Medicare for All: Is it the Answer?

          There is little doubt that the healthcare system in The United States of America has problems that need to be addressed. For instance, there is no debating that costs for the average citizen are well above where they should be and that not everyone has the access to healthcare that they sometimes need. In my pharmacy career, I have worked in multiple different community pharmacy settings that range from large chains to small independent pharmacies and I have seen these issues come to light for many patients in each setting which is heartbreaking. However, the only solution so far that has come to light is “Medicare for All” which would essentially enroll all United States citizens into Medicare and guarantee them coverage. While I agree that everyone should be able to have adequate access to healthcare, I do not believe that the current proposals for a “Medicare for All” system would be the best way to solve the problem. 

One of the biggest problems I see in this system, is the ability to adequately pay healthcare professionals such as pharmacists and physicians. There is no doubt that reimbursement rates to pharmacists in the community setting have been falling over the last 20 years. In the past it would be unheard of for a pharmacy to lose any money on a prescription that was filled. Now losing money is becoming commonplace and one of the insurers that tends to reimburse at consistently low rates is Medicare/Medicaid. Medicare and Medicaid will generally reimburse pharmacies based on AWP minus a certain percentage, which can exceed 80%-90% of AWP plus a dispensing fee. This can result in many claims to fall as negative or below overhead cost to pharmacies. Many private plans, however, will reimburse based upon AWP plus a dispensing fee that can vary based upon the PBM. Pharmacies are still reimbursed 15%-25% regardless of how the price is calculated which allows pharmacies to either lose money or make very little on claims from government plans. Pharmacies can still lose money from commercial insurers but reimbursement is generally better from them. For example, one pharmacist I worked with calculated that it cost around $10-$15 in labor, supplies and expenses to dispense one prescription for the pharmacy and it is becoming more common to see margins of prescriptions to fall below that overhead cost which creates an unsustainable environment for many smaller pharmacies. An expansion of the medicare system to all citizens would most certainly increase the difficulty for smaller independent pharmacies to stay in business and could encourage large chains to further cut costs.

A conversion to a single payer system could also further increase the cost cutting that large chains make, making life even more difficult for pharmacists at large chains while potentially having a negative impact on their salary. A decrease in the salary would not necessarily be a bad thing for pharmacists if the cost of living and the cost of a PharmD was not also extremely expensive. Many pharmacists graduate with massive amounts of student debt and a decrease in salary would most certainly deter some students from pursuing pharmacy as well as having those who are either still in school or recently graduated see longer periods of their career in large amounts of debt. 

Another issue I see with this system is the impact it would have on the medical and pharmaceutical industry as a whole. Many pharmaceutical and medial device companies seek to have their products approved in The U.S first as there is better opportunity for them to profit here as opposed to abroad. With a switch to a single payer system, the opportunity to recoup their investment would likely be much lower in the U.S.. This could lead to changes in the amount companies invest in The U.S. and could be detrimental to our economy as whole if some of the large companies decide that it is no longer worthwhile to invest into the U.S. system. 

The healthcare system has problems however, I do not believe that there is one single solution that is adequate to solve them. While an expansion to a single payer system would grant access to all citizens, it has the potential to create serious problems going forward which have not been adequately discussed. It creates opportunities for pharmacists to practice in business environments which are unsustainable. Additionally, while a switch to a single payer system would guarantee coverage for all,  would it be quality coverage? It is up to us as future professionals to be educated to the highest extent and consider the benefits and costs of any change that is made to our healthcare system as they could have serious ramifications going forward for both citizens and healthcare professionals.