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.

Published in Economics, Healthcare
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There are 44 comments.

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  1. Mendel Inactive
    Mendel
    @Mendel

    Mark Camp (View Comment):

    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.

     

    At the risk of being rude, I have no idea what you’re trying to convey in this comment.

    • #31
  2. Bob Thompson Member
    Bob Thompson
    @BobThompson

    Mendel (View Comment):

    Mark Camp (View Comment):

    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.

     

    At the risk of being rude, I have no idea what you’re trying to convey in this comment.

    I had to jump to the next page to see if I was the only one who found those ‘explanations’ incomprehensible. 

    • #32
  3. Flicker Coolidge
    Flicker
    @Flicker

    Mendel (View Comment):
    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.

    “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).”

    I think what Pethokoukis is saying is that popular support for MfA goes down to 32% if it will increase taxes.

    • #33
  4. Mark Camp Member
    Mark Camp
    @MarkCamp

    Mendel (View Comment):
    At the risk of being rude, I have no idea what you’re trying to convey in this comment.

    I re-read it just now, and when I figure it out, I will post an update.

    • #34
  5. Mark Camp Member
    Mark Camp
    @MarkCamp

    Mendel (View Comment):
    At the risk of being rude, I have no idea what you’re trying to convey in this comment.

    I just confessed to the Brown-Eyed-Beauty that I’d had a flare-up of a condition I inherited from my father, called Incomprehensible Sermonizing Disorder.  I told her I’d been held accountable by Mendel, one of my compassionate friends–sort of a Ricochet Comments Intervention.  But was avoiding reading any more of the Comments because I didn’t want to come under hostile fire.

    I tried to explain the economics point I had waved my hands over in my Comment, about us conservatives and Rightists seeing only the short-term, fiscal problem with taking the inevitable next step down the Democrat’s road to socialism. Not seeing that, by allowing them to dictate the terms of the argument, we were providing them with the ammunition they needed to win.

    She understood what I was trying to say (she’s well-accustomed to dealing with my eruptions of economic theory and dire warnings to America).  She told me I should just use Medicare Supplemental as a practical example.  How it has gone from yesterday’s Medicare covering “decent, quality care” for all for free, and Medicare Supplemental just covering luxury care for a fee, to now: What was a luxury before is now a necessity.

    I could probably figure out how to develop that into a Comment that would be at least clearer than what I wrote.  But I’m feeling too tired and too stupid–I don’t have any facts in my pea brain about Medicare then or now.  Whenever I step into the sterile, comfortable anteroom to the terrifyingly consumerist-friendly maze of socialized medicine (the latest beta version), I just dump out all of the welfare docs (insurance cards) in my wallet and wait for the receptionist to tell me if she needs any more.

    • #35
  6. CarolJoy, Above Top Secret Coolidge
    CarolJoy, Above Top Secret
    @CarolJoy

    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.

    Except in the future, the term “Mother” will be outlawed as it is far too cis.

    The term has too many connotations of thousands of years of female suppression. Why have women do something that any test tube and laboratory could do better?

    • #36
  7. CarolJoy, Above Top Secret Coolidge
    CarolJoy, Above Top Secret
    @CarolJoy

    Ralphie (View Comment):

    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.

     

    I was so sad to hear about the tragedy of misdiagnosis surrounding your mom’s death. A parent’s death is always difficult, but when it occurs due to medical neglect, that  makes it even worse. The idea of any individual having to endure 6 weeks of unnecessary  suffering is absurd. Period.

    • #37
  8. Chuckles Coolidge
    Chuckles
    @Chuckles

    CarolJoy, Above Top Secret (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.

    Except in the future, the term “Mother” will be outlawed as it is far too cis.

    The term has too many connotations of thousands of years of female suppression. Why have women do something that any test tube and laboratory could do better?

    Oops.  Mea culpa!

    • #38
  9. Flicker Coolidge
    Flicker
    @Flicker

    Mark Camp (View Comment):

    Mendel (View Comment):
    At the risk of being rude, I have no idea what you’re trying to convey in this comment.

    I just confessed to the Brown-Eyed-Beauty that I’d had a flare-up of a condition I inherited from my father, called Incomprehensible Sermonizing Disorder. I told her I’d been held accountable by Mendel, one of my compassionate friends–sort of a Ricochet Comments Intervention. But was avoiding reading any more of the Comments because I didn’t want to come under hostile fire.

    I tried to explain the economics point I had waved my hands over in my Comment, about us conservatives and Rightists seeing only the short-term, fiscal problem with taking the inevitable next step down the Democrat’s road to socialism. Not seeing that, by allowing them to dictate the terms of the argument, we were providing them with the ammunition they needed to win.

    She understood what I was trying to say (she’s well-accustomed to dealing with my eruptions of economic theory and dire warnings to America). She told me I should just use Medicare Supplemental as a practical example. How it has gone from yesterday’s Medicare covering “decent, quality care” for all for free, and Medicare Supplemental just covering luxury care for a fee, to now: What was a luxury before is now a necessity.

    I could probably figure out how to develop that into a Comment that would be at least clearer than what I wrote. But I’m feeling too tired and too stupid–I don’t have any facts in my pea brain about Medicare then or now. Whenever I step into the sterile, comfortable anteroom to the terrifyingly consumerist-friendly maze of socialized medicine (the latest beta version), I just dump out all of the welfare docs (insurance cards) in my wallet and wait for the receptionist to tell me if she needs any more.

    So it’s just another day. :)

    • #39
  10. Mark Camp Member
    Mark Camp
    @MarkCamp

    Flicker (View Comment):
    So it’s just another day. :)

    Yeah.  Thanks for a smile at the end of it.

    • #40
  11. Chris Campion Coolidge
    Chris Campion
    @ChrisCampion

    Ralphie (View Comment):

    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.

     

    It was really that simple.  The cost would have almost doubled the state’s budget, and no one had the stomach (nor, really, the dollars) for the tax increase required to fund it.

    • #41
  12. Chris Campion Coolidge
    Chris Campion
    @ChrisCampion

    CarolJoy, Above Top Secret (View Comment):

    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.

    Yeah.  I have a solution.  It’s called “skip a meal”.

    • #42
  13. Chuckles Coolidge
    Chuckles
    @Chuckles

    Chris Campion (View Comment):

    CarolJoy, Above Top Secret (View Comment):

    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.

    Yeah. I have a solution. It’s called “skip a meal”.

    Your “skip a meal” reminds me of practices put in place during WWII to support the war effort.  (Medical) Rationing for All might ultimately be supported by just such means.

    • #43
  14. Flicker Coolidge
    Flicker
    @Flicker

    Chuckles (View Comment):

    Yeah. I have a solution. It’s called “skip a meal”.

    Your “skip a meal” reminds me of practices put in place during WWII to support the war effort. (Medical) Rationing for All might ultimately be supported by just such means.

    Skipping a meal doesn’t really help, but rather hurts.  I’m pretty certain that it’s a mini-starvation that the body reacts to differently than merely taking in a few hundred Calories each meal.

    • #44
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