Medicare for All Will Cripple Doctors and Hospitals
By Sally C. Pipes
Americans have health on their minds. Nearly four in 10 voters think health care is the most important policy issue our country faces.
Some lawmakers — including several Democratic presidential candidates — think a government takeover of the nation’s health insurance system is the answer.
But Medicare for All isn’t what voters are looking for. It would drive doctors from the profession and cripple hospitals. Fewer of America’s brightest students will pursue medicine. Ultimately, Medicare for All would make it harder for patients to gain access to care.
Already, the United States is facing shortages in the supply of care. Our nation will be short more than 120,000 doctors by 2032. Rural and underserved communities will be hit hardest.
In many ways, this is a stress-driven shortage. More than four in 10 physicians report being burnt out. Around half plan to change career paths. A similar proportion wouldn’t recommend that their children go into medicine.
A survey of physicians found that “bureaucratic tasks” were the most common contributor to burnout. More than one-third cited long hours as a stressor; a similar share pointed to insufficient pay. Two of every 10 doctors said government regulations contribute to burnout.
Medicare for All would make these problems worse. A government takeover of healthcare would smother doctors in new bureaucratic tasks. Meanwhile, patients would consume even more care, now that it’s free. Doctors would have to work longer hours to meet that demand.
And they’d do so for less pay. Medicare for All envisions paying doctors at Medicare’s rates, which are significantly lower than those for private insurance. Physicians would receive about 30 percent less for procedures including hernia repairs or gallbladder removals, compared to current private rates. Reimbursement rates for emergency visits and chest x-rays would be 60 percent lower.
Asking doctors to treat more patients for less money is no way to address the looming physician shortage. Practicing doctors will leave the profession, and budding doctors will consider other lines of work.
Hospitals would also see revenues decline under Medicare for All. Currently, hospitals receive just 87 cents for every dollar they spend on Medicare patients. Over two-thirds of hospitals lose money on Medicare inpatient services.
Hospitals depend on private insurers to stay in the black. By eliminating private insurance, Medicare for All will deprive hospitals of the revenue they need to balance their books. One study estimates hospitals will lose $151 billion in annual revenue under Medicare for All.
Hospitals would likely have to cut staff or eliminate services. Some might close entirely. Already, one-fifth of rural hospitals are in such poor condition that they are at risk of closing.
These dire scenarios are not hypothetical. They’re the reality in single-payer systems in other countries.
In the United Kingdom’s National Health Service, a majority of general practitioners said in 2017 they felt pressure due to long working hours, increasing workloads, and burdensome paperwork. Two in five planned to leave direct patient care by 2022. That’s twice as many as were planning to quit in 2005.
Many British hospitals lack the funds to replace outdated and low-quality equipment.
Voters are right to focus on health care. But if Democrats interpret that level of interest as an opportunity to sell Medicare for All, they’ll be sorely disappointed.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The False Promise of Single-Payer Health Care (Encounter). Follow her on Twitter @sallypipes. This piece originally ran in the Oklahoman.
Those early days of retirement can be exciting as you are finally rewarded with a little rest and relaxation after all those years of toil.
But it can be a bit unsettling as well when the regular paychecks you counted on stop appearing in your bank account.
That’s why anyone who’s still a few years away from retirement should ask themselves: Am I ready for that moment both financially and emotionally?
The answer could come down to whether you have a solid retirement plan – or a plan at all.
“Regardless of how much you accumulate for your retirement, poor planning or lack of planning can put you at risk of exhausting your resources,” says Tad Hill, a retirement planner and author of Retire with Freedom: The Five Steps to Getting a Good Night’s Sleep After the Paychecks Stop (www.askfreedomfinancial.com).
Hill says people nearing the end of their working years should follow this five-step process for a more secure retirement:
- Create your ideal picture of retirement. What is it you want out of retirement? Do you want to travel? Volunteer with a charity? Spend time with the grandkids? The first step isn’t about your financial portfolio, Hill says, it’s about forming a clear image of the big “why” of your ideal retirement. “Otherwise, even though your money may last the rest of your lives,” Hill says, “you may never achieve your dreams because you’re unclear on your dreams.”
- Put your situation to the “stress test.” With the help of a financial professional, give your retirement plan a “stress test.” That can include reviewing how to best maximize your Social Security benefits and examining how your portfolio might perform under a variety of market scenarios. “Analyze all the factors that could affect your retirement plan over the next few decades and create a strategy for dealing with those risk factors with as much certainty as possible,” Hill says.
- Design your plan. Designing a retirement plan, Hill says, is much like creating the blueprint for a house. “These blueprints identify the strategies available to help minimize risk, increase certainty, avoid excess taxes and ensure an adequate retirement income,” he says. Some of the concerns that need to be addressed include income planning, investment planning, health care planning, tax planning and legacy planning.
- Build the plan. Once the design is agreed upon, it’s time to implement it. “That can mean making changes to your current structure, adding some things and getting rid of others,” Hill says. “Maybe risk-prone aspects of your current approach that we need to eliminate were discovered in the design step. We also often identify new strategies that you aren’t using that can really make a difference.”
- Seek continued guidance. Even a great retirement plan may need tweaks and adjustments over the years. “Times change, people change and situations change,” Hill says. With his clients, he holds a regular yearly consultation to help ensure they are on the right pathway to retirement success at all times. “You need to look at whether there are things that have changed in your life that need attention,” he says. “Are there decisions you need to make about a pension or Social Security? Is your spending tracking at the amount you thought it would?”
“There are no guarantees of anything in life, including how your retirement will work out,” Hill says. “But taking action to create a solid and well-thought-out plan for this important part of your life is a critical first step.”
About Tad Hill
Tad Hill, author of Retire with Freedom: The Five Steps to Getting a Good Night’s Sleep After the Paychecks Stop (www.askfreedomfinancial.com), is the founder and president of Freedom Financial Group. He is registered as an Independent Advisor Representative and is a radio and TV host, industry trainer and speaker who helps retirees work toward their financial and retirement goals. Hill has passed the Series 65 securities exam and holds licenses in life and health insurance in Alabama, Florida and Texas. He has earned his Registered Financial Consultant (RFC®) and Chartered Retirement Planning CounselorSM (CRPC®) designations.
When 6-year-old Kaiser Whittaker broke his leg last year jumping on a trampoline, his parents’ first priority wasn’t taking him to the emergency room. Instead, it was more important to give him medicine to prevent any possible internal bleeding. Then, they rushed him to the hospital.
Kaiser has hemophilia, which means his blood doesn’t clot easily. Kaiser’s dad, Jed, said what’s most worrisome about this type of medical disorder is something they can’t see: If Kaiser falls and hits his knee hard on the concrete, for example, Jed’s concern immediately centers on the chance of internal bleeding.
“It’s a stressful reality for me and my wife,” Jed said.
Protecting Washingtonians against that uncertainty is why Gov. Jay Inslee and legislators passed the nation’s first public health care option.
“We should not be cautious and conservative on this,” Inslee said. “We should be bold and energetic.”
Inslee convened health care leaders, legislators, elected leaders and stakeholders in Seattle Wednesday to discuss the first steps of implementing Cascade Care, an effort that will be led by the Exchange.
Mayor Durkan and the City of Seattle joined with organizations from across the Puget Sound to host a resource fair at the Rainier Beach Community Center to help residents learn how to protect their health during wildfire smoke season.
Wildfire smoke has become increasingly normal in the Seattle area during summertime. Last year, wildfire smoke led to 24 days of poor air quality. This year, the air could get even worse.
In response, Smoke Ready Communities Day was created to ensure that our diverse communities will have the resources they need to stay healthy and safe when our air quality is poor. Smoke Ready Communities Day comes as a joint effort between Pierce, King, Kitsap, and Snohomish counties, Mayors of cities in all four counties, including Seattle, Tacoma, and Everett, Emergency Management departments across the counties, the Washington Department of Health, the Washington Department of Natural Resources, and Puget Sound Clean Air Agency.
As an outdoors-loving city and region, we must ensure that while we do enjoy nature and the outdoors, we stay safe and inside during heavily smoky times. Stay safe this season!
Thumb-sucking. Prolonged thumb-sucking or the use of pacifiers beyond the age of 4 increases the risk of altering the bite. “In a proper bite pattern,” Booms says, “the upper teeth slightly overlap the lower teeth. But dependence on thumb-sucking or a pacifier for extended periods can prevent that from happening. The back molars may touch when the jaws are closed but the front teeth don’t. And the frequent presence of a thumb, finger or pacifier while the two front adult teeth erupt can cause them to come in improperly.”
Mouth-breathing. The inability to breathe through the nose can be a major cause of growth-related bite problems. “This happens to a lot of children who have precursors to sleep-disordered breathing, such as enlarged tonsils or adenoids, or allergies,” Giannetti says.
Damaged or prematurely lost baby teeth. Booms and Giannetti note that many parents undervalue the importance of baby teeth in regard to how they can affect the bite. For one, accidents can affect the development of a child’s teeth and bite. “When a child knocks a baby tooth out, the buds of the permanent teeth grow underneath the roots of the baby teeth,” Booms says. “So sometimes trauma to a baby tooth can dislodge or move the developing bud of the permanent tooth, which eventually comes in crooked.”
Cavities in baby teeth. “When children get cavities that cause their baby teeth to crack or be lost, if the baby tooth isn’t fixed, or a space maintainer is not put in, the teeth just drift around,” Giannetti says. “Teeth grow until they touch another tooth, and this process can be the root of most problems when it comes to environmental causes.”
In 1920, female life expectancy in the United States was one year longer than male. Half a century later, that gender gap had grown to 7.6 years. Over the next few decades, the difference shrank to 4.8 years. But, over just the past two years, while women’s life expectancy has remained steady, men’s declined, and the gender gap has crept back up to 5 years[i]. Despite numerous advances in medical science, men continue to die at younger ages and in greater numbers than women of nine of the top 10 causes of death.
Within the broader men’s health crisis, there is one area where differences between male and female mortality and morbidity are especially stark: mental health, the most visible manifestation of which is suicide.
Across all ages and ethnicities, American men commit suicide at far higher rates than women. According to the most recent CDC data, between the ages of 15 and 64, roughly 3.5x more men than women commit suicide. From 65 to 74, male suicides outnumber females by more than 4:1. For those over 74, the difference is a startling 9.3:1[ii]. Overall, for males, suicide is the 7th leading cause of death. For females, it’s number 14[iii].
One sub-population that’s profoundly affected by the epidemic of male suicides is the military. Historically, servicemembers were less likely than their civilian counterparts to take their own lives. But since 2001, more active duty servicemembers (including Reserve/Guard) have killed themselves than have died in combat. And those numbers are dwarfed by the number of veterans who complete suicide. According to the Military Times, veterans account for a total of 14% of all adult suicides in the US, even though only 8% of the population has ever served[iv].
The alarming disparity in suicides is undoubtedly driven by equally alarming disparities in the underlying mental-health conditions that lead to suicide itself, including depression and anxiety[v], psychosis, and substance abuse. In fact, nowhere is the connection between suicide and an underlying mental health condition more obvious than with substance abuse.
Between 2015 and 2016, male life expectancy decreased by .2 years[vi], a rather dramatic decline over such a short period of time. That decline was driven, to a large extent, by an even-more-dramatic 9% increase in the male suicide rate, which, in turn, was related to a parallel increase in substance abuse—in particular opiate use—among men. Such a change in the suicide rate over the course of a single year could easily be classified as the bellwether of a looming public health catastrophe. Actually, two catastrophes. The second is the dramatic increase in opiate overdose deaths. According to the Kaiser Family Foundation, between 2015 and 2016, those deaths increased 20.4% among women and 31.5% for men[vii]—primarily middle-aged men, who would otherwise be expected to be among the most productive members of their communities and our society as a whole.
Medical providers, members of the public health community, community organizations, politicians, and the media have collectively been unable (or unwilling) to acknowledge the massive scope of the mental health issues that affect men. As a result, tens of thousands of American men and boys are dying and suffering from what many experts believe are preventable or treatable behavioral and mental health issues.
The effects of this collective mismanagement of mental health issues in men and boys extend into nearly every aspect of American society and have broad implications for the ways we provide (or don’t provide) preventive mental health services to our fathers, sons, brothers, partners, and friends. (The Affordable Care Act, for example, provides girls and women with annual, free, well-woman visits, which include mental-health screenings. No such coverage exists for boys and men.)
At the very least, the lack of adequate mental health care negatively impacts men’s and boys’ academic endeavors and achievements, their productivity in the workplace, the overall quality of their family life, their ability to care for their children and spouse or partner, and their level of community engagement and the contributions they make to the social capital of their communities and our nation.
So what can we do about the male mental-health crisis? First, most experts agree that in order to help boys and men manage the behavioral health and mental health issues, particularly those that are inextricably linked to violence, we need male-focused tools, programs, social support systems and clinical care, not only in primary care providers’ offices, but also in our schools, work environments, social support networks, and community organizations, both on the hyper-local and national levels.
Second, rather than criticize “toxic masculinity,” we need to celebrate fathers and other male role models. From a very young age, boys grow up hearing that “big boys don’t cry,” “play through it,” and “man up.” Those powerful messages keep boys and men from recognizing that they need help and from reaching out to get that help—especially with regard to mental health issues. Fathers and other adult male role models can help boys and young men understand that expressing emotions and asking for help are signs of strength, not weakness, and that caring and nurturing are far better ways of showing you’re a man than committing senseless acts of violence.
When it comes to having access to quality health care, minorities still lag behind their white counterparts, research shows, and that can include dental and orthodontic problems that get postponed or go untreated.
“This is a huge problem because regular checkups and care are critical to keeping your teeth and gums healthy,” says Dr. Bobbi Peterson (www.allthingsdrbobbi.com), an orthodontist who is an African-American.
One contributing factor to the limited care for minorities is a lack of diversity in the medical profession. Studies have shown that minority patients are more likely to visit medical professionals who also are minorities, but diversity among dentists does not mirror the overall population at all, according to the American Dental Association. In a 2015 study, for example, just 3.8 percent of dentists were black, while the nation’s overall black population was 12.4 percent.
Meanwhile, just 5.2 percent of dentists were Hispanic, compared to 17.7 percent of the overall population.
For many people, this does matter, and there’s even a mobile app and website called Hued that tries to match patients with black and Latino doctors.
“Of course, for many people there might not be any medical providers whose offices are that close to them,” Peterson says. “Even in a place as large as Brooklyn, I’m one of only three black-female orthodontists with their own office.”
The lack of care for minorities has been a concern for years, and some of the issues that have been raised include:
- Minorities have more oral-health problems. African-Americans and Hispanics have significantly greater rates of untreated cavities than non-Hispanic whites, according to data from the Centers for Disease Control and Prevention. African-Americans and Hispanics also have disproportionate rates of tooth loss, the CDC reports. Would those statistics be different if the patients had access to a dentist or orthodontist who was a minority? Perhaps, though other factors could play a role, such as the cost of dental care. Still, in 2015 psychiatrist Damon Tweedy wrote in a New York Times guest column that black patients are more likely to feel comfortable with black doctors, and studies have shown they are more likely to seek them out for treatment.
- Trust can be an issue. In that same column, Tweedy wrote that, compared to other races, black patients are less trusting of physicians and their medical advice. As a result, they often delay or refuse needed treatments. Peterson says she has seen in her practice how important trust is. In some cases, that may transcend race. “The mouth and the face are two really intimate zones as part of your personal space,” she says. “To allow someone into that personal space patients have to trust them.”
- Reaching out to the community is important. Peterson says it’s important for healthcare providers to reach out to their communities, especially in areas where there are low-income families who can’t always afford care. Peterson often volunteers in community schools to teach students and staff dental health, and to provide free screenings to middle school students.
Peterson says it’s important to put patients at ease when they arrive in the office. Otherwise, they might not be inclined to return.
“I like to greet them with a smile and give them a detailed description of what their treatment plan should be,” she says. “They need to know what to expect.”
About Dr. Bobbi Peterson
Dr. Bobbi Peterson (www.allthingsdrbobbi.com) is an orthodontist whose office, Aces Braces, is in the East Flatbush section of Brooklyn, NY, where she offers child, adolescent, and adult orthodontic services. In addition to instructing new Dental Residents at Kings County Hospital, she volunteers in community schools to teach students and staff dental health and to provide free screenings to middle school students. Dr. Peterson’s training allows her to specialize in all aspects of orthodontics – including retainer installations, crooked or crowded teeth, gapped teeth, and crossbites. Dr. Peterson earned her dental degree from Howard University, and she completed a residency in orthodontics at Maimonides Medical Center. She is multilingual, speaking English, French and Spanish.
While friends and families cheered from the sidelines, about 130 students who are blind or visually impaired participated in a track and field meet that first lady Trudi Inslee attended Thursday. The event took place at the Washington State School for the Blind in Vancouver and included athletes who ranged in age from about 5 to 21 years old.
While the bulk of students traveled from Washington, some traveled from other parts of the Northwest and Oregon to compete, participate and network with each other.
The first lady said the event was an appropriate highlight of the student’s accomplishments.
“The student athletes from today are such an inspiration to all of us as they overcome challenges, enjoy competition, build teamwork and — most of all — have fun,” Inslee said. “Thank you for sharing your day with us.”