WASHINGTON — The Trump administration this week continued its spirited attack on Democratic proposals for a “Medicare for All” healthcare system.
“I will never understand mandating one-size-fits-all coverage for every American,” Joe Grogan, director of the White House Domestic Policy Council, said Monday at a meeting of the Federation of American Hospitals, a group of for-profit hospitals and health systems. “But then again, I am not in favor of coercion over freedom … I believe in choices and I believe in the power of competitive markets.” He praised the administration’s implementation of short-term, limited-duration insurance plans and association health plans, which are less expensive than other insurance policies but are not required to meet all requirements under the Affordable Care Act (ACA), such as covering essential health benefits.
“Side by side with the [ACA’s health insurance] exchanges, these plans aim to give Americans the choice and control they want, the affordability they need, and the quality they deserve,” he continued. “The exchanges are out there, with all their mandates and coverage requirements; they serve as an option. They shouldn’t be the only choice, however. But this is not how everyone sees it. There are those out there who want to take away choice from the American people, and aren’t content with the mandates of the ACA.”
The Medicare for All proposal introduced in the House last week, which would ban private insurance, “goes in exactly the wrong direction — more regulation, more centralized control, one size fits all, designed by a distant, elite group of super-regulators,” he said. Instead, “we need to empower patients, promote choice and competition, and take care of people who truly need it because we are a compassionate and caring society … Compassionate and caring, however, does not mean divorced from reality.”
The right answer, Grogan said, was to give consumers choice and allow them to pick the plan that is right for them, while also “ensuring that government policies promote value, encourage competition, and unleash innovation.” Although people with pre-existing conditions should be taken care of, “no one, including our government, should be bankrupted by the healthcare system,” he added.
Grogan wasn’t the only one from the administration talking about Medicare for All on Monday. Seema Verma, administrator of the Centers for Medicare & Medicaid Services, also slammed the idea, as she has done in previous speeches. “I would be remiss, as the person charged with strengthening and protecting Medicare, if I didn’t take a moment to talk about the greatest threat to the American healthcare system, and that threat comes from proposals to expand the program to cover everyone,” Verma said in prepared remarks also given at the Federation of American Hospitals meeting.
“Let me be clear, expanding Medicare will ruin the program for the seniors it was created to serve, and it would decrease the quality of care that we, as Americans, have come to expect as the world’s leader in innovative health care. Medicare for all is, in reality, Medicare for none. This isn’t hyperbole. As the administrator of one of the largest government-run healthcare programs in the world, I see first-hand its shortcomings.”
She listed some of them: “Government-run healthcare means taking years to change rules that force patients to use less advanced medical equipment, even when newer technologies can save lives and lower costs. Government-run healthcare means having bureaucrats dictate decisions about your care, even things like how often you have to see your physician in order to receive treatment. Government-run healthcare means being forced to accept reimbursement rates calculated by rigid formulas set by Congress – that don’t consider the outcomes that a provider achieves.”
“It is true that our present system needs improvement,” Verma said. “However, doubling down on government and mimicking the failed socialist healthcare systems of Europe that ration and restrict care, where patients face long periods of time for care, is not the answer … I believe the answer to what ails the system is to unleash competition and choice to control costs; to empower patients with access to price and quality information; to make the system less bureaucratic, not more, reducing paperwork requirements while increasing time spent by providers with patients; [and] to foster innovation in the system through both technology and payment reform so we transform our system of sick care into health care.”
Medicare for All wasn’t the only issue to come in for criticism; Grogan also homed in on physician payment under Medicare. Under the traditional fee-for-service structure, which rewards doctors for each service they perform, “providers perform a lot of unnecessary services and spend too much time recording them to be sure they’ll be reimbursed. Our doctors and nurses are focused on iPads and computer screens when they should be focused on the patient.”
He also noted that 40% of physicians are now employed by hospitals. “Medicare spends more because it generally pays a higher fee for a service provided by hospital-owned physician [practice] than it would for the same service in an independent doctor’s office … Providers and systems willing to be paid based on the quality of care they deliver rather than services they perform should be freed from reporting burdens necessitated by our current structure. We can break the cycle of these terrible incentives.”
In November, Medicare issued a final rule phasing in a “site-neutral” payment policy — phasing in over 2 years beginning this year — under which payment for physician services would be the same regardless of where the service was provided. Hospitals sued over the rule in federal court in December.