Response to Robert Gebelhoff Editorial – Progressives can’t be trusted with Medicare-for-all

Gentle Reader –

Mr. Gebelhoff, an assistant editor and opinions contributor for the Washington Post, published the above-cited piece today, 3 January, 2019. I detail the URL for the piece below, and then detail a brief criticism laying out why I think he is off base in his analysis.

Article URL:

progressives can_t be trusted with medicare-for-all – the washington post

Mr. Gebelhoff –
1. The cost of MfA: we currently spend about $3.5 trillion yearly for health care. That’s government spending and what citizens must add in terms of non-coverage, co-pay, drugs, etc. That’s $ 35 trillion, give or take a few billion, over 10 years. About $3 trillion more than MfA costs. With MfA, there would be significant savings due to decreased administrative costs – one study puts these at 30 cents of every dollar spent for health care. That’s another $ 1.05 trillion yearly. Then there is the decrease in drug costs through negotiated prices. Further, there is Evidence Based Medicine which will decrease waste by no less than 20%, another $700 billion yearly.

2. So to the 10 yr cost of MfA $ 32 trillion subtract at least $ 17.5 trillion, leaving $ 14.5 trillion cost over 10 yrs. Then subtract what we pay now – about $ 35 trillion in a decade. That leaves a net positive gain of $ 20.5 trillion. It is less costly. And drug savings aren’t figured into these numbers.

The challenge will be in the transition; in what is covered and what isn’t; and a host of ethical and operational issues. MfA is a first step, not the end.

I would be pleased to discuss with you electronically or some other way if you wish.

PAYGO is a separate issue.

About AJ Layon

AJ Layon was, for 28 years, at the University of Florida College of Medicine, in the Division of Critical Care Medicine, in Gainesville, FL. For the approximately 10 years until September 2011, he was Professor and Chief of Critical Care Medicine at UF; In September of 2011 he became System Director and Co-Chairman of Critical Care Medicine in PA; this ended in 2017. He served as a Physician in the Surgical Group with Médecins sans Frontières (MSF, Doctors without Borders) through 2018 and is presently an intensivist in Florida, struggling through the SARS-CoV-2 crisis. While his interests are primarily related to health care, health care reform, and ethical issues, as a citizen of our United States and our world, he will occasionally opine on issues of our "time and destiny". Follow on Twitter @ajlayon
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1 Response to Response to Robert Gebelhoff Editorial – Progressives can’t be trusted with Medicare-for-all

  1. GM says:

    The problem with Medicare-for-All advocates is that they refuse to face the full reality of the situation.

    “It will be all the same as before, only now government serves as the insurer, the government will not be running anything” is the usual claim.

    But I don’t see how you can actually properly control costs unless you indeed nationalize the hospitals. There is enormous amount of waste and profiteering in the system because of the existence of the middlemen, but if you take them out but do nothing to reign in the hospitals, Big Pharma, and device manufacturers, who are all in it for the one and only purpose of extracting as much profit/rent/racket/whatever-you-wanna-call-it from the rest of society, you will not have solved the problem.

    And yes, that does mean that the government should nationalize the hospitals and run a Soviet Union-type system. It happens to work, which is why the UK copied it.

    The problem arises from not completely copying it, as seen, again, in the UK. If you have private hospitals, then the rich can just go there and dissociate themselves from the overall socialized system. And if that alternative exists, they can then start chipping away at the public system, because they don’t need it. Which is precisely what has been happening.

    Such public systems only works as long as everyone pays their fair share, once the rich are allowed to practice rampant tax avoidance and to have their own separate facilities, they starts to crumble.

    What that means is that there should be no private hospitals whatsoever. And no private schools either, or private anything that is a common good of that type. Then the powerful are forced to use the same services as everyone else, and that ensures that those services are not underfunded and degraded over time.

    Needless to say that is too heretical of an idea to even mention, which is why you never hear about it, even from the Medicare-for-all crowd.But that does not make it any less true. And if you are not willing to follow cold hard logic where it remorselessly leads and face the true reality of the situation, you are likely to fail in making a real difference.