By Dr. Merrill Matthews Institute for Policy Innovation
National Public Radios Weekend Edition aired a news story recently highlighting the many problems with Puerto Ricos health care system--which is essentially what Bernie Sanders would like to do for (or to) the whole country.
About two-thirds of Puerto Ricos residents are in Medicare and Medicaid compared to about a third of the mainland population.
Sanders has made moving to a single-payer health care system--often referred to as a Medicare for all approach--a key element in his presidential campaign. And hes not alone. President Obama Senate Minority Leader Harry Reid and House Minority Leader Nancy Pelosi all prefer a single-payer system. Oh and so
do 81 percent of Democrats.
So how is the Sanders-Obama-Reid-Pelosi health care paradise working out?
Both Medicare and Medicaid pay doctors hospitals and other health care providers government-set rates--in other words price controls. Those reimbursement rates are low on the mainland but much lower on the island.
According to the New York Times Medicare pays Puerto Rican doctors about 60 percent of what doctors receive on the mainland. Medicare Advantage pays health plans about 60 percent--before an 11 percent cut in January.
The Times story says Puerto Rico has lost more than 3000 doctors in five years. Patients are waiting months to see a doctor.
And its not just doctors who are scarce. In San Juan the Puerto Rican capital beds in hospital emergency rooms line the hallways. There are so few nurses that people often hire their own private nurses during hospital stays writes the Times.
Remember this a story about the U.S. territory known as Puerto Rico--not communist Cuba.
Puerto Ricans cited in the story are begging for more government money; $25 billion of Puerto Ricos $73 billion debt is a result of borrowing for Medicaid spending.
Many assert that if Medicare and Medicaid paid island providers the same as they paid mainland providers everything would be fine.
But that is exactly the issue. When health care is funneled through government coffers there is never enough money to go around. And when politicians are looking to make budget cuts lower provider reimbursements is one of their favorite options.
On the mainland many doctors limit the number of Medicare and especially Medicaid patients they see which allows them to survive. When almost everyone is on Medicare and Medicaid limiting those patients may not be a viable option.
The good news is we dont have to wait until he is elected to see Sanderss ideal health care system; we can look at Puerto Rico. The bad news is thats the system virtually all Democrats really want.
Todays PolicyByte was written by Dr. Merrill Matthews resident scholar with the Institute for Policy Innovation.
