If you look at the Google search trends for the words “Medicare for All” over the last 12 months, you’ll a significant spike in the last 30 days.
It’s easy to understand why — the Democratic primary has brought the subject of a universal health care system to the limelight. Supporters of Medicare for All including Democratic Presidential candidate Bernie Sanders. On the other side, former Vice President Joe Biden and others are against the idea. To say the topic has generated a lot of debate would be an understatement.
While there have been numerous polls on how the general public sees “Medicare for All,” there aren’t as many industry surveys on the concept. The reason is obvious — most health care CEOs are against the idea. You don’t need a survey to understand that.
And then there’s Eric Dickson, MD, CEO of UMass Memorial Healthcare. Dickson, who became CEO of the Central Massachusetts-based health system. in 2013, praised Warren’s Medicare for All plan in a letter to the Senator and received a public compliment from the candidate in return on Facebook.
Health Evolution spoke to Dickson about why he has come out in favor of Medicare for All, what the reaction has been from his employees and peers and more. Below are excerpts from this conversation.
Health Evolution: You have been one of the few — if not only — health care executives to support Medicare for All. What implored you to speak out in favor of this?
Eric Dickson: When you’re put into the role of CEO, you have a fiduciary responsibility to your organization. As these policy changes come up, everyone’s first reaction is “What’s best for my organization?”, instead of stepping back and saying, “What’s best for society as a whole?” Sometimes you’re conflicted with … this may not be good for UMass Memorial Healthcare or for the organization vs. what do you think is best for society. This is one of those things where Medicare for All, as its designed and as people talk about it, might be bad for UMass Memorial Healthcare. But I think it’s the right thing for society. I talked to the board and said, “I have to support this because of the principle. It may not be great UMass Memorial Healthcare.” The board was supportive of me speaking out.
Health Evolution: Why is Medicare for All worth the risk of supporting it even though you recognize it might not be the best thing for UMass Memorial?
Dickson: I’m focused on the problems we’re trying to solve. What’s wrong with the U.S. health care system today? And then you compare any solution that’s proposed as to whether that is likely to fix those problems.
The biggest problem for me is the number of uninsured people. Even in Massachusetts with the highest coverage in the country, 10% of the population is not covered. I run into it all the time in this state. And then you have an administrative burden that is put on physicians by dealing with multiple payers and denials and documentation requirements, pre-authorization forms. We’re seeing physicians spend a significant portion of their time, not taking care of patients, but taking care of paperwork. That’s a huge issue. And then you have health care systems that takes care of a relatively small percentage of the poor. And those that take care of a high percentage of the poor, they get paid differently. The hospitals taking care of the wealthy class get paid twice as much than places taking care of Medicaid beneficiaries.
What I’ve said is that any proposal that comes forth needs to address these three things, while dropping the cost of care for patients. When Warren put her plan out, it checked all those boxes. It wasn’t so much Medicare for All, because that means different things to different people, but it was the best plan. Joe Biden came out with a public option, but that doesn’t help bring Medicaid people up to a Medicare rate. It would make things worse. Sanders’ plan, there isn’t enough there that addresses administrative simplification or that tertiary medical centers are paid at a slightly different rate. He hasn’t talked about Medicare Advantage as an option, which would allow us to move things forward.
Eric Dickson, MD, , CEO of UMass Memorial Healthcare
I’ve looked at and read all the plans as they’ve come out. Of all the plans, [Warren’s] plan works the best and it happens to go under the title of Medicare for All. I could switch tomorrow if there was another plan that has a better pathway. I haven’t seen anything that’s better than her plan yet. I want to assess people’s plans and whatever one solves those problems, that’s the one I’ll support.
As a leader, these candidates don’t know this business well. I know [President Trump] said, “Health care is complicated, who knew?” He’s right about that. The people want to know what the experts in health care say. I go out and give talks in town halls about why health care costs so much. I feel obligated. This is a major gap between us and other wealthy countries. We don’t have everyone covered and we routinely fail to address the social determinants of health. I’ll continue to be on my soap box until that gets solved. It’s what I believe.
Health Evolution: How have people reacted when hearing a CEO advocate for Medicare for All?
Dickson: I thought there would be a lot of pushback and backlash. In fact, the opposite has happened. Other health care system leaders have come out and supported my position. [Michael] Apkon of Tufts Medical Center, who comes from Canada, talked about how single payer isn’t that bad. At a national level, you’re starting to see people coming out in support. Once one speaks out, others are willing to do so as well. I knew there were people who believe what I believe.
And I come from a system that might be devastated by Medicare for All, and I still believe single payer is the way we have to go in this country. It’s the only way to solve most of the problems we have in health care.
Health Evolution: If you’re a CEO speaking out on something controversial — or maybe not speaking out, how do you deal with potential backlash from your employees?
Dickson: Some people said I was picking a candidate. I was using my office to pick a candidate. That wasn’t the case at all. I was looking at the proposals for health care finance reform and explaining why I thought this was the best one. I wrote to my employees exactly what I stand for and what’s important.
First words out of my mouth [whenever someone has backlash], “Thank you, I appreciate your feedback. This is why I believe the things that I said. I completely respect you have a different opinion.” What I have trouble with is, “I hate Obamacare because X.” They tie the policy to the person. Obamacare was largely mimicked after the Massachusetts plan from Mitt Romney, when he was governor.
[Read more: CEOs are divided on speaking out in polarizing times]
Every other wealthy country in the world covers all its citizens with basic medical insurance. I had a case we discussed today about a child that died and was lost to follow up because they didn’t have health care insurance. We’ve seen things in the paper where kids couldn’t get their seizure medications and seized to death. There was a gap in coverage, and they couldn’t get the pharmaceutical prescription filled. That shouldn’t happen here. Kids shouldn’t be without insurance. We shouldn’t force doctors to jump through one thousand hoops to give the patient medication they need.
Health Evolution: Why are CEOs being asked to speak out more?
Dickson: Our current political environment seems to not be based on reason/principle, but on the color of your tie or which side of the aisle you sit on. It’s incredibly frustrating to all of us. John McCain, God rest his soul, who did not support the Repeal of Obamacare within the Senate, said it best. This is not way our political system is supposed to work. There is supposed to be a debate about the facts and principles. Not just voting with one party or the other. That was a landmark vote. One of the most conservative Senators out there voting against an Obamacare repeal because of the principle. The nation is looking at the way politics is being conducted in 2020 and feels the urge to speak out on multiple things, whether it’s Medicare for All, undocumented immigrants or something else. Party politics is driving us to speak out.
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