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Medicare For All Weaken’s Our Healthcare


By Representative William M. Marsh MD


The New Hampshire Presidential Primary is almost here. This is a rare and fascinating time to observe the intersection of politics and public policy.


Every day the Democratic Presidential candidates fight over who is more progressive and who has the best plan for our health care, so let’s take a close look at the hottest topic: “Medicare For All”.


Many use Canada as the model of a perfect healthcare system.  In fact, Medicare For All champion, Bernie Sanders, recently visited Canada to emphasize his belief that Canada has the best system in the world.  


However, alarming statistics about Canada’s system have surfaced that must be considered. 


According to Vancouver based think-tank, the Fraser Institute, patients waited a whopping 21 weeks in 2018 to receive treatment from a specialist after being referred by their general practitioner. It’s even worse for orthopedic care, which averaged a 41 week wait.  


In Nova Scotia, waiting isn’t the worst problem in Annapolis Royal. The hospital emergency department in that town is now closed on Tuesdays and Thursdays because they don’t have enough doctors to work. So, don’t plan your heart attack for Tuesday or Thursday.


According to Calgary-based, patients are also fleeing the country in droves to receive health care procedures.  They calculated over 369,000 patients and their family members traveled abroad spending $690 million on health care outside of Canada in 2017. 


But for us in NH, Medicare For All presents three additional problems.


First, private insurance would be eliminated. The Political Economic Research Institute at UMass projects as many as 2 million jobs will be lost in the health care industry. If you have worked and trained for your job in the insurance industry, you will soon be in the unemployment line. Yes, the so-called “public option” gets around this issue, but substitutes an unstable system where premiums spiral upward for those who buy insurance.


Second, we are already facing a physician shortage and have seen physicians flee private practice for hospital employment. Physician salaries have been maintained as hospitals have subsidized employed physicians. But hospital margins are already problematic in NH, with several hospitals seeking bailouts by better financed partners. The shift to Medicare is likely to implode hospital finance, making current physician salaries unsustainable. Retirement and other careers will lure away some physicians, exacerbating access issues.


Third, Medicare For All requires massive tax hikes on the middle class. According to the Heartland Institute, Americans earning $50,000 - $75,000 would need to pay an additional $8,000 - $9,000 more in new taxes every year.  Those earning $75,000 - $100,000 would need to pay an outrageous $13,000 - $15,000 more each year.  While this may be somewhat offset by eliminating insurance costs, most of that benefit would be enjoyed by employers who will no longer pay for health care benefits. Medicare For All’s tax scheme would destroy the middle class in America.


Then again, past history leaves us to wonder whether our politicians actually intend to fund this healthcare scheme. For years we have heard that the Medicare Trust Fund is running out of money. But since the Sustainable Growth Rate formula was adopted in the Balanced Budget Act of 1997, the emphasis has been on cutting benefits more than funding the system.


Here at home, even the New Hampshire Hospital Association says Medicare For All would “upend” a system that is working. More hospitals will become financially unstable with a shift to Medicare. And if your local hospital closes, everyone in the community suffers the effects on the local economy and local property values.    


Can our health care system be improved at every level?  Of course.  But, giving the federal government control, laying off 2 million people, taxing us into the poor house, creating severe doctor shortages and thereby making us wait almost 1 year for specialty treatment is an extreme measure.  


One cannot help but wonder whether the multimillionaires proposing this system really intend to utilize it for themselves and their families. When Senator Sanders suffered his heart attack in October 2019, did he have to get a referral from his primary care physician, or go through prior authorizations? Or did he go straight to the cardiac catheterization lab at a premier medical facility? Does Medicare for All really mean Medicare for none?


I hope the presidential candidates and the New Hampshire voters pay very close attention in these last few days before making their choice.


(William Marsh is serving his second term in the N.H. House of Representatives, where he sits on the Health and Human Services Committee. He is a retired ophthalmologist and a trustee of Huggins Hospital. He and his wife, Stefanie, live in Brookfield.)