Medicare For All And The McNamara Fallacy

July 18, 2019

Lately, most if not all presidential candidates from one unnamed party are in favor of Medicare For All. Further, they intend to eliminate private insurance. They say that eliminating billions of dollars of profit from the insurance companies and attaining billions of dollars in savings by the government negotiating with drug manufacturers will pay for this expansion of benefits to all 330,000,000 people in the U.S. and illegal emigrants. Only one candidate states that taxes will go up, but will be more than offset by savings on premiums, co-pays, and deductibles.

The scary thing for me is that a significant percentage of our population is in favor of such a plan. This so called plan will reshape the healthcare industry in dramatic fashion and should receive significant thought, study, and discussion with community members. It is my belief that Medicare For All could virtually destroy rural hospitals as we know them. In no way am I advocating for one party or candidate over another. I am simply pointing out the dangers of a single payer system. Let’s look at a few points that should lead to some interesting discussions:

• McNamara Fallacy or Quantitative Fallacy involves making a decision based solely on quantitative observations (or metrics) while ignoring all others. The reason given is often that these other observations cannot be proven. To date, all the candidates have focused on the hypothetical cost savings and expense of Medicare For All. Across the healthcare landscape, there are significant variables and combinations of variables that have not been considered and cannot be quantified.
• The last two studies I saw stated that private insurance pays 134% to 222% of the Medicare fee schedule.
• Cost Shifting is alive and well! Who will we cost shift to when we have one payer?
• Do we have confidence in Congress that they will pay a reasonable amount for services so that we can maintain health services at existing levels?
• How will we negotiate rates with a single payer?
• In their quest to save money to support Medicare For All, is it possible they adopt assembly line medicine and demand that all outpatient services are provided in stand-alone labs, imaging centers, infusion centers, and surgical centers? I think it is more than possible!
• How will be pay for the last service that we will be able (required) to provide, the Emergency Room? Local taxes?

The above are just a few of the questions that I have regarding Medicare For All. You most likely have many more. The fear I have is that rural hospitals will become stabilize and ship centers with virtually no inpatient or outpatient services. Perhaps this is meant to be. However, I believe that the people most affected by these changes should be involved in the decision process. A federal bureaucracy that will undoubtedly over promise the benefits and underestimate the exorbitant cost of Medicare For All will once again prove the McNamara Fallacy!