To the editor:
(re: “Medicare for All will cripple doctors, hospitals,” July 25)
The July 25 op-ed opposing Medicare for All by Sally Pipes is riddled with errors and exaggerations. This is not surprising given her prominent position in a right-wing Libertarian organization funded by the notorious billionaire Koch brothers.
Citing no evidence and clearly unfamiliar with the Medicare for All bills in Congress, she uses scare tactics to suggest that physicians will quit and hospitals will close were Medicare for All to be enacted. The bills, however, include no specifics on hospital and physician payments, stating only that payment will be negotiated with providers based on a reasonable estimate of the actual cost of providing care.
The House bill (H.R. 1384), for example, indicates that the government will negotiate operating budgets with individual hospitals and nursing homes based on historical costs, expected increases, patient population characteristics, and needed operating improvements, including achieving safe nurse staffing levels.
Capital budgets will be handled separately, so that a poor rural hospital will get its first MRI machine before an elite urban institution gets its fifth, or an unneeded new branch.
Every other advanced nation regulates and budgets health care institutions, spending half of what we spend, and with better health outcomes and life expectancy. Budgeting is a rational approach that can contain costs by ending the insurer practice of overpaying hospitals in order to keep them in-network, by limiting the exorbitant salaries of hospital and nursing home executives, and by refusing to fund excessive profits and surpluses.
Yet hospitals will experience little pain because they will not need a staff of hundreds to process claims involving hundreds of insurers, and thousands of different plans with ever-changing requirements and drug formularies. They will no longer need to fight claim denials, seek unnecessary prior authorizations, and collect balances from patients.
Their administrative costs will drop dramatically, and the savings will allow institutions to spend more on actual health care.
Pipes claims that government-run insurance will add to the administrative burden of physicians. Nothing could be further from the truth. Physicians will no longer have to spend hours on the phone with commercial insurance staff to get approval for a service or drug, or fight a claim denial.
Half of physicians list dealing with insurance companies as the main cause of burnout.
Savings in administrative costs will allow the program to maintain or increase the income of primary care physicians, especially those serving mainly Medicaid and Medicare patients. High-priced specialists who have benefitted from lucrative reimbursement from commercial insurers (costs passed along to consumers) may be paid somewhat less, but still fairly.
The author is on the board of the New York Metro chapter of Physicians for a National Health Program.