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Monday, I wrote: If we can, we should. And if you agree, then I’m sure you also agree that if we can’t, we shouldn’t.

If you don’t accept that simple logic, then you are not
being objective.

I have as many friends who call themselves Democrats as
Republicans, and lately, the conversation has increasingly turned to the
concept of Medicare for All. While I’m sure it’s pure coincidence and has
nothing to do with the work of Broken Healthcare, I often get asked my opinion
of Medicare for All. Unfortunately, I have proven woefully inept at getting
people to understand why I believe Medicare for All would not only be a
disaster but would be the death knell for American healthcare.

A couple of months ago I started trying a different tack. I
had observed that my friends who are supporters of Medicare for All favor it
for moral reasons, and on that subject, we are mostly in agreement that
something must be done to fix our broken healthcare system. But moral justification
tends to lead to emotional, not objective, economic reasoning, thus making it a
hard debate to win.

Essentially, what I’ve said to people is, “Why don’t we step
out of the world of healthcare for a moment—it’s too emotional. Instead, let’s examine
how things might work through an analog, say the food industry.”

For me, there are many similarities between food and
healthcare. Clearly food (along with water) is a basic necessity of life. And I
think most of us believe that everyone has (or at least should have) the right
to not starve to death in the United States of America, where food is abundant
and cheap. We ache for children who are going hungry, feeding millions of them
through our schools. We help the poor with food stamps (now SNAP) and we
subsidize farmers. So, what would happen if we adopted a Food for All program that ran like today’s Medicare?

A Cars for All
program might be similarly appealing. What would the auto industry look like if
government established what features a car needed, what price would be paid,
and how repairs and maintenance would be paid?

How about a Housing
for All
program? We all care about ending homelessness. So why not let the
government decide what housing everyone needs? It would certainly be a lot more

You see, it’s the “All” in Medicare for All that is the
problem. I am in favor of subsidizing healthcare for those who need it, but when
we start to make the assumption that the government should provide a minimum
level of something for everyone, we distort the market in ways we can barely
imagine. Right now, government-sponsored healthcare is only half the market and
it’s destroyed the entire market for all of us, creating price distortions and
stifling competition. Medicare and Medicaid, the lowest prices in the market,
don’t result from competition, they result from price setting by bureaucrats
which makes people believe they are truly the lowest prices possible. Only
competition can find the lowest prices. This misperception has also created the
concept of cost-shifting to the private sector.

Taken in sum, it’s a dysfunctional economic system that all
started with government interventions.

Medicare created hospital Charge Masters and mandated that
everyone be “charged” the same price (before discounts). In other words, the
government created hospitals’ greatest Weapon
of Mass Corruption
. In 1973, the Federal Government allowed the nation’s
non-profit health insurers to become for-profit businesses while leaving intact
certain exemptions from anti-trust regulation that was only intended for
non-profits. Decades later, we have an incredibly corrupt health insurance
industry that is already starting to do the same to Medicare through Medicare
Advantage plans.

Government created the fee-for-service model and allows
obscene abuse of patent law that enables pharmaceutical companies to keep
generic options off the market. The Federal Government also wrote into law that
it may not negotiate drug prices, which keeps costs artificially high.

Government also created the Medical Loss Ratio (MLR) via the
Affordable Care Act (ACA), eliminating the incentive for insurance companies to
drive prices down, instead creating a perverse incentive to allow prices to

For the private sector, government has created High
Deductible Health Plans, Health Savings Accounts, and Health Reimbursement Accounts,
none of which have brought down the cost of healthcare by driving greater
consumerism; and there was never any evidence to suggest they would in the
first place. These were merely political ideas. Every government-lead effort to
engineer a better healthcare system has failed, leaving us with what we have
now. So now, for some reason, we believe we can achieve better results by
further broadening government’s domain?

The only tried and true system, the one that we have 250
years’ of experience with—one that has given us the cheapest energy in the
world, the cheapest and most abundant supply of food in the world, broad home
ownership, a car in every driveway , and so much more—is the one system we
haven’t tried.

The Free Market is
capable of giving us the best healthcare system in the world. The confusion is
that because our healthcare system is so economically dysfunctional, many
believe it is capitalism run amok, when in fact the problem with our healthcare
system is just the opposite—it’s capitalism denied.

This is the debate that must take place before we go any
further down the path of Medicare for All. The question is whether we have truly
tried free market principles in healthcare yet, and if we haven’t, is it smart
to move to a more engineered system, whatever form Medicare for All might take,
without first trying the one system that we know works in every other market?

And finally, please just come back to the original question:
“If you believe we can engineer a Medicare for All system, then why wouldn’t we
also apply the same principles to food, automobiles, and housing?” If you
cannot, or will not, answer that question, then ask yourself “why not?”

So, this is the bottom line for me—it’s not about morality,
because on the grounds of morality, I think If we can, we should.
Unfortunately, we can’t, so we shouldn’t. And there’s still another way that
we haven’t tried.


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You don’t have to be a news junkie to know that the concept
of Medicare for All is going to be
front and center between now and the 2020 elections.

The challenge so many of us face is deciding where we personally
stand on the concept. It’s very complicated and has tremendous ramifications
for the future of our country and our selection of candidates in 2020.

We all know our healthcare system is broken and is only
getting worse; we know something needs to be done; and we feel for those who
can’t get reasonably priced health insurance, or decent medical care, or who
are the victims of predatory billing practices. There’s something morally
compelling about the possibility of providing for the medical needs of the
entire population. That’s why I’ve concluded that if we can, we should.

Medicare for Some

To understand the concept of Medicare for All, we should first do the obvious: understand
Medicare as it is now, which I’m going to refer to as Medicare for Some.

Just as those who supported the creation of Medicare
believed every person over 65 had a right to decent medical care, those who
support Medicare for All believe that any person, regardless of age, has a
right to decent medical care. That’s hard to argue with. So, if we can, we

What Led to the Creation of Medicare?

Social Security was introduced decades before Medicare to
address the national disgrace and human tragedy of older Americans finding
themselves out on the street late in life.

Prior to Social Security, people tended to work until they
couldn’t. Once Social Security became law, the right to retire at age 65 become
engrained in the national psyche. Unfortunately, retirement meant giving up
medical insurance, because it was almost always tied to employment. Thus, we
had a fast and growing retirement age population without medical coverage at
the very same time that medical science was providing many more late-in-life
medical options. The result was a moral imperative that led to Medicare.

Now, more than 50 years on, we have a much broader and
younger population facing similar challenges. The potential of modern medicine
offers increased life-saving and quality-of-life improving possibilities, while
affordable medical insurance is becoming increasingly hard to come by. With the
cost of healthcare skyrocketing at twice the rate of inflation and insurance
companies increasingly failing to honor their commitments, the result is a new moral
imperative in which we now need to figure out how to provide medical insurance
for everyone, not just seniors. Extending the concept from Medicare for Some to Medicare
to All
makes perfect sense. That’s why I think that if we can, we should.

If We Can, We Should

To consider Medicare
for All
, the first question I ask myself is whether Medicare for Some
. If it does, then there is every reason to believe that Medicare for All will work, too. If Medicare for Some doesn’t work, then it
would make sense to question whether it will work for All.

Of course, there’s great debate about whether Medicare for Some works, and it’s mostly
a matter of conjecture and opinion. There’s lots of data, but it gets twisted,
misused, and is genuinely conflicting.

Some believe it’s working just fine, while others believe
Medicare has created incredible distortions in the overall healthcare market,
causing the price of everything to be higher than it should be. In other words,
I don’t believe there’s a good way to evaluate the success of Medicare for Some using objective
criteria that the broader electorate will accept. It’s a polarizing issue, to
say the least.

So, to answer the question of whether Medicare for Some works, I propose a different way of looking at
the question. Rather than talking about why Medicare does or doesn’t work,
let’s be positive. Let’s assume that Medicare works well. And for those who say
that Medicare for All will be
different, and better, let’s give them the benefit of the doubt and assume
they’re right. That leads us to the second question which is:

Why, if Medicare for Some works, and Medicare for All will work, won’t we extend the same concepts to other parts of the
After all, if we can design and manage a better healthcare system,
ensuring prices are reasonable, access is universal, value is high, and
innovation will continue, why can’t we also have a better, fairer, more
efficient system of agriculture, food production, and food distribution by
applying the same principles? And why can’t we have a better automobile
production and distribution system? And for that matter, a better system for

Think about what we could do if we could better manage
automobiles, food production, and housing. We could solve the problem of
climate change by forcing the switch to electric cars, eliminating CO2-producing
cattle herds, and ensuring every home was smaller and had solar panels on the
roof. It just makes good sense. If we can, we should.

Food, housing, and addressing climate change seem right up
there with medical care when it comes to moral imperatives. So, if we can, we
should, right?

Just remember that America’s healthcare system is equivalent
in annual financial throughput to the fifth largest economy on the planet
(currently Germany). If we can engineer an economy the size of Germany’s for
the better, we should.

So, in evaluating Medicare
for All
, instead of trying to reason your way through whether it will work
or will not, just assume it will, and instead think about why we wouldn’t apply
the same principles to every other marketplace, all of which are smaller than
the healthcare market.

Of course, you already know it’s been tried before, so
perhaps we can learn from the success of prior efforts at providing food,
shelter, and medical care. I think there used to be a name for it, and it
wasn’t socialism.


Do you have a hospital bill that you believe is obscenely high or you just don’t understand? Or do you merely want to join the fight for real price transparency in healthcare? Whatever the situation, I ask that you STOP PAYING HOSPITAL BILLS until hospitals comply with the law.

You have a right to know where the prices come from. Below is a template for a letter I recommend you send to any hospital anytime you have a bill—even if your insurance company has already paid part of it. We have the ability, right now, to force hospitals to become transparent in their pricing. While flooding hospitals with letters that force them to invest time and effort to open, read, and respond to sounds like a very aggressive and obnoxious way to deal with them, it will be easy for them to put an end to such headaches and expense. All they have to do is become transparent and comply with the law that is already on the books.

As I’m sure you know, there is no penalty for failing to pay your hospital bill right away. In fact, there is no penalty for sitting on it for months. There is no penalty for calling and asking them to accept a lesser payment (which they sometimes do—why not try?). And there is no penalty for waiting until they send it to a collections agency. None of these steps will affect your personal credit score. The only thing that can affect your credit score comes after a collections agency receives it and does its due diligence. You can pay it at any time, and if you do, it won’t affect your credit score. A hospital bill that you do not pay for a year is not like a late mortgage or credit card payment. It won’t affect your credit score so long as you ultimately pay it. And if you wish to continue disputing it, just follow our process and never pay it if the hospital will not comply with the law.

By doing this, you will cost the hospital a great deal of money, time, and effort. And it costs you nothing. So stop paying bills for hospitals that will not be fully transparent and comply with the law. Call this a form of civil disobedience if you like. It does not appear our government is going to enforce the law, so we have to do it ourselves. You should not feel guilty about this. All a hospital has to do is comply with the law.

Here is a letter I recommend you send every hospital that is not 100% compliant with Federal Law:

Dear [insert hospital name]:

I am in receipt of your bill for [insert date(s) of service]. My account number is: [insert account number].

As I’m sure you are aware, hospital bills are notorious for their errors. Depending on the source of the information, estimates range from 40% to 90% of all hospital bills having errors. You may refer to the links below to understand my concern:

[Customize this paragraph. Was it you, a child, etc.? Did you have insurance?]
While your bill may have been reviewed by my insurance company, I am well aware that my insurance company does not compare your billed charges to your price list. Nor was anyone from my insurance company present in the hospital when I was there and I’m sure they did not review my actual medical record. Thus, they cannot know what was actually done or not done. They merely pay based on what you tell them.
Accordingly, I believe it is my responsibility as the patient to validate the charges, even if I have insurance, since either myself or my employer or the tax payers are paying the ultimate price. As such, I am going to need two things:
  1. A copy of your entire price list which I am entitled to under 42 U.S.C.A. § 300gg-18(e). I am not interested in a bill that only shows the prices for the services I received. I cannot know if what appears on my bill is correct and whether there may be another charge that was more appropriate without seeing the entire list of charges. And in any event, I am entitled to your price list under the law. I will need your entire price list that I have most often seen referred to as a chargemaster.

  2. I will also need a copy of my medical record. Please feel free to transmit it to me electronically at [insert an email address]. You may accept this letter as my written authorization to release my medical record. I’m sure you’ll understand that with the high rate of errors in medical billing, I will need to see my medical record and where each charge is derived from. While I understand you use a complex system of medical coding, I simply cannot pay a bill for something I cannot personally validate.
Thank you,
[Insert name and address]

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