Why I'm not enthusiastic about Medicare for All

Posted Saturday morning, December 14, 2019.

Seems I was over-prepared.

I brought all these books to my meeting at the Social Security office in Poughkeepsie yesterday morning. To my shock and delight and relief I didn’t have a chance to open a single one of them. I was in and out of there in an hour and a half. They don’t let you make an appointment. It’s first come, first serve, and I was told if I wasn’t there when the doors open there was a good chance there’d be dozens of people there ahead of me and I might have to wait all morning, possibly well into the afternoon. I was there to pick up a form. One form. Another hoop to jump through on the road to getting Mrs M’s disability payment approved. (We’ve only been at this for over a year.) I got there around 10 minutes after they opened, and there were about a dozen people waiting ahead of me. But I had only just settled in my seat and dug out my notebook when my number was called. By the time I was done, most of the 100 or so chairs in the waiting area were filled.

Lucky me.

Here’s the thing.

I was lucky. I really was there to pick up the one form. It’s to let the feds know I have Mrs M’s permission to handle her finances. She just has to sign it and mail it back. You’d think this was something that could have been taken care of online or solely through the mail. Nope. I had to present myself in person and prove I’m me and then they had to call Mrs M to hear her say it was me sitting there and it was ok to give me the form. That was the whole of it. A two hour drive round trip, an hour and half’s worth of paperwork in order to proceed with more paperwork. I have a blog rant in the works about this, but for now, I hope you don’t mind if I let off some steam: 

This is why so many people, including me, aren’t enthusiastic about Medicare for All. We expect that it’s going to put us all to work filling out paperwork and making multiple trips to less than congenial and comfortable government offices devoted to keeping the bureaucracy functioning first and helping us a distant second.

The first order of business of any government agency is to cut costs. This is the case whether it’s the Democrats or the Republicans in charge. All politicians at every level love to boast as one of their primary achievements that they’ve cut taxes. (This is almost always a lie. What they’ve actually done is shifted the tax burden from their base to someone else’s.) The usual way of cutting taxes is to cut costs, and the usual way to cut costs is to cut them at the lower-levels of government agencies, and the usual way to cut costs at any agency is to cut services, not hire enough people to handle the job, not pay the ones hired enough (thereby shrinking the pool of competent applicants to draw from), and find ways to make anyone who needs the services pay for them, if not with actual dollars and cents then with their time and emotional labor. Our fates are in the hands of overworked, underskilled, not just unmotivated but demoralized paperpushers and keyboard punchers with no incentives to go out of their way to help out the people who come to them for help.

Please don’t try to tell me this is better than having to deal with customer care reps at private insurance companies. You’re talking to someone who’s been dealing with both for almost two years. My worst experiences have been with the feds. I don’t expect it to change, even if some version of Medicare for All is Green Lanterned into being the first day of Bernie Sanders’ presidency.

I do want to say that everybody I dealt with at the Poughkeepsie office was relatively friendly and cheerful and did their best to be helpful despite their already being overwhelmed an hour into their workday.

Comments

[Tom Benjamin]

I don't think this is a valid concern. I'm Canadian and I spend none of my time fighting with bureaucracy over health care. I am sure that some of us have had that experience, but I am also sure it is rare.

The real problem is that delivering healthcare services is the hardest thing government does in Canada. Contrary to what M4A advocates think, Blue Cross et al do essential work. In Canada each province has a large bureaucracy - built incrementally over 80 years - doing that work. They have large numbers of skilled employees who understand healthcare and the issues. They have office space, computer networks, sophisticated software and hard won institutional expertise. Healthcare is fucking hard.

Somehow, the Federal government is going to do all that work in America? Someone is going to design a system that bypasses each state? We do healthcare at the state level. All the Feds do is set standards and help with funding. Find office space for, say, a million new emplyees? Train them? Actually implement?

A guaranteed clusterfuck.

[DocAmazing]

I deal with insurers from the other side--I'm a physician.

The Feds are terrible.

Private insurers are significantly worse. They will change the rules in the middle of a phone call. Drugs that were covered on Tuesday are rejected on Thursday. Procedures that were pre-approved are suddenly no longer covered after they've been performed.

There are few organized functions that cannot be made worse by greed, profit-seeking, and a lack of accountability. Private insuracne is all three of those things, but swollen and throbbing.

[Larry B]

Yes, the sign up is a pain in the butt. Once you're in and have chosen your supplemental and prescription plans, it is almost completely painless. Show your card(s) to the receptionist, that's it. You know what your costs will be upfront. The only downside is the deal that the supplemental insurance providers made with the Feds that you have to re-select your supplementals every Nov/Dec, and that blizzard of incomprehensible bullshit is pretty thick. If you're happy with what you have, just roll it over. In 5 years my only issues have been a bad choice of an Rx plan the first year, so I had to wait 12 months to fix that, and one procedure that required pre-approval. Almost everyone I know who is on Medicare is surprised at how happy they are, once you get settled in. Good luck.

[Kaleberg]

If I read your post correctly, you were dealing with SSI, not Medicare. Disability does make one jump through a lot of hoops, if only because there is a lot of fraud. Do you really want someone filing for disability benefits in your wife's name? Do you really want to deal with untangling that kind of mess?

I remember someone complaining that the military had a 20 page definition of cherry pie for the purposes of procurement. It all sounded like scar tissue. There is always someone willing to sell a cherry pie without cherries, an inch in diameter, without a bottom crust, with cherry pits included and so on.

If everyone was on Medicare, your wife would have received her Medicare number shortly after she was born and you would have had to post about something else.