Column | Leadership

Medicare for All — for what?

Column | Leadership

Medicare for All — for what?


If we fail to define or articulate a problem correctly, there is virtually no chance we can solve it.

Drawing strongly from Lean training that I’ve been exposed to in my career, I’ve learned to be laser-focused on solving the right problem. Consider “Medicare for All,” for example. It’s certainly a combustible phrase in our political circles, regardless if you are left, center or right. So let’s put aside our political alliances and cognitive bias for a few minutes and sort through the rhetoric. The question we should ask ourselves about Medicare for All — or any technical “fix” for healthcare, for that matter — is, what problem are we trying to solve?

The cost of healthcare is marching toward 20% of our GDP, and most agree that healthcare in this country is too costly. Is it? Is that what we are solving for?

But wait. A 2016 article in the Quarterly Journal of Medicine includes data suggesting that when medical and social services spending are combined, the United States has the ninth-highest spending in the world, in line with most of Europe. So is the problem how we are spending our dollars, rather than how much we are spending? Would Medicare for All reduce healthcare spending?

Or are we trying to solve the problem of the uninsured? The number of uninsured was estimated to be 44 million in 2013 before the Affordable Care Act was passed, and it dropped to 27 million by 2016, according to data on the uninsured population published in 2018 by KFF.org. But by 2017, it began rising again. Is having everyone covered necessary to have a rational system of financing healthcare? And what problem does insuring everyone solve?

How about simplification of healthcare billing, through a single payer? Is that the problem Medicare for All would solve? No one would say Medicare billing is simple, but at least there would be one complex billing algorithm instead of dozens of them. Would we get a simpler system with Medicare for All?

Simply put, when we consider Medicare for All or any other “solution,” we need to start with the problem. And that often requires asking and answering tough questions.

HFMA as an Association has intentionally stayed out of political arenas, which allows us to be a credible convener around important national healthcare topics. Our mission is to lead the financial management of healthcare, and realistically, everything in healthcare has a financial implication. Fortunately, healthcare finance professionals are ideally suited to gather objective facts, inform the decision-makers, frame the problem and help land an effective solution.

Is there a problem you could help frame? I "Dare You 2 Move." 

About the Authors

Michael M. Allen, FHFMA, CPA

is CFO, OSF Healthcare in Peoria, Ill., and National Chair of HFMA for 2019-20.

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