#MedicareForAll – How It Will Really Work

While New Zealand has been in the news for other reasons lately, a hearing before the health select committee of the New Zealand Parliament last week should be of interest to those who think “Medicare for All,” or some other form of government-run single-payer health plan, is the answer to our problems with health care.

At the hearing, women with advanced breast cancer asked for pressure to be brought on Pharmac, the government-run drug-buying agency, to fully fund two additional drugs for breast cancer, Kadcyla and Palbociclib (also known as Ibrance).

The pleas of the women were very moving.  One of the women said that Ibrance was a “game-changer” in other countries for conditions like hers.  She asked why women in New Zealand had to travel to Malaysia or move to England or Australia to get access to cheaper life-extending drugs.  Another woman said that she was alive only because she had paid for the drug herself.  “This would … be impossible if I had to rely on Pharmac.” 

In response, Sarah Fitt, the head of Pharmac, said that Kadcyla and Ibrance were two of many drugs that the agency was reviewing for possible funding.  She explained:

“We have a fixed budget, which means we have to make careful and considered choices about which medicines will deliver the best health outcomes for New Zealanders.

While some medicines may be available in other countries, the funding and reimbursement systems are often not comparable. New Zealand must make its own decisions, carefully assessing the available evidence and thinking about medicines use in the New Zealand health context."

This is what “Medicare for All” will result in, too.  With the government paying the bills, there will eventually be a limit on the amount of money that the government is willing to, or can, spend for health care, whether it is for drugs, operations, doctors’ visits, or other things.  People won’t be able to get all the medical care they want whenever they want it.  There will be limits.

And the money that is available for healthcare will have to be divided up among the various needs and demands for medical services.  For doctors’ visits or operations, one of the ways of dividing things up could include waiting lists for operations or delays to get an appointment.  They already have the former in New Zealand.  Political parties in New Zealand actually include, in their election manifestos, promises to spend more money to reduce the waiting lists for specific types of operations.¹  In Canada, on the other hand, there can be long waits to get an appointment to see a specialist.

For drugs, we may wind up with something like they have in New Zealand.  While there might not be an absolute fixed amount of money that can be spent on drugs each year, like Pharmac has in New Zealand, the one thing we know is that there won’t be an unlimited amount of money to spend on drugs.  And therefore, at some point, somebody is going to have to decide which drugs the government will pay for and which ones it won’t.

For the drugs that the government won’t pay for, it will be up to patients to pay for the drugs themselves (assuming that is allowed²).  It will mean, as in New Zealand, that some people will be able to get the drugs that the government won’t provide, either because they are rich or they can successfully run a “Go Fund Me” campaign or some other reason.  Others won’t be able to pay, and they won’t get the drugs.

Proponents of single-payer may say that is the way it is now.  The rich get medical care and the poor don’t.  That may be true.  But point of this post is that a single-payer system is not going to solve all of the problems of accessibility to healthcare, in spite of what some of supporters would have you believe.  There are still going to be drugs or treatments that people can’t get because they cost too much and the government won’t pay for them.  As in New Zealand, the government will be “mak[ing] … choices about which medicines will deliver the best health outcomes” and which ones the government think cost too much for the good they do and, therefore, won’t pay for.³

In other words, even with Medicare for All, there are still going to be people who are not getting medical care because of cost.  It’s just that the government will be telling them no, instead of some insurance company.
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¹ See, for example, Audrey Young, "Leaders dangle carrots for grey voters," The New Zealand Herald, August 17, 2005.
² If somebody really wants a healthcare system that is equal for everyone, then they might say that people should not be allowed to buy drugs or anything else on their own.  Nobody would be allowed to buy better medical care than somebody else just because they are rich.
³ That sort of sounds like a variation of Sarah Palin’s death panels from ten years ago, doesn’t it?  At least it would to people who needed drugs that were not funded.  Speaking of former Governor Palin, novelist Thomas Mallon recently said that, compared to Donald Trump’s tweets, former Governor Palin’s Facebook page, where she commented on things, looked like “a lost volume of the Federalist Papers.”