“Medicare for All” — the dream wherein every American regardless of age, status or wealth will have 100% access to health care. Medicare for All low cost/no-cost health care for all is the American dream.

It’s not a new idea, and now the time has finally come. Yes? I wish the answer was a yes, but sadly the answer is no. Why? Well, for starters, the dirty little secret Bernie Sanders and Elizabeth Warren aren’t telling us is there will not be enough doctors or hospitals to deliver it. What? In 2016, approximately 67% of health-insured Americans were privately insured. With Medicare for All, that 67% will become a part of the insured pool at a time when an infrastructure, both physical and regulatory, is not in place to manage it.

Applications to medical schools have been declining since the mid-’90s. Why? Possibly because Medicare and Medicaid, as well as the private insurers’ “Allowable Fees For Service” have been cut and continue to be cut every year. Additionally, health care insurers, government and private, are reducing reimbursements, while at the same time adding more and more non-covered services to their already long list.

The consequence is the cost of first acquiring a medical degree plus maintaining a private practice is a debt burden few can afford, much less satisfy. This issue is most apparent in rural areas, which are significantly under-served. Here in Rutland, the fact is almost every “specialist” practice is owned and operated by the hospital and more and more, “clinic” health care is the norm.

Do not misunderstand. Hospital ownership of medical practices and clinic health care delivery is a good thing. It is the causation of that circumstance that is not a good thing.

Add to the shortage of physicians, the plight of the hospitals. They are under strict financial controls by their states with the consequence they are forced to cut services and raise fees where they can, if they can and even if they can’t. In addition to the shortage of physicians we are seeing, it is nothing compared to the shortage of nurses. Hospitals are closing all over the country, including Vermont.

Health care in this country is in major crisis, which a catchphrase will not solve. This writer believes that Medicare for All is a politically effective sound-bite that is overly simplistic and as such, is a promise that may not, or cannot, be kept. Do I personally believe every American at every age should be guaranteed the best health and health care possible? Big yes. Do I have the answer to this huge problem? Of course not! But, surprise, surprise, I do have a suggestion or two.

First, federally subsidize medical schools and medical education. Heath care, by any name, without enough doctors and nurses to meet the demand, is not likely to succeed. Second, by federal and or state legislation, empower all state medical practice boards to void an insurer’s decision to remove, or failure to cover, a previously covered service if, in the board’s judgment, such removal is contrary to the needs of the community in general, or a particular at-risk group in the community. Third, empower those same state boards to determine what treatment proposal is an at-risk “experiment” or an allowable treatment modality, not the insurers. Fourth, take mental health off the back burner, and recognize it is no less important than diabetic, coronary or cancer care.

In short, health care should not be managed, much less driven, by politicians, politics or accountants. It belongs in the hands of the health care experts.

Enid K. Reiman lives in Rutland.

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