As a retiree from high school teaching in NYC, we have Medicare (80%) and supplemental insurance (20%).  Effective Jan. 1, our insurance will be NYC Medicare Advantage Plus Plan and will be administered by Emblem Health and by Blue Shield, not by the troika of Medicare, Emblem Health, and Blue Shield as is presently the case.  All medical bills will go to the new plan.  The plan in turn will pay the doctors and hospital.  There is a $253 deductible for each person and a $300 deductible for hospital admission.  My experience is that we are already moving toward Medicare for All even though legislation has not yet been passed authorizing it.  One need only look at the handwriting on the wall.

This system is a blending of the private and the public (Medicare will still pick up its share of the cost) under a single umbrella and is staging Medicare for All.  You see, the senior citizen retirees paid into Medicare during the course of regular employment, and we continue to pay for Part B Hospitalization (although those payments are reimbursed once a year by NYC).  The private insurance that supplements Medicare is publicly funded under the union contract with the city for the teachers.  So the retirees have paid into the government Medicare fund, and the citizens of NYC through taxes have paid into the city and thus pay the 20% not covered by Medicare.  Thus, Medicare, now conceived as a Medicare advantage plan, has shifted into being phase one of a type of "Medicare For All."  The renaming as a Medicare advantage plan (with the word "plus") is part of the re-conceptualizing.  The insurance company manages the billing to create the illusion that it is a non-governmental program, but actually the cash flow is entirely governmental, with small supplements by the individual.

There will be administrative consolidation as of Jan.1, but Medicare is still funding 80%.  So they are trying to find organizational frameworks that make it possible to have a single-payer system (government) that has different revenue streams — some federal deductions from paychecks; some from local government (which would lead to raising local taxes); some out-of-pocket charges to the patients; and a range of benefits that would differ according to age, pre-existing conditions, and severity of the health issue.  Charges would be based on statistical models.  Since "caring" cannot be measured, it will not be factored in.  Also, under the Affordable Care Act, payments by Medicare to physicians for individual visits and other treatments were reduced.  Two different internists have told me this.

Medical appointments and practices would be regulated according to administrative requirements rather than according to patient illness.  During my heart surgery hospitalization last year, I saw this reversal of priorities.  Efficiency clearly took precedence over individualized care.  I even wrote my complaints to the hospital in this regard after I was discharged.  For example, now, during major heart surgery such as I had, they have only the surgeon and anesthesiologist at the surgery.  Other surgeons, or even one other surgeon, are not there, as in years past.  They even acknowledge this in their post-op surgical report, where they state that a physician's assistant was present instead of an M.D.  In fact, I noticed this before being wheeled into the operating room, and the head nurse told me I was correct in my observation.  Ten minutes later, I was unconscious.

The night before my surgery, an aide came in and said she was there to shave my torso, and that afterward, someone else would come in to cover me with lotion.  Why was this being done?  The aide couldn't tell me.  Then, after arguing about the matter, the nurses managing the heart surgery wing (no doctors were on the floor) came in and told me that after the surgery, to keep patients from trying to pull out a ventilator in their mouths, my hands would be in restraints.  Had I not complained and fussed about the shaving, I never would have been told about this.  None of these procedures had been conveyed to me ahead of time.  Why?  Because it is part of the emphasis on efficiency.  Talking to patients, explaining procedures, and reassuring patients takes time and thus is not cost-effective.  Applying skills to the patients is more efficient, more measurable, and thus more cost-effective.

Also, no residents or attending doctors were in charge of the heart wing.  When I was in the hospital for intestinal surgery in 2015, the gastroenterology wing had supervising doctors in the hallway on duty 24/7.  Having nurses in charge costs less than having doctors in charge.  The above examples are what I mean when I say efficiency (cost-cutting) is being prioritized over care.

I hope this gives a more detailed and intimate picture of where we are going and what it will look like.  The train toward socialized medicine has already left the station.  Get ready for more and more treatment as a body without a soul.

Image via Pixabay.

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