Health Systems

Medicare-for-All: The DFW Hospital Perspective

What to do about the United States’ ever-expanding medical costs has been a key issue during the presidential primary season. Medicare-for-All, Medicare-for-more, Medicare-if-you-want-it, and a bevy of other healthcare policies have been key talking points for every serious Democratic presidential candidate.

Steve Love is the CEO of the DFW Hospital Council, a 90 member hospital organization that helps hospitals collaborate and advocate for initiatives they value, and he says that while the hospitals want to be politically neutral and are for increased coverage, Medicare for all is not the answer. He calls it a “cry for help.” There is a legitimate issue in lack of coverage, but a single payer system is not the answer. “A ‘ Medicare-for-All’ product would upend 180 million Americans who currently receive health insurance through their employer. The funding could become political and not in the best interest of the patient,” he says.

But as healthcare spending creeps toward one fifth of the total US economy, and quality lags behind other developed nations in several key health measures, all parties are looking for a solution, and countries with universal healthcare spend less to get better results than the US. But Love pointed out that though the US spends a higher percentage of GDP on healthcare than other countries, other places make up for that spending in preventative measures, such as housing, education, and other social determinants of health.

In addition to upending the existing employer-based system, Love worries that the funding models would negatively impact progress. “Since most hospitals lose money or are lucky to break even on Medicare, this ‘Medicare-for-All’ would stifle innovation, limit capital investments and negatively impact research and development.” He also worries that Medicare funding levels would exacerbate the physician shortage. “Since approximately 50 percent of physicians do not participate in our current Medicare program, an entirely single payor Medicare system could limit even more provider participation and have a negative impact on access.”

But according to a Kaiser Family Foundation analysis of a Commonwealth Fund survey, the percent of adults who made a same-day or next day appointment when they needed care was lower in the United States than in many comparable countries. Only 51 percent of US adults were able to get an appointment when they needed it, while the average for economically comparable countries was 57 percent. 

The likelihood of a supermajority in the Senate that would be necessary to overcome a filibuster on a change to the healthcare law is low, but that hasn’t stopped candidates from explaining their plans and how they would pay for them. Love says that DFW hospitals think that time should be spent working on realistic solutions rather than political posturing.

The hospitals say time should be spent focusing on improving the existing legislation, the Affordable Care Act. The hospitals want to expand Medicaid but not uproot the employer based, private insurance system that accounts for 180 million Americans right now. In addition, Love says the federal subsidy should increase for lower income families who don’t have enough coverage through Medicaid and the individual market exchanges, and that enrollment efforts in the individual market should improve as well. In the last several years, funding for health marketplace navigators has decreased dramatically.

“Through cooperation of all stakeholders we can answer the ‘cry for help’ in a constructive and meaningful way,” Love says.

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