Why “Medicare for All” Is a Pipe Dream

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By Alieta Eck, MDhttp://zhcenter.org/

As I listened to the Town Hall where Democratic Presidential candidate Bernie Sanders proclaimed his dream of Medicare for All, I realized that he was speaking in vague generalities that were void of realism. Medical care would be “free at the point of service with no co-pays.” Would there be any brakes on the over-utilization of services? He had no answer. He thus needs to understand that the demand for medical services is limitless when other people are paying the bill.

A pipe dream is an allusion to the dreams experienced by smokers of opium pipes. The suggestion that “Medicare for all” would save money is surely an example of a pipe dream promoted by politicians seeking votes.

Medicare has already become a system to be gamed. A Medicare patient went to an optometrist for new glasses, knowing that glasses are not covered under Medicare. When asked for an insurance card, she said she did not have insurance for glasses, but they wanted the Medicare card anyway.

She had a rather comprehensive examination, was given a new prescription for lenses and proceeded to choose her frames and pay for her new glasses.

Several months later she received a “Medicare Summary Notice for Part B.” Medicare was billed $817.09, approved $552.07, and paid out $432.82. She was told that the maximum she may be billed would be $110.41 or 20 percent of the approved amount. She never received a bill.

Rather shocked at those numbers, she looked more closely at the charges that were approved:

  1. $147.01: Eye and medical exam for diagnosis and treatment, new patient
  2. $20.41: Photography of content of eyes
  3. $26.01: Examination of right eye by ophthalmoscope with retinal drawing
  4. $26.01: Examination of left eye by ophthalmoscope with retinal drawing 
  5. $58.17: Photography of the retina
  6. $40.24: Microscopic evaluation of deep cells of the eye
  7. $79.79: Ultrasound of eye disease, growth, or structure (right)
  8. $79.79: Ultrasound of eye disease, growth, or structure (left)
  9. $74.64: Measurement of field of vision during daylight conditions

TOTAL for CLAIM APPROVED– $552.07

TOTAL PAID by Medicare-  $432.82

All this for a healthy, asymptomatic patient who just needs new glasses! It is clear that Medicare has become a cash cow for enterprising “providers.” This does not appear to be fraud, just creative billing for services that were not asked for and probably not needed. Medicare was willing to pay, but the self-paying patient might have been content with #1 only, unless it revealed a cause for concern. And what is #6? An ophthalmoscope is a microscope for examining the deeper structures (see #3 and #4), and a slit lamp is a microscope for looking at the structures in front. All eye examinations by an eye doctor would routinely include these for both eyes every time.

Waste, fraud, and abuse are rampant in the current Medicare system and would be multiplied ten-fold if everyone were to be included. The estimated price tag for “Medicare for All” would exceed our entire federal budget.

And what if you had an eye injury that really needed an emergency expert consultation? Medicare generally underpays for such services, and there is a liability risk if the patient does not have a perfect outcome. Why wouldn’t eye doctors prefer to collect generous fees to both draw and photograph normal retinas during normal office hours?

Medicare is already bankrupt and need of serious reform of its bizarre billing system. Is a  proposal to expand it to all a cynical politicians’ power grab, supported by cash-hungry “providers”? Or are people in a delusional haze from literally smoking that pipe?

It’s time for reality-based thinking.


Bio: Dr. Alieta Eck graduated from the Rutgers College of Pharmacy and the St. Louis University School of Medicine in St. Louis,MO.  She studied Internal Medicine at Robert Wood Johnson University Hospital in New Brunswick, NJ and has been in private practice with her husband, Dr. John Eck, MD in Piscataway, NJ since 1988, affordablehealthinc.orgShe has been involved in health care reform since residency and is convinced that the government is a poor provider of medical care.

  • Dr. Eck testified before the Joint Economic Committee of the US Congress in 2004 about better ways to deliver medical care in the United States. In 2011, she testified before a Senate Health Committee chaired by Senators Bernie Sanders and Rand Paul– about ways to avoid non-urgent visits to the emergency rooms.
  • In 2003, she and her husband founded the Zarephath Health Center, a non-government free clinic for the poor and uninsured that currently care for about 300 patients per month utilizing the donated services of volunteer physicians and nurses. It is only open 12 hours per week. zhcenter.org
  • She is working to pass NJ S239, a bill that would provide medical malpractice protection for the private practices of physicians who donate 4 hours per week in a clinic like the ZHC. njaaps.org
  • Dr. Eck was the 2012 President of the Association of American Physicians and Surgeons and serves on the board of Christian Care Medi-Share, a faith based medical cost sharing ministry.
  • In March, 2015, she chaired a meeting of the National Physicians Coalition for Freedom in Medicine, about 30 physicians, who gathered in Washington, DC to draft a “One-Page Plan” to restore affordability, promote patient choice and retain quality in medical care. https://aaps.wufoo.com/forms/m11okp2x1yjc8qf/
  • Dr. Eck spoke at the National Press Club in Washington, DC in June, 2016 to help unveil the Wedge of Health Freedom, an initiative of the Citizens’ Council for Health Freedom, with President Twila Brase.  JointheWedge.com
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