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Dr. Toby Cosgrove says Medicare for All won’t work, but here’s what might happen


MedCity News editor-in-chief Arundhati Parmar and Dr. Toby Cosgrove at MedCity INVEST

The government’s role in healthcare is a hot topic, particularly as the 2020 election approaches. Some, like Democratic presidential hopeful Bernie Sanders, are advocates for Medicare for All. But as MedCity reporter Alaric DeArment highlighted in a recent opinion piece, there are challenges to implementing such a model.

That’s why former Cleveland Clinic president and CEO Dr. Toby Cosgrove doesn’t think it’s attainable.

“I cannot believe that [Medicare for All is] even a remote possibility for a number of reasons,” Cosgrove said during a discussion at MedCity INVEST in Chicago on April 23.

One reason, he said, is because “you can’t take the biggest industry in the United States and turn it on its ear in an election.”

Additionally, he noted that social programs are traditionally slow to evolve in America. A third reason he put forward is that individuals who are insured want choice as far as coverage is concerned.

But on the opposite end of the spectrum, Cosgrove doesn’t think the Affordable Care Act is going to be repealed. “Historically, once you have a social program in place, it’s almost impossible to reverse it,” he said.

So what’s the middle ground? Can we find a model that fits?

“As I travel around the world, I see countries that have the government pay moving increasingly to private pay and countries that have private pay moving increasingly to government pay,” Cosgrove said. “So my sense is there’s not a perfect solution, and everybody is struggling with this across the world.”

But he did have a thought or two on what might happen. Cosgrove believes “we’re going to see an increasing percentage of healthcare being paid for by the government.”

For instance, at Cleveland Clinic, about 62 percent of patients are Medicare, Medicaid or no pay, he said. That number is increasing by approximately 1 percent annually, and it’s also seeing a 1 percent reduction in that pay per year.

Cosgrove believes the United States will end up with a model similar to what exists in England. People can buy private insurance, but the majority of individuals insurance paid for by the government.

“That creates an interesting dilemma for providers because Medicare and Medicaid pay about 87 percent of the cost of providing care in the hospital setting,” he said. “So that’s going to ultimately … cause us to change the way we deliver care, and I think it’s going to be using technology, consolidating hospitals, moving more and more care out of hospitals into a less expensive facility and taking on more and more risk.”

Photo: Natalie Bahmanyar

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