now imagine what will happen if Sanders extends Medicaid to all Americans. There won't be a doctor left to care for anyone. 

There is one and only one reason for a healthcare system: to improve the health and longevity of people. Would MedicAID-for-All do that? Does Medicaid make its recipients healthier?

One study of medical outcomes shows that Medicaid-covered patients do no better than those with no insurance at all! A different study showed that Medicaid recipients actually did worse after surgery than other groups. In other words, avoid Medicaid if you want to live and if you don’t want to waste taxpayer dollars.

Successful marketers tell us to forget reality -- image is everything. Medicare, despite impending bankruptcy, has the “sweet smell of success” while Medicaid connotes failure. That is why Bernie calls his plan MediCare-for-All even though it is really MediCaid-for-All.

Sanders hopes we won’t notice his bait-and-switch. We noticed. Let’s refuse to buy what he is selling.

“Dr. Deane” Waldman MD MBA is the author of the 4.7-star reviewed, The Cancer in the American Healthcare System; and the new Amazon Bestseller, Our Allies Have Become Our Enemies. Dr. Deane is host of www.wecanfixhealthcare.info; Professor Emeritus of Pediatrics, Pathology and Decision Science; and Adjunct Scholar (Healthcare) for the Rio Grande Foundation, a public policy think tank. Dr. Deane serves as “Consumer Advocate” Director on the Board of the New Mexico Health Insurance Exchange. Opinions expressed here are solely his own and do not necessarily reflect those of the Board.