The Case For Medicare For All Is Simple It Would Cover Everyone Period Done Right It Would Lower Costs And It Would Ease Paperwork And Confusion
With costs rising painfully, insurance companies denying care and nearly 30 million people still uninsured, America desperately needs an honest health policy discussion. Thats why it has been so disappointing over the past several weeks to watch multiple candidates parrot right-wing attacks on “Medicare for All,” like claiming that it will greatly increase spending on health care or ringing alarms about raising taxes on the middle class.
The truth is the opposite: Medicare for All would sharply reduce overall spending on health care. It can be thoughtfully designed to reduce total costs for the vast majority of American families, while improving the quality of the care they get.
Over my career, I have witnessed the problems with our health care system firsthand. As a pediatrician, I have seen how our fragmented, expensive system hurts children and families. As a researcher at Harvard Medical School, I have studied the causes of waste and overspending in our system. And as President Barack Obamas head of the Centers for Medicare and Medicaid Services, I led the existing Medicare system and helped stand up Obamacare.
Americas Current Health Insurance System
Medicare for All looks very different from the way we pay for health care in the United States today. Under the current system, people get health insurance from a patchwork of different providers.
Most workers buy into health care plans sponsored by their employers. Other people get insurance through various government programs such as Medicare, Medicaid, and the Veterans Health Administration that provide care for specific groups. People who dont fit into any of these categories, such as freelancers, must buy their own insurance on the private market or go without.
This hodgepodge of a system creates a lot of problems. Many Americans have no coverage, and even those who do pay more for care than people in most developed countries. Yet our expensive care doesnt make us healthier. In fact, by most measures, Americans have worse health outcomes than people in other developed nations.
Would I Pay More Or Less Overall
We cant know yet. Everyones existing health care costs are different, and people in different financial situations would see different effects depending on the tax changes under Medicare for All. Depending on the tax funding model and your tax situation, you could end up paying either more or less overall.
Most studies, including Friedman’s own estimates and analysis by the nonpartisan Congressional Budget Office, suggest that overall health care spending would decline under Medicare for All. On the other hand, some models with different assumptions show spending increases instead. For example, a study by the RAND Corp., a nonprofit public policy research organization, suggests that higher demand for health care might outweigh other cost savings, so the country would spend slightly more overall.
About the author:Alex Rosenberg is a NerdWallet writer focusing on Medicare and information technology. He has written about health, tech, and public policy for over 10 years.Read more
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How Medicare For All Could Affect The Health Care System
Medicare for All would shake up pretty much every part of our nations health care system, from the doctors who provide care to the insurers who pay for it. Heres how the plan could affect different types of providers:
- Doctors and Hospitals. They would most likely receive less pay under the new system because Medicare pays lower rates for all forms of care than private insurers do. On the plus side, they would no longer have to worry about unpaid bills from patients who dont have insurance or insurers who refuse claims. They would also have to spend less time on paperwork, which would keep their administrative costs down. Still, the lower payment rates could force some hospitals to close if they can no longer meet their expenses.
- Drug Companies. Once the government takes over the health insurance system, it would be able to negotiate for lower prices on drugs across the board. As a result, the companies that make these drugs would most likely see their profits drop. In the long run, that could discourage them from spending money to develop new medicines.
- Health Insurers. Private health insurers would most likely go out of business as the new program takes over. As a result, people who work for these companies would lose their jobs if the program goes into effect. Sanderss plan sets aside up to 1% of the governments total health spending budget for the first five years of the program to help displaced workers find new jobs.
Having Health Insurance Tethered To Employment Is A Terrible Idea
A protest for health-care justice outside New York Citys barricaded Trump Tower in 2017.
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Weve all heard, read and seen the claims that Medicare for All is bad for the the economy, anti-business, and an attack on the free market. In response, advocates for Medicare for All like myself have instead made the case about the moral urgency of ensuring that everyone has health care, no matter their means.
But what if Medicare for All is the moral and economically smart course? What if a business-friendly figure, like an entrepreneur, explained that Medicare for All would be one of the best things we could do to create better paying jobs, faster new business growth, and an economy that could better compete in the world market?
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Medical Innovation Will Suffer Without Market Incentives
The picture critics paint on this point sounds intuitive enough on first glance. Pharmaceutical companies make more money selling drugs in the United States than they do in countries whose government-run systems set lower rates of reimbursement. If they started making less money in America, theyd have less of an incentive to innovate. Hence, innovation would suffer.
Dig a little deeper, though, and we can ask at least two follow-up questions. First, is it true that our current system is good for medical innovation? Second, even if it were, would this be enough to make that system morally acceptable?
Even if we could be sure that this gamble would work, it doesnt follow that it would be morally defensible. Think about one of the statistics references abovethe much higher rate of infant mortality in the U.S. as compared to Canada and the U.K. If youre an uninsured or underinsured American parent, anyone making the Medical Innovation Argument is essentially saying, Sure, if we gave you national health insurance, your baby would have a greater chance of surviving right now, but by letting your baby dieby in effect sacrificing it to the hungry gods of the free marketwere creating financial incentives that will lead to the development of new treatments that will save other babies in the future. So you really have no legitimate complaint!
Voting With Their Feet: I Couldnt Work There
Many of Canadas most senior physicians and policymakers simply consider health care a human right. Dr. Bob Bell, a former deputy minister of health for Ontario from 2014 to 2019, then responsible for a $50 billion budget, half of all provincial spending, is an orthopedic surgeon specializing in bone cancer who trained at Harvard, and at Massachusetts General Hospital, before running several Toronto hospitals.
I was going to work in the U.S. but what concerned me was the kids we saw with osteosarcoma, he says, a horrific disease that demands intense chemotherapy, inpatient treatment for months, and really aggressive surgery. Bell ultimately had a reckoning. I couldnt work there, he explains. There was such a differential with patients with good insurance and those that didnt have it. I could not imagine working in that environment. People who present with disease need to be treated with equity and equality. It is a human right.
Dr. Emily Queenan, who is American, also voted with her feet after studying biology at Williams College, working for Americorps in Peekskill, New York, in community health, and attending medical school at the University of Pennsylvania, she did her residency in Rochester, New York. She opened a family medicine practice there in June 2009, closing it in May 2014and moving to Canada.
Jose R. Lopez
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How Likely Is It That Medicare For All Will Happen
Likely, but not any time soon, guesses Weil.
I think were divided politically in lots of ways as a country, he explained. I dont see our political process able to metabolize change on this scale.
Plus, healthcare providers, legislators, policy makers, and insurance providers are still trying to wrap their heads around what this change would mean.
On the other side of optimism, McDonough stresses that Medicare for All would have to accomplish what looks like a Herculean task in todays world pass a divided U.S. Congress.
From his perspective, McDonough said financially and administratively, Medicare for All could be achieved, recognizing some significant disruption and confusion as a certainty.
Looking at the current roadmap to healthcare reform of any kind, McDonough said unless the Democrats control the Senate with at least 60 votes, Medicare for All would not be achievable in 2021, even with a President Sanders.
Right now, according to nonpartisan polling, the odds of Democrats retaining a majority in the U.S. Senate is less than 50 percent, he added.
When citizens are polled on the subject, they agree that the concept of Medicare for All sounds good, said Weil. But when you start to talk about disruption in coverage and the potential of taxes to go up, peoples support starts to weaken, he said.
In other words, you may despise your health insurance, but at least you understand just how awful it is.
Additional reporting by Brian Mastroianni
Medicare For All Pros And Cons
Pros and cons for this program partially depend on your income bracket. If you make less than $250,000, Sanders additional tax will not affect you. If you make more than $250,000 a year, or are in the top 0.1 % of household, Sanders tax to pay for Medicare for All would be a con for you.
In addition, universal health care requires healthy people to pay for medical care for the sick. However, that is how all health insurance programs work. Everyone buys in and pays the costs of health insurance, but the insurance company only pays when someone needs medical care or coverage. In every insurance plan, healthier people absorb the costs incurred by sicker people.
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Public Opinion On Medicare For All
According to a KFF poll, 56% of citizens support Medicare For All. Yet, 68% like a public option where a government plan competes with private insurance and is accessible to all Americans.
A majority of Americans feel that taxes for most would increase under a Medicare for All plan. Many also think that more people would have coverage with a Medicare for All system.
How Will We Pay For It
The most important thing to remember when discussing taxes and Medicare for All is that the new taxes are not an additional net cost or spending burden. Rather, they will amount to a mere fraction of what Americans currently spend on premiums, co-pays, and deductibles, which will all be eliminated.
The PERI authors are quick to point out that there are many workable approaches to raising the needed $1.05 trillion in tax revenue, and that their proposed methods are not definitive. Their approach differs from the approach offered in Sanderss bill, for instance. But they explain that they decided on these particular taxes in an effort to finance the program in a progressive manner, with the greatest savings going to the working class and the greatest burden falling on the wealthy.
Here are the four taxes proposed in the study.
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Restoring Health Care Competition
Health care consolidation has also contributed to rising health care costs. One analysis found that over 90% of metropolitan areas had health care provider markets that were either highly concentrated or super concentrated in 2016. And despite the same kinds of empty promises we see every time thereâs industry consolidation â in this case, that bigger hospitals would lead to better care â the data have not borne this out. In fact, itâs theopposite: more competition between providers creates incentives to improve care, and that incentive will only increase under a Medicare for All system where quality, not price, is the main differentiator in the system.
Under Medicare for All, hospitals wonât be able to force some patients to pay more because the hospital canât agree with their insurance company. Instead, because everyone has good insurance, providers will have to compete on better care and reduced wait times in order to attract more patients.
Where The Presidential Candidates Stand
Sanders, of course, did not win the Democratic Primary. Joe Biden, widely considered significantly more moderate, won. Biden has an extensive healthcare proposal which expands many parts of the Affordable Care Act, but does not include a single payer Medicare For All program. Instead, it is based around a public option a government plan only for those who want it, while private insurance companies remain the main driver of healthcare in the US.
President Donald Trump has not offered a comprehensive healthcare plan this time around. Early in his term, he and the Republicans in Congress tried to repeal and replace The ACA, but were unsuccessful.
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The Upshot: M4a Creates A Small Amount Of Manageable Churn But Increases The Overall Demand For Labor And Boosts Job Quality
The job challenge relating to a fundamental health reform is managing a relatively small increase in job churn during an initial phase-in period. Most Medicare for All plans explicitly recognize and account for the costs of providing these workers the elements of a just transition. As noted previously, this sort of just transition is far easier when health care is universally provided.
Besides this challenge, the effect of fundamental reform like M4A on the labor market would be nearly uniformly positive. The effect of a fundamental reform like M4A on aggregate demand is almost certainly positive and will therefore boost the demand for labor. The number of jobs spurred by increased demand for new health care spending will certainly be larger than the number displaced by realizing efficiencies in the health insurance and billing administration sectors.
Finally, the introduction of fundamental health reform like M4Aparticularly reform that substantially delinks health care provision from specific jobswould greatly aid how the labor market functions for typical working Americans. Take-home cash pay would increase, job quality would improve, labor market transitions could be eased for employers and made less damaging to workers, and a greater range of job opportunities could be considered by workers. The increased flexibility to leave jobs should lead to more productive matches between workers and employers, and small businesses and self-employment could increase.
Like Your Insurance Too Bad
Move on to what? To a government takeover that has proven ineffective and deadly all over the world?
After her jaw-dropping declaration, Harris was asked what shed say to those Americans who like the insurance they have, which according to a recent poll, is 71 percent of employed Americans. Harriss answer was, effectively, too bad.
Lets eliminate all that, Harris said, speaking about private insurance and the hassle of getting approval for certain costly procedures. Lets move on.
Move on to what? To a government takeover that has proven ineffective and deadly all over the world?
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What Would I Pay Out Of Pocket
Nothing. You would not pay anything directly to a health care provider, clinic, hospital or insurer. Tax dollars would pay for all of the services you would receive under Medicare for All. By eliminating copays and deductibles, people would have access to health care, Friedman says. People dont go to the doctor because they cant afford it.
Providers would also be prohibited from sending bills for any remaining charges above the amount they receive from the government a practice known as balance billing.
How Did These Systems Evolve
It became nationally obvious that health care improvements were badly needed in Canada when residents signed up to fight World War I and World War II, many of them in poor physical condition thanks to unaffordable medical care. An astounding 56 percent of WWII volunteers failed their initial physical examination. The Depression also hit hard broke patients needed care, and doctors and hospitals had to get paid promptly for it.
Tommy Douglas, grandfather of actor Kiefer Sutherland, is considered the father of Canadian health care, as revered and well known as Martin Luther King to Americans. Born in Scotland, Douglas grew up in Glasgow and Winnipeg, Manitoba. He attended theology school and became an ordained Baptist minister. While studying sociology in 1931 at the University of Chicago, he also witnessed the desperation of Americans in the Depression. He became leader of the Co-Operative Commonwealth Federation, a democratic socialist party. In 1961, it was renamed the New Democratic Party, and is currently headed by Jagmeet Singh.
Douglas led the party to five successive wins in Saskatchewan, pushing to create a provincial medical insurance program. The provinces doctors fought the effort hard, even going on strike in 1962, but the plan went through that year anyway. Throughout the 1960s, successive provincial and territorial governments adopted the Saskatchewan model, and in 1972, Yukon Territory was the last subnational jurisdiction to adopt it.
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