Why “Medicare for All” Is a Pipe Dream
Alieta Eck, MD
As I listened to the Town Hall where Democratic Presidential candidate Bernie Sanders proclaimed his dream of Medicare for All, I realized that he was speaking in vague generalities that were void of realism. Medical care would be “free at the point of service with no co-pays.” Would there be any brakes on the over-utilization of services? He had no answer. He thus needs to understand that the demand for medical services is limitless when other people are paying the bill.
A pipe dream is an allusion to the dreams experienced by smokers of opium pipes. The suggestion that “Medicare for all” would save money is surely an example of a pipe dream promoted by politicians seeking votes.
Medicare has already become a system to be gamed. A Medicare patient went to an optometrist for new glasses, knowing that glasses are not covered under Medicare. When asked for an insurance card, she said she did not have insurance for glasses, but they wanted the Medicare card anyway.
She had a rather comprehensive examination, was given a new prescription for lenses and proceeded to choose her frames and pay for her new glasses.
Several months later she received a “Medicare Summary Notice for Part B.” Medicare was billed $817.09, approved $552.07, and paid out $432.82. She was told that the maximum she may be billed would be $110.41 or 20 percent of the approved amount. She never received a bill.
Rather shocked at those numbers, she looked more closely at the charges that were approved:
- Eye and medical exam for diagnosis and treatment, new patient $147.01
- Photography of content of eyes $20.41
- Examination of right eye by ophthalmoscope with retinal drawing $26.01
- Examination of left eye by ophthalmoscope with retinal drawing $26.01
- Photography of the retina $58.17
- Microscopic evaluation of deep cells of the eye $40.24
- Ultrasound of eye disease, growth, or structure (right) $79.79
- Ultrasound of eye disease, growth, or structure (left) $79.79
- Measurement of field of vision during daylight conditions $74.64
TOTAL for CLAIM APPROVED– $552.07
TOTAL PAID by Medicare- $432.82
All this for a healthy, asymptomatic patient who just needs new glasses! It is clear that Medicare has become a cash cow for enterprising “providers.” This does not appear to be fraud, just creative billing for services that were not asked for and probably not needed. Medicare was willing to pay, but the self-paying patient might have been content with #1 only, unless it revealed a cause for concern. And what is #6? An ophthalmoscope is a microscope for examining the deeper structures (see #3 and #4), and a slit lamp is a microscope for looking at the structures in front. All eye examinations by an eye doctor would routinely include these for both eyes every time.
Waste, fraud, and abuse are rampant in the current Medicare system and would be multiplied ten-fold if everyone were to be included. The estimated price tag for “Medicare for All” would exceed our entire federal budget.
And what if you had an eye injury that really needed an emergency expert consultation? Medicare generally underpays for such services, and there is a liability risk if the patient does not have a perfect outcome. Why wouldn’t eye doctors prefer to collect generous fees to both draw and photograph normal retinas during normal office hours?
Medicare is already bankrupt and need of serious reform of its bizarre billing system. Is a proposal to expand it to all a cynical politicians’ power grab, supported by cash-hungry “providers”? Or are people in a delusional haze from literally smoking that pipe?
It’s time for reality-based thinking.
Dr. Alieta Eck, M.D. graduated from the Rutgers College of Pharmacy in NJ and the St. Louis School of Medicine in St. Louis, MO.
She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988.
In 2003, they founded the Zarephath Health Center, a free clinic for the poor and uninsured that currently cares for 300-400 patients per month utilizing the donated services of volunteer physicians and nurses.
Dr. Alieta Eck is working to enact NJ S94 in New Jersey whereby physicians would donate their time caring for the poor and uninsured in non-government free clinics in exchange for the State providing medical malpractice protection within their private practices. She is convinced that this would relieve taxpayers of much of the Medicaid burden currently consuming 1/3 of the NJ budget.
Alieta Eck has been involved in health care reform since residency and believes that the government is a poor provider of medical care. Dr. Alieta Eck testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver health care in the United States.
In 2013, Dr. Alieta Eck put her name forward in the Republican primary race to win the party’s nomination for a temporary seat on the U.S. Senate. Confident she could make a change in Washington she ran on a platform of shrinking the federal government and repealing ObamaCare – President Barack Obama’s Affordable Care Act.
Despite losing her bid for Senate, Dr. Alieta Eck pushed forward, running for Congress in 2014 but, lacking enough votes to win the predominantly Democratic 12th Congressional District, came second to Bonnie Watson Coleman, the first African-American female member of New Jersey’s congressional delegation in state history.
Dr. Eck is a long time member of the Christian Medical and Dental Associations and in 2009 joined the board of AAPS, the Association of American Physicians and Surgeons, which advocates the preservation of the practice of private medicine.
In addition, she serves on the advisory board of Christian Care Medi-Share, a faith-based medical cost sharing Ministry and is a member of Zarephath Christian Church. She and her husband John have five children, one who is now an ophthalmology resident in St. Louis, MO.
Additional links:
http://health.usnews.com/doctors/alieta-eck-482714
https://www.facebook.com/eckforcongress/
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