This is my ongoing series summarizing and evaluating the Medicare for All Act of 2019, sponsored by Senator Sanders. Even though he is out of the running now for president, this Medicare for All (M4A) idea is gaining steam and will come back every few years with seemingly increasing popularity. People need to understand that there are quite a few implementation details of M4A that, if done wrong, will cause it to fail. This is yet another attempt of mine to help us avoid that if it does in fact eventually pass!
Part 1 reviewed Title 1, which states that basically everyone will be covered and can receive care from pretty much any provider. Part 2 reviewed Title 2, which states that insurance benefits will be comprehensive without any regular out-of-pocket expenditures.
Title 3
This title reviews which providers get to participate in M4A–any who meet state and federal requirements–and also outlines the rules of participation, which include the usual nondiscrimination requirements, no charging fees to patients, submission of proper statistical information, and submitting bills in a timely manner. It also includes the usual national standards for healthcare facilities.
It also says providers can enter into private contracts with patients (and sets forth in detail what needs to be written in that contract) as long as they’re not also receiving any reimbursement from M4A for those same services.
All necessary stuff, but really nothing to see here.
Title 4
This talks about how this law would be administered. The Secretary of Health and Human Services is granted the power to develop policies, procedures, guidelines, and requirements to carry out the act, including eligibility, enrollment, benefits, provider participation, and really anything I’ve already discussed in the prior titles. Nothing new here.
Title 4 does get interesting though. It also requires the Secretary to develop uniform reporting standards and then require providers to report on those things, including quality and outcomes (without “excessively burdening providers”). And it says this information will be made available for research purposes.
I like all of that. It’s the necessary groundwork for getting patients standardized quality information about providers, and it’s exactly what I have requested patients be given so that they can make good decisions and, thereby, reward better providers with more patients. Unfortunately, as discussed last week, there would be no cost sharing, so there will be no motivation to offer slightly lower quality at a drastically lower cost, but at least there would competition to optimize quality at the pre-specified level of reimbursement.
It then goes on to establish regional offices, which will be responsible for providing regular state health needs assessments, recommending changes in provider reimbursement, and establishing quality assurance mechanisms.
Ok, that’s it for this week. I am starting to think that, at the end of this series, I will need to write a list of recommended changes to this act–just the minimum necessary–to allow us to build an optimal M4A system. That should be fun!
Continue to Part 4.
Clear Thinking on Healthcare 