This blog is not intended as a political commentary. But it is intended as a healthcare information site and one that will inform you on healthcare issues being debated by our politicians.

Now that it appears Vice President Kamala Harris is the intended nominee of the Democratic Party for President, her views on healthcare should be known. Harris is a supporter of Senator Bernie Sanders’ views on socialized medicine. When Sanders promoted changes in our healthcare system he called Medicare for All, Harris supported his bill in the Senate. She has called for the elimination of private health insurance in favor of a socialized system where government controls all healthcare. What would that mean?

When Senator Sanders promoted Medicare for All, in 2018, I wrote a two-part series on the subject. Since this subject is sure to be discussed in the election campaign soon, I am re-publishing that two-part series here:

Understanding Medicare For All – Part I

Robert S. Roberts, M.D.

9/10/18

It is the duty of every American voter to be educated on the issues. As we rapidly approach another election day in November, many Democratic candidates are touting “Medicare For All” as a solution to our failing healthcare system.

Vermont Senator and avowed socialist Bernie Sanders introduced his version of healthcare reform in 2016 when he campaigned for the presidency touting a new single-payer system he calls Medicare For All. Other Democratic candidates have jumped on Bernie’s bandwagon as a growing number of mostly young Americans favor socialism over capitalism.

Today I begin a series of posts to help readers understand what Medicare For All really means to the healthcare of Americans. To assist me in this analysis I will be relying on the excellent work of healthcare economist John C. Goodman.

Ten Things You Need to Know

Goodman gives us ten fundamentals you need to understand about Medicare and what it mean if it were the only healthcare system available to everyone, as Senator Sanders promotes.

1. Medicare is not really government insurance.

Although Medicare is mostly funded by taxpayers, it is not strictly a government system. It was formed originally by providing a standard benefit package offered by Blue Cross in 1965. It has always been privately administered, mostly by Blue Cross, that continues to provide private insurance to non-seniors. In recent years, one third of all seniors are enrolled in plans offered by private insurers such as Cigna, Humana, and United Healthcare under a cooperative program called Medicare Advantage.

2. The most successful part of Medicare is run by private insurance.

This refers to the above-mentioned Medicare Advantage program. Studies have found this program delivers higher quality care at less cost than traditional Medicare. (Choice of doctors, however, is more limited.)

3. Medicare is often the last insurer to adopt innovations that work.

Medicare started prescription drug coverage only after all the private insurers had been doing that for years. It still doesn’t pay for doctor consultations by phone, email, or Skype. It won’t pay for house calls at night or on weekends, even though the cost and the wait times are far below those of emergency rooms.

4. Medicare has wasted enormous sums on innovations that don’t work.

Medicare has spent billions on pilot programs and demonstration projects trying to find ways of lowering costs and raising the quality of care. Yet instead of finding places in the healthcare system where these techniques work (private Medicare Advantage plans), Medicare set out instead to reinvent the wheel. Medicare frequently has regulations that are counter-intuitive and wasteful, such as requiring patients to be hospitalized before they can receive home physical therapy.

5. Most seniors in conventional Medicare are participating in stealth privatization, even though they are unaware of it.

There are over 32.7 million patients enrolled in a managed care program called Accountable Care Organizations (ACOs). The Obama administration started this practice without telling seniors they were participating in a grand experiment. Not only that, but it is illegal for an ACO to tell a senior they are enrolled! Furthermore, ACOs are not achieving their intended purpose – they are neither saving money nor are they improving the quality of care.

6. There is nothing Medicare can do that employers and private insurers can’t do.

For many years the Physicians for a National Health Program argued that a single-payer health insurer would be a single buyer in the market for physicians’ services. They reasoned this would give the government the power to bargain down the fees paid to physicians. Reality, however, is that Medicare doesn’t bargain with anyone. They simply put out a price for services and doctors can either accept or reject it. Private insurers have been doing the same thing for years. This is currently bringing doctor fees down in the ObamaCare exchange market – which is why the best doctors and hospitals avoid these plans.

7. Medicare For all would be costly.

There is no such thing as a free lunch. This is one of the first lessons of adulthood. Even Bernie Sanders admits this, but only when pressed. A study by Charles Blahous of the Mercatus Center has estimated the cost at $32.6 Trillion over the first ten years. This would necessitate a minimum of a 25% payroll tax – but only if it is assume doctors and hospitals provide the same amount of care they provide today. Since Medicare rates are 40% or more below private rates, a realistic assumption is that doctors and hospitals would increase the amount of care to make up the difference. This would then require at least a 30% payroll tax.

(This post will be continued next time.)

A recent birthday and a vacation trip to New England made me realize how much our world has changed. Indulge me as I reminisce for just a minute.

Many years ago when I was sixteen, I took my first airline flight to visit my brother who was a student at the University of Colorado. I dressed up in my best coat and tie, like church, because that’s what everyone else was wearing on the plane. There weren’t many passengers younger than me and certainly no infants or “service animals.” The flight attendants, called stewardesses at that time, were young women no taller than about 5 feet nine and no heavier than about 150 lbs. The airline regulations made sure of that! Meals were served in both first class and coach. It was a serious business for serious travelers only and it was a pleasant, even exciting experience.

Today, the contrast couldn’t be greater. Most people show up in clothes more suitable for the beach than church, wearing flip flops and carrying a back pack. Passengers are of all ages, including fresh out of the oven, and animals abound – some of them “service animals” and some clearly not. Flight attendants come in all shapes and sizes, all ages and genders, including some not easily identified. It’s more of a cattle car than a serious method of transportation. It’s far from pleasant and you’re relieved just to get to your destination in one piece on the same day.

At the airport, we stopped for breakfast at a well-known fast-food restaurant. In the old days, you could talk to a cashier who would take your order in a minute or two. Usually, there are five cashiers to handle the early morning rush at the airport. This day, the cashiers had been replaced by three kiosks to take your order.  It seems that demands for higher minimum hourly wages has eliminated the cashiers. The usual one or two minutes/customer wait was now five to ten minutes as people struggled with the digital technology. The resulting line seemed to go on forever.

In New England we encountered new challenges to our ability to use modern technology. I tried to park our rental car in a large, open parking lot before we embarked on a Windjammer harbor cruise. We arrived with plenty of time, but little did I anticipate the trouble I was about to encounter with the simple task of paying for parking. No attendant was available to pay the parking fee (minimum wage laws again?) and no meter would allow us to put in change. A kiosk required we scan the QR Code (you’d better know what that is!) so we could pre-pay for the parking. When that didn’t work, I tried using a credit card but 30 minutes later and despite help from the ship’s receptionist, I still couldn’t make it work. I was reassured the car wouldn’t be towed before I got back from my cruise!

Parking became an issue again later in our trip in Portsmouth, N. H. We hoped to enjoy a casual lunch with a view of the harbor. There were zero free parking spaces provided and the same kiosk payment was required. Fortunately, this time the technology worked, but the rates started at $28 for two-hours minimum. We lost our interest in lunch quickly!

We finally settled on a fast-food burger chain out of the downtown but once again encountered zero cashiers willing to take our order. Fortunately, we had already gained valuable experience with the kiosk system earlier so we managed to order in record time of eight minutes! The food was eventually delivered but the dining experience wasn’t memorable.

Our next challenge was on the toll road where the traffic was so heavy and the signage so poor that I drove through the “E-Pass” booth without the transponder because I couldn’t get into the cash lane fast enough. I tried to go back and pay the attendant at the toll booth but he wouldn’t take my money. He gave me a slip with a website address where I could pay the toll online in the next 7 days to avoid a penalty. Once again, I was forced to depend on the use of online technology to pay a $0.75 cent toll. Cash wasn’t good enough.

My advice to folks my age is be sure you travel with a smart phone and a credit card (cash is worthless) and take classes in scanning QR Codes! Either that or take along your grandchildren to handle the technology you don’t understand. It’s a different world out there!

 

The Biden Administration wants to reclassify marijuana as a less dangerous Schedule III drug – on par with anabolic steroids and Tylenol with Codeine. The reason they want to do this is quite transparent – they want to buy the votes of young people in the next election. But is this good for these young people and the country?

In Part I , we learned about an interview of Bertha Madras, marijuana expert from Harvard Medical School, by Allysia Finley of The Wall Street Journal. She discussed her great concerns for this change since marijuana has significant side effects and causes more lasting damage to the brain than alcohol. Today we will read more about the dangers of marijuana usage:

Marijuana and Violence

Marijuana has also been associated with violent behavior, including in a study published this week in the International Journal of Drug Policy. Data from observational studies are inadequate to demonstrate causal relationships, but Ms. Madras says that the link between marijuana and schizophrenia fits all six criteria that scientists use to determine causality, including the strength of the association and its consistency.

Ms. Madras says at the beginning of the interview that she was operating on three hours of sleep after crashing on scientific projects. Yet she is impressively lucid and energized. She peppers her explanations with citations of studies and is generous in crediting other researchers’ work.

Marijuana and Pregnancy

Another cause for concern, she notes, is that more pregnant women are using pot, which has been linked to increased preterm deliveries, admissions of newborns into neonatal intensive care units, lower birth weights and smaller head circumferences. THC crosses the placenta and mimics molecules that our bodies naturally produce that regulate brain development.

“What happens when you examine kids who have been exposed during that critical period?” Ms. Madras asks. During adolescence, she answers, they show an increased incidence of aggressive behavior, cognitive dysfunction, and symptoms of ADHD and obsessive-compulsive disorders. They have reduced white and gray matter.

A drug that carries so many serious side effects would be required by the Food and Drug Administration to carry a black-box warning, the highest-level alert for drugs with severe safety risks. Marijuana doesn’t—but only because the FDA hasn’t cleared it.

The agency has selectively approved cannabis compounds for the treatment of seizures associated with Lennox-Gastaut or Dravet syndrome, nausea associated with chemotherapy for cancer, and anorexia associated with weight loss in AIDS patients. But these approved products are prescribed at significantly less potent doses than the pot being sold in dispensaries that are legal under state law.

Marijuana and Medicinal Benefits

What about medicinal benefits? Ms. Madras says she has reviewed “every single case of therapeutic indication for marijuana—and there are over 100 now that people have claimed—and I frankly found that the only one that came close to having some evidence from randomized controlled trials was the neuropathic pain studies.” That’s “a very specific type of pain, which involves damage to nerve endings like in diabetes or where there’s poor blood supply,” she explains.

For other types of pain, and for all other conditions, there is no strong evidence from high-quality randomized trials to support its use. When researchers did a “challenge test on normal people where they induce pain and tried to see whether or not marijuana reduces the pain, it was ineffective.”

Ms. Madras sees parallels between the marketing of pot now and of opioids a few decades ago. “The benefits have been exaggerated, the risks have been minimized, and skeptics in the scientific community have been ignored,” she says. “The playbook is always to say it’s safe and effective and nonaddictive in people.”

Advocates of legalization assert that cannabis can’t be properly studied unless the federal government removes it from Schedule I. Bunk, Ms. Madras says: “I have been able to study THC in my research program.” It requires more paperwork, but “I did all the paperwork. . . . It’s not too difficult.”

Instead of bankrolling ballot initiatives to legalize pot, she says, George Soros and other wealthy donors who “catalyzed this whole movement” should be funding rigorous research: “If these folks, these billionaires, had just taken that money and put it into clinical trials, I would have been at peace.”

It’s a travesty, Ms. Madras adds, that the “FDA has decided that they’re going to listen to that movement rather than to what the science says.” While the reclassification wouldn’t make recreational marijuana legal under federal law, dispensaries and growers would be able to deduct their business expenses on their taxes. The rescheduling would also send a cultural signal that marijuana use is normal.

Ms. Madras worries that “it sets a precedent for the future.” She points to the movement in states to legalize psychedelic substances, for whose medicinal benefits there also isn’t strong scientific evidence. Meantime, she says it makes no sense that politicians continuously urge more spending on addiction treatment and harm reduction while weakening laws that prevent people from becoming addicted in the first place.

Her rejoinder to critics who say the war on drugs was a failure? “This is not a war on drugs. It’s a defense of the human brain at every possible age from in utero to old age.”