Why “Medicare for All” Isn’t Really Medicare at All

 

It was only days ago that Democrats were lambasting the Trump administration for its perceived indifference to the plight of 800,000 federal workers temporarily going without pay. Yet there seems to be little concern about the long-term fate of the more than half-million Americans who work in the health insurance industry from Democrats who support “Medicare for All.”

During a CNN interview Monday, anchor Jake Tapper asked presidential candidate Kamala Harris whether people would be able to keep their private insurance, if they preferred, under her MfA plan. Harris breezily responded “Let’s eliminate all of that. Let’s move on.” Now maybe some of these folks would end up working for the government helping to administer the expanded Medicare program. Others, seeing the writing on the wall, might start transitioning to other work before such a plan was ever implemented. The rest? Well, that’s the way the labor market churns, I guess. Millions of American gain and lose jobs every month, as it should be in a dynamic economy.

But it’s certainly worth noting the trade-off and acknowledging that there would be costs as well as benefits. Granted, consideration about employment disruption in the health insurance sector probably wouldn’t change public opinion about MfA. That, even though healthcare jobs overall have been a massive driver in the recovery of the US labor market since the Great Recession.

But other issues might. For instance: Most Americans support MfA, by a healthy 56-42 percent margin, according to a recent Kaiser Family Foundation survey. They are less likely, however, to support the idea once they hear about trade-offs such as eliminating private health insurance companies (37-58 percent) and requiring most Americans to pay more in taxes (32-60 percent). (Such numbers are hardly surprising if you know that an overwhelming number of the 180 million American with private insurance — 70 percent, according to Gallup — rate their coverage as “excellent” or “good.”)

And then consider what the average American thinks they hear about “Medicare for All.” They probably think everyone would get the same Medicare coverage currently going to their parents and grandparents. Not so. Despite the clever branding, the MfA plan that Harris has supported is actually a universal coverage plan that covers more services than Medicare while eliminating deductibles, co-insurance, and co-pays.

Indeed, once more Americans hear about MfA, they might start wondering how total healthcare spending would be the same or even less under such a regime. As my AEI colleague Ben Ippolito notes in a recent blog post, such fiscal estimates assume Washington would require providers to accept Medicare payment rates for treating all patients — a 40 percent reduction from what privately-insured patients currently pay. That’s a big number, and the comforting “Medicare for All” name barely hints at the sizable economic and policy implications — such as, Ippolito notes, tasking a single federal agency with setting the correct price of any given medical service or procedure — that come with it.

There are 44 comments.

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  1. DonG Coolidge

    The dis-employed could LearnToCode.

    There is a lot of devil in the details, but I assume that MFA means no health services is allowed outside of MFA. No cash. No private insurance. Everyone is treated equal…except politicians…and maybe some elites that can buy into a health exchange. The real problem is that the typical American wants world-class healthcare for $10/month. 

    I get that Dems. like the power grab, but even H. Schultz could not come up with a market-based response to an MFA question. 

    • #1
    • January 29, 2019, at 5:28 PM PDT
    • 3 likes
  2. MACHO GRANDE' (aka - Chri… Coolidge

    Shockingly, Americans balk at free stuff when they find out it isn’t free. What’s really laughable is that there’s an assumption for increased services for something, public or private, will not require additional spending.

    It’s a net increase in gov’t spending and control over peoples’ lives, so details, like how to pay for something, can easily be swatted away by elected simpletons like Harris. Especially when they know they can sell the “free” thing to 51% of the electorate, stay in office, and finance deficits indefinitely through disbursements from the US Treasury ™.

    If Medicare for Some isn’t working, and has multi-trillion-dollar liabilities, what makes anyone think that Medicare for All would work? Wouldn’t it just inevitably be worse, especially with the cost shift, when there’s now no more private insurance to shift the under-payments onto?

    Answer: Yes. Yes, it will be catastrophically worse, and Kamma-Lamma-Ding-Dong won’t be stuck with the results. We will be.

    Which is why that clownshow should be beaten from Fort America.

    • #2
    • January 29, 2019, at 5:38 PM PDT
    • 6 likes
  3. Sweezle Member

    Off topic (sorry James) 

    Please consider a response to Philip Klein’s article in Washington Examiner today “CBO report shows spending, not Trump tax cuts, are primarily driving the nation’s deficits.” I am very interested in your expert opinion. TY!

    https://www.washingtonexaminer.com/opinion/cbo-report-shows-that-spending-not-trump-tax-cuts-are-primarily-driving-the-nations-debt

    • #3
    • January 29, 2019, at 5:44 PM PDT
    • 1 like
  4. James Gawron Thatcher

    James Pethokoukis: Indeed, once more Americans hear about MfA, they might start wondering how total healthcare spending would be the same or even less under such a regime. As my AEI colleague Ben Ippolito notes in a recent blog post, such fiscal estimates assume Washington would require providers to accept Medicare payment rates for treating all patients — a 40 percent reduction from what privately-insured patients currently pay. That’s a big number, and the comforting “Medicare for All” name barely hints at the sizable economic and policy implications — such as, Ippolito notes, tasking a single federal agency with setting the correct price of any given medical service or procedure — that come with it.

    JimP,

    I think we already know how this goes. Jonathan Gruber laid out the game plan. Relying upon “the stupidity of the American voter” you employ a “lack of transparency as a huge political advantage”. For those who need a translation, “you lie”. The Obama Administration lied for 2 years about what Obamacare would do for and do to the average American. The President’s speeches alone, if spoken by a private sector CEO, would have put him behind bars for a long time for the massive fraud.

    They are the same old Democrats. In fact, they have only gotten worse.

    Regards,

    Jim

    • #4
    • January 29, 2019, at 6:24 PM PDT
    • 5 likes
  5. MarciN Member

    The organizers and activists would be more truthful if they called it Rationing for All.

    • #5
    • January 29, 2019, at 6:45 PM PDT
    • 5 likes
  6. Bob Thompson Member

    Just think about it for a minute. What does one do when it doesn’t work or one just doesn’t like it? There is only one thing to do, complain. Ha ha.

    • #6
    • January 29, 2019, at 6:51 PM PDT
    • 1 like
  7. RushBabe49 Thatcher

    Your Life…A line item in the Federal Budget.

    • #7
    • January 29, 2019, at 6:52 PM PDT
    • 7 likes
  8. Ralphie Member

    When Vermont passed single payer and then repealed it, some of the factors that doomed it were that doctors and hospitals didn’t want to take cuts, and politicians didn’t want to pass the tax increase it would cost.

     

    • #8
    • January 29, 2019, at 7:00 PM PDT
    • 3 likes
  9. Slow on the uptake Thatcher

    It’s only a matter of time. (Thanks for getting the ball rolling, Lyndon – and Presidents Democrat and Republican since then for expanding it!)

    What I’m trying to envision is how my children and their families will live under it.

    Is there a medical black market in the UK?

    • #9
    • January 29, 2019, at 7:05 PM PDT
    • 1 like
  10. Clifford A. Brown Contributor

    MarciN (View Comment):
    Rationing for All.

    Which is exactly what we need to call MfA every single time on every platform. And every Republican at every level needs to have this phrase burned into their short and long term memory banks, especially into the speech subroutine.

    • #10
    • January 29, 2019, at 7:23 PM PDT
    • 3 likes
  11. Sweezle Member

    RushBabe49 (View Comment):

    Your Life…A line item in the Federal Budget.

    Exactly. Our medical care will be decided by bureaucratic managers not by us with a medical expert who graduated from medical school. 

     

     

    • #11
    • January 29, 2019, at 7:48 PM PDT
    • 3 likes
  12. CarolJoy, Above Top Secret Coolidge

    Sweezle (View Comment):

    RushBabe49 (View Comment):

    Your Life…A line item in the Federal Budget.

    Exactly. Our medical care will be decided by bureaucratic managers not by us with a medical expert who graduated from medical school.

    Yeah, boo on bureaucratic managers, as they are so unlike the current bureaucrats who are part of the absurd current health care predicament. In our current situation, we pay some 300% more than people in other nations for much worse health care. Most Americans pay out premiums, co pays, and wait out illnesses hoping the ailments self resolve, as so many of us have heavy duty deductibles. Then when we do venture out into the world of American medical practice we only receive what some insurance company employee decides we can get. Often we also learn why it is called a “medical practice.”

    Seven hundred thousand people a year face medical bankruptcies here in the USA. Many of these are people who had health insurance. That was our fate in 2005 to 2007 when Kaiser did a major screw up and we were forced to rely on our retirement to survive. At the time we were paying almost 1,000 bucks in premiums each month to participate in this health disaster.

    Beyond the above is the fact that most doctors are into testing, and testing some more, as actually learning how to diagnose a health condition apparently is no longer taught in medical schools. Also there is little concern about how to best cure the ailment. Apparently the big wizards of modern medicine feel it is far far better, for the modern medical model to instruct our physicians and nurses to simply administer pills and injections.

    • #12
    • January 29, 2019, at 9:19 PM PDT
    • 3 likes
  13. Flicker Inactive

    I had to read MfA 5 times before I realized it didn’t mean what I thought it meant.

    • #13
    • January 30, 2019, at 1:07 AM PDT
    • 1 like
  14. Mendel Member

    James Pethokoukis: Yet there seems to be little concern about the long-term fate of the more than half-million Americans who work in the health insurance industry from Democrats who support “Medicare for All.”

    Of all the countless reasons to oppose Medicare-for-All, “won’t somebody think about the poor healthcare insurance industry employees?” is perhaps the worst rallying cry.

    The one aspect of our healthcare system that both progressives and conservatives can agree upon is that our third-party payer system together with our byzantine government/private frameworks have bloated the American healthcare “insurance” industry to a point far past its utility. A huge number of those 500,000 workers Pethokoukis mentions are doing little more than adding dead weight (and cost) to our system.

    So with the requisite “I’m sure they’re all nice, hard-working, well-meaning people”, we should not let the insurance industry’s employment numbers hold us hostage. Many, if not most, of those jobs deserved to be eliminated yesterday.

    • #14
    • January 30, 2019, at 3:26 AM PDT
    • 6 likes
  15. Manny Member

    If anyone is under any delusions of where the Democrats are going, that interview should clear your head. This is their holy grail. They are going for it in 2020. 

    • #15
    • January 30, 2019, at 4:07 AM PDT
    • 4 likes
  16. DonG Coolidge

    The biggest flaw in MFA is that it will be controlled by the US Congress, which is a totally corrupt institution. The outcome will be necessarily corrupted.

    • #16
    • January 30, 2019, at 6:20 AM PDT
    • 1 like
  17. Mark Camp Member

    Mendel (View Comment):
    Of all the countless reasons to oppose Medicare-for-All, “won’t somebody think about the poor healthcare insurance industry employees?” is perhaps the worst rallying cry.

    But it’s effective on the faithful of the magical religion of our time.

    Western civilization can only fix the problem of economic superstition and aggressive stupidity by starting with education in the original sense of the word.

    • #17
    • January 30, 2019, at 6:50 AM PDT
    • Like
  18. Richard O'Shea Coolidge

    Health insurance and health care are two different things. One of the biggest problems is the expense of health insurance. Those that have employer based health insurance are generally happy with the system, as they have no idea of the cost.

    A monopoly is by its nature the most expensive, least effective way of meeting demand. A government monopoly is the worst sort of monopoly.

    We need a competitive, clear, free market solution, like we have with car insurance and life insurance. If there is not an alternative, MfA is the only solution on the table.

     

    • #18
    • January 30, 2019, at 6:52 AM PDT
    • 3 likes
  19. Ralphie Member

    CarolJoy, Above Top Secret (View Comment):
    Beyond the above is the fact that most doctors are into testing, and testing some more, as actually learning how to diagnose a health condition apparently is no longer taught in medical schools.

    Just because the car can be plugged into a scanner doesn’t mean the mechanic doesn’t have to know anything. And so the reliance on technology deceives everyone a lot of time in thinking it is infallable.

    My mother was diagnosed by a PA in the emergency room for mesenteric ischemia. Then the dr. ran a test without dye because my mother had slight kidney dysfunction (not close to dyalisis), and ruled it out. She died 6 weeks later from mesenteric ischemia. The PA didn’t run a test, just talked to her. In the 6 week period, she was treated for the flu and cdiff. She was in so much pain she couldn’t talk and they kept asking her her name and birthday over and over that it was like torture to hear her barely be able to talk. I guess they do that in the hospital now to see if you are mentally cognizant or something. By the time she had surgery, she was too weakened to recover.

    Dr. Gall’s Systemantics: “A complex system that works is invariably found to have evolved from a simple system that worked. The parallel proposition also appears to be true: A complex system designed from scratch never works and cannot be made to work. You have to start over, beginning with a working simple system.”

    I’m 62, and they’ve been talking about reforming schools since I can remember. If I live to 100, I can believe there will still be talk of fixing the medical system. 

     

    • #19
    • January 30, 2019, at 7:11 AM PDT
    • 5 likes
  20. Randy Weivoda Moderator

    For a moment, set aside the obvious problems with Medicare for All, such as the cost and the lack of alternatives when there is only one health insurance policy for the whole nation. I’m also concerned about the inevitable slow loss of freedoms. As it is, some people want to ban or limit how much soda or sugar or salt or whatever you can consume, Michael Bloomberg being a ringleader for this movement. People want to make life miserable for smokers so that they will quit. We already have mandatory seatbelt laws and motorcycle helmet laws. 

    How much more of this will there be when every taxpayer is paying for every other person’s healthcare? It won’t happen all at once. But over the course of decades we will slowly lose our freedom of choice on a hundred different little ways. It won’t just be food and beverages, either. How many recreational activities will be banned because you could hurt yourself? Very popular sports like football will be safe because so many people watch it. But I can certainly picture 60 Minutes doing stories on how many cowboys are injured riding rodeos each year, and for what? Mere entertainment for a small redneck portion of society. Why should someone in Manhattan or San Francisco have to pay for some Oklahoma yokel’s medical bills because he chose to ride a bull? No, we better just outlaw that.

    • #20
    • January 30, 2019, at 12:15 PM PDT
    • 3 likes
  21. Thejokewasonme Inactive

    @Randy Weivoda,

    At first, it would also be a means of added gun control. Over time, it, I have no doubt, would be ever expanded.

    • #21
    • January 30, 2019, at 1:08 PM PDT
    • 2 likes
  22. Flicker Inactive

    Mendel (View Comment):
    The one aspect of our healthcare system that both progressives and conservatives can agree upon is that our third-party payer system together with our byzantine government/private frameworks have bloated the American healthcare “insurance” industry to a point far past its utility.

    Two things. I try to not get sucked into using “health care” as terminology, we are talking about medical care according to current medical science. “Health care” would include any sort of encouraged or coerced “healthy” dietary counseling, and including outlawing or taxing certain “unhealthy” foods, and would include proper rest, relaxation, meditation and massages. This is all not a “right”, and not medical care.

    When we, or actually the Left say health care they really mean and are targeting medical care.

    And secondly, the “bloat” in providing medical care has only to do with regulation; employer purchasing so-called “health insurance”; government-mandated medical care such as Medicaid and Medicare; government-mandated medical coding; billing, HIPPA, EMRs and it goes on. Furthermore, paper was and is fine, but government-mandated EMRs waste time, interfere with doctor-patient relationships and visit times, cost a bundle to purchase, train, and retrain as it’s always up-graded, largely limit temp and part-time employees (from other institutions with different propriety EMR programs) from taking part, and are hackable*. And third-party payer systems always drain more money out of the system as the more demands are made on them and this bloats the system, too.

    We don’t need better and more targeted regulation, we need far, far less. If — if — the government wants to become the insurer of last resort, perhaps that can be tried (and will certainly fail to control costs) but once it’s started it will never go away, and will still grow and grow as the government always does.

    Bloat isn’t naturally in medical care. Government regulation is the driver.

    *(Such as the files for Daniels Ellsberg’s psychiatrist were not, which necessitated the famous “break-in” which helped take down the Nixon presidency, for example).

    • #22
    • January 30, 2019, at 1:21 PM PDT
    • 3 likes
  23. CarolJoy, Above Top Secret Coolidge

    Randy Weivoda (View Comment):

    For a moment, set aside the obvious problems with Medicare for All, such as the cost and the lack of alternatives when there is only one health insurance policy for the whole nation. I’m also concerned about the inevitable slow loss of freedoms. As it is, some people want to ban or limit how much soda or sugar or salt or whatever you can consume, Michael Bloomberg being a ringleader for this movement. People want to make life miserable for smokers so that they will quit. We already have mandatory seatbelt laws and motorcycle helmet laws.

    How much more of this will there be when every taxpayer is paying for every other person’s healthcare? It won’t happen all at once. But over the course of decades we will slowly lose our freedom of choice on a hundred different little ways. It won’t just be food and beverages, either. How many recreational activities will be banned because you could hurt yourself? Very popular sports like football will be safe because so many people watch it. But I can certainly picture 60 Minutes doing stories on how many cowboys are injured riding rodeos each year, and for what? Mere entertainment for a small redneck portion of society. Why should someone in Manhattan or San Francisco have to pay for some Oklahoma yokel’s medical bills because he chose to ride a bull? No, we better just outlaw that.

    The medical people, the government and those who lost family and friends to cigarettes or snuff all got together and went after the smokers. When that happened, I applauded them.

    So now we have a society where every other person is approaching being seriously overweight. Cigarettes did curtail a person’s appetite, so it would be great if someone soon found a healthier solution to appetite control than nicotine products.

    • #23
    • January 30, 2019, at 2:03 PM PDT
    • 1 like
  24. Clifford A. Brown Contributor

    Flicker (View Comment):

    I had to read MfA 5 times before I realized it didn’t mean what I thought it meant.

    Me Too.

    • #24
    • January 30, 2019, at 2:20 PM PDT
    • 2 likes
  25. Slow on the uptake Thatcher

    Randy Weivoda (View Comment):
    Very popular sports like football will be safe because so many people watch it.

    Really? I started playing in high school, 1960. From that day to this, the equipment and the rules have changed radically – not just to make it more exciting for the spectator but to make it harmless for the participants. Sorry, but I don’t think popularity will prevent the nanny state from getting involved. Hasn’t kept the state out of gun regulation, has it. Slowed the process down is about all.

    Your descendants may have to say “Mother may I” before – well, anything. 

    • #25
    • January 30, 2019, at 7:20 PM PDT
    • 1 like
  26. Randy Weivoda Moderator

    Chuckles (View Comment):

    Randy Weivoda (View Comment):
    Very popular sports like football will be safe because so many people watch it.

    Really? I started playing in high school, 1960. From that day to this, the equipment and the rules have changed radically – not just to make it more exciting for the spectator but to make it harmless for the participants. Sorry, but I don’t think popularity will prevent the nanny state from getting involved. Hasn’t kept the state out of gun regulation, has it. Slowed the process down is about all.

    Your descendants may have to say “Mother may I” before – well, anything.

    But I think the nannies will come after the sports/activities that have far fewer viewers/participants first. Especially if the fan base of the activity in question is made up the uncool, such as rural westerners. It’s like with gun control. The smart gun controllers know that they will fail if they propose banning all guns all at once. You have to divide and conquer, so you try to drive a wedge between those who own “assault weapons” and those who own guns that look less Rambo-esque. If they can accomplish that goal, then they can let the issue rest for a while and come back for the next bite of the apple.

    But getting back to the insurance topic, it won’t be just the activists who will be the problem. They already desire to tell us how to live. When every taxpayer is paying for everyone else, it will be the natural inclination of everyone to control their neighbor’s behavior. But hey, maybe I’m mistaken. Maybe people will be live and let live.

    • #26
    • January 30, 2019, at 7:38 PM PDT
    • 1 like
  27. Slow on the uptake Thatcher

    Randy Weivoda (View Comment):

    Chuckles (View Comment):

    Randy Weivoda (View Comment):
    Very popular sports like football will be safe because so many people watch it.

    Really? I started playing in high school, 1960. From that day to this, the equipment and the rules have changed radically – not just to make it more exciting for the spectator but to make it harmless for the participants. Sorry, but I don’t think popularity will prevent the nanny state from getting involved. Hasn’t kept the state out of gun regulation, has it. Slowed the process down is about all.

    Your descendants may have to say “Mother may I” before – well, anything.

    But I think the nannies will come after the sports/activities that have far fewer viewers/participants first. Especially if the fan base of the activity in question is made up the uncool, such as rural westerners. It’s like with gun control. The smart gun controllers know that they will fail if they propose banning all guns all at once. You have to divide and conquer, so you try to drive a wedge between those who own “assault weapons” and those who own guns that look less Rambo-esque. If they can accomplish that goal, then they can let the issue rest for a while and come back for the next bite of the apple.

    But getting back to the insurance topic, it won’t be just the activists who will be the problem. They already desire to tell us how to live. When every taxpayer is paying for everyone else, it will be the natural inclination of everyone to control their neighbor’s behavior. But hey, maybe I’m mistaken. Maybe people will be live and let live.

    I think that’s right, except for one thing. You’re right, it will all happen “Line by line…Here a little, there a little.” The only reason I don’t think you’re mistaken is because I don’t think pigs will fly.

    • #27
    • January 30, 2019, at 8:11 PM PDT
    • 2 likes
  28. Joker Member

    Tax rates of 32 – 60 percent?

    Disagree there. Every country with nationalized medicine imposes a value added tax that adds 10-20% tax to everything you buy. Everything.

    The Big Lie is that VAT is the only way to do it. We’ve become accustomed to expressing paying for social programs by jacking up income tax rates on the “wealthy.” So for most people taking a poll, that means somebody else pays for my benefit.

    VAT pounds everyone, including the 46% of Americans who currently pay no income tax. VAT reaches to those who presently receive Earned Income Credits, which is welfare administered through the tax system.

    I doubt the polls would look that way if Harris and Sanders were forced to admit how Medicare for All gets funded. 

    ‘Cause you know, Fair Share is something Other People should pay.

    • #28
    • January 31, 2019, at 4:00 AM PDT
    • 3 likes
  29. Mendel Member

    Joker (View Comment):

    Tax rates of 32 – 60 percent?

    Disagree there.

    I think you may be misunderstanding what Pethokoukis is trying to say. He’s saying that 32-60 percent of Americans would see their taxes go up under Medicare for All, not that those would be the actual rates.

    Of course, as you point out, taxes would actually have to go up for everybody. But there’s a slight inaccuracy in your comment: even though all countries with nationalized medicine have value added taxes, in many of those countries the VAT is not primarily used to pay explicitly for their health systems. Rather, the VAT typically goes into the general fund while individuals also pay for healthcare separately, either through premiums, income taxes, or something else.

    For example, Germany (which calls its system “public/private hybrid” but is really just nationalized health care) has a 19% VAT, plus nearly everybody pays a flat 15% of their income toward insurance premiums, plus there’s a normal income tax with high marginal rates.

    In other words, in most cases the VAT isn’t linked to healthcare, it’s just another way they get you coming and going.

    • #29
    • January 31, 2019, at 7:06 AM PDT
    • 2 likes
  30. Mark Camp Member

    Mendel (View Comment):
    Of course, as you point out, taxes would actually have to go up for everybody.

    I think that is a common and fatal misconception. That in fact we can have universal medical care, and tax whomever we like. We can tax only the 1 percent, and still have universal medical care.

    It may sound wrong, or more likely pedantic: technically true, but not true in practice.

    If it seems to be pedantic, it may be because you have implicitly accepted the fallacious assumptions about the economy that underlie all collectivist, statist, utopian ideologies, whatever you choose to call them.

    I won’t go into this right now, except to say that the expression “providing free access to quality medical care to all will require higher taxes” is meaningless. If you agree with a politician that it is meaningful, then you have already lost the argument.

    Ricocheteers and those of our general political orientation do understand “that which is seen.” They understand that a further incremental shift of the medical care from the voluntary to the involuntary sector will result, in the short term, in marginally worse and more costly medical care to society as a whole.

    What those of us who accept the premise of the welfarists that the idea is meaningful do not understand is that the unintended consequences of “that which is not seen” must necessarily grow without limit.

     

    • #30
    • January 31, 2019, at 8:38 AM PDT
    • 2 likes
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