For background, I have was the Chief Financial Officer for Medicare’s Fiscal Intermediary in the past. I also have experience as an executive with Blue Cross and also administering benefits for several other large insurance companies for specific claims related to radiology. I co founded a very large primary care group of over 400 physicians and was Chief Operating Officer, CEO, or CFO for several other providers. I am now retired. My point of mentioning this is that I have seen how things work as a patient, a provider organization, a government health program, and a private insurer.

Medicare is great when you have a good physician and many physicians are good physicians, in fact most are. Medicare pays claims. It does not worry about whether your physician is a good one or a bad one. If your physician has a high infection rate or a low one. If you are an expert on physicians quality and facility quality, then Medicare is right for you. If not, the Medicare is relying on you to be one… whether you realize it or not.

It sounds like you have never experienced the abuse of a physician doing open heart surgery on you when you did not need it. If you ever were given a battery of tests you did not need, it did not trouble you, because the government was paying for it, and it felt like the doctor was really worried about you (not that they were running up the benefit costs).

Private health insurance does not guarantee you the best care, but most good private health insurance companies shave off the worst providers from their networks. Another difference, when I was CEO of a radiology benefits management program we were paid a bonus to set up an operation to insure “at risk” women got regular mammography done according to the CDC guidelines by contacting them and trying to arrange for them to come to a mammography center. How many women were saved through early detection is hard to predict, but those women with Medicare that got breast cancer and subsequently got “great care” will tell you how wonderful their physicians were… never realizing a good health plan would have helped them avoid the mastectomy.

I am surprised you waited a long time for a referral. That was a “bad” practice in the past, but most of those insurance companies went out of business for good reason. Today, most delayed referrals occur when physicians fail to submit the purpose behind the proposed referral.

I have seen physicians order a battery of tests at the same time, when the standard protocol is to do them in a specific sequence. In the physician’s mind, they were “speeding up” the diagnoses. Patients are impressed, their doctor is all over their problem. Why did we insist they do them properly in the correct sequence… not to save money, but rather to avoid the patient getting excess radiation (which has become a bigger issue these days) and so while it is a bit more cumbersome, it reduces the risk of cancer in the future. So yes, we were trying to reduce future cancer claims… don’t you want your risk of cancer reduced?

I highlighted some serious abuses I have seen in the health care system, that someone like you might never see. Then of course there was the over subscribing of narcotics that happened around the country. Private health insurance companies like the one I have today (I need narcotics for pain, because blood thinners disallow the use of other pain medications), monitor narcotic ordering which while a pain is for my own good. I don’t complain because I know the purpose of that monitoring.

With respect to Medicare, 34% of seniors choose private health insurance (Medicare Advantage) over traditional Medicare. And that percentage has been increasing at a steady rate since Medicare Advantage first began. I will be switching from my current HMO to a Medicare HMO plan this fall with my current insurance company whose integrated medical record system insures every physician that sees me has all the information they need and they don’t need to order redundant tests.

Also, you are a bit confused with regard to prices… States that have looked at Medicare for All plans have estimated the additional cost to offer it to their citizens is 15% of wages. Some politicians are promising to offset that with higher income taxes on the wealthy, but those higher taxes are going to be needed to fund the existing Medicare and Social Security programs so politicians are lying and trying to use the same pot of money to support existing Medicare and Social Security, expanding Medicare to all Americans, and paying off student debt. That money pot is simply not big enough to support any one of their initiatives, much less all. Economists estimate raising the top tax rate on high income earners to 70% will produce an extra $70 billion in tax revenue a year… less than 7% of the current deficit so how is it going to pay for all these other programs… that is why virtually every serious proposal includes raising taxes on wages (before any tax deductions by 15% of wages… not a 15% increase… but a 15% higher tax rate).

Imagine the low wage worker who now gets extended Medicaid at no cost suddenly losing 15% of their wages. Medicare for All will need a revenue source that it can depend on and that is not subject to “experts” figuring out how to avoid. That comes down to a tax on payroll or a national sales tax like the VAT they use in Europe which is 2–3 higher than most state sales tax levels in the US. What most Americans do not understand is that corporations are paying the bulk of healthcare today, the Sanders proposal largely relies on corporations giving their employees the money they use to pay for health care as extra wages so the government can take those extra wages from them… there are a lot of “ifs” in that assumption…