News | Healthcare Reform

‘Medicare for All’ leader laments Medicare problems

News | Healthcare Reform

‘Medicare for All’ leader laments Medicare problems

  • “Medicare for All” would not repeat the problems that Rep. Debbie Dingell, a leading advocate, encountered when her husband was a patient, she said.
  • The ongoing challenges stemmed from disputes between Medicare fee-for-service administrators and Medigap plans over financial responsibility for various service charges.
  • Dingell insists providers would benefit from single payer, which they broadly oppose.

A leading congressional advocate of “Medicare for All” this week excoriated Medicare for the billing problems she dealt with during her late husband’s last years of declining health. But she insists such headaches would not follow expansion of the program to all Americans.

“I spent 14 hours just trying to get bills paid and pushing my numbers on Medicare and getting nowhere and sitting on hold, listening to music, talking to Blue Cross and Blue Shield as they both said that the other was the primary payer or the first payer,” Rep. Debbie Dingell (D-Mich.) said at a July 9 staff briefing on Capitol Hill. “And you couldn’t get anyone to agree, and I documented every one of those minutes and then I finally gave up and called my congresswoman.”

Dingell, who is co-chair of the “Medicare for All” caucus and lead co-sponsor of the single-payer Medicare for All Act, added that “people just don’t know how broken the system is.” The bill, introduced in March and cosponsored by 114 Democrats, has been endorsed by most of the Democratic presidential candidates.

Dingell said that as part of her efforts to care for her late husband, former Rep. John Dingell (D-Mich.), who was covered by Medicare fee-for-service (FFS) and a Medigap plan, she faced challenges figuring out how to get home-based care and who would pay for it, and finding providers.

She also was critical of the lack of long-term-care coverage in Medicare.

“We have a broken system that doesn’t work,” Dingell said. “You don’t realize until you’re trying to make some of our systems work how broken and out of date they are.”

Would similar problems affect ‘Medicare for All’?

In an interview after her criticism of the existing Medicare system, Dingell said the time-consuming problems and frustrations she encountered would not be repeated if the “Medicare for All” legislation she backs is enacted into law.

“If we were to get to “Medicare for All” — and we have to sit at the table and we’ve got to figure this out — private insurance wouldn’t cover any of the basic services,” Dingell said.

Such “basic services” would include hospitalization, for which the single-payer entity would be solely responsible, Dingell said.

When asked, Dingell said private Medigap plans would not be allowed to provide any of the peripheral coverage now offered to Medicare FFS beneficiaries.

The health system also would change under a single-payer approach by eliminating much of the billing and other paperwork burdens that hospitals and physicians face when dealing with multiple commercial plans, Medicare, Medicaid and the Department of Veterans Affairs, she said.   

“We need a universal single biller to take costs out of the system,” Dingell said.

Hospital, health plans and physician groups have joined forces to oppose the Dingell-backed bill, as well as other bills that would expand Medicare enrollment or use Medicare rates in a so-called public-option health plan. The stakeholders worry that such plans will have to use Medicare payment rates (or some ratio of Medicare rates), causing many hospitals to financially deteriorate or close.

“It is no time to impose a one-size-fits-all program such as ‘Medicare for All,’ a public option or Medicare buy-in that will lead to Americans paying more and waiting longer for worse care,” Chip Kahn, president and CEO of the Federation of American Hospitals, said in June after a House committee hearing on single-payer proposals.

Challenges continue to affect the patient experience

Following her own recent medical procedure, Dingell said she is still trying to figure out a billing dispute similar to the one she had when her husband was ill.

“And Blue Cross and Blue Shield has told me to send it all to them and they’ll get it done,” Dingell said about a development that may resolve the issue. “You can’t help people fix problems if you’re not living them yourself.” 

About the Authors

Rich Daly, HFMA senior writer/editor

is based in the Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

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