politics
economics
Medicare for All Just Isn’t Going to Happen
Boston University, New York Times
Washington Post
0
0
Genesis
Response
Penultimate
Finale
August 17th, 2019
The Democratic candidates for president, as well as many in Congress, are proposing and debating Medicare for All. Many people have strong feelings in favor or opposition. It’s not always clear what they’re favoring or opposing, though. So, when I talk to anyone about it I always start with these questions:
1. What does "Medicare for All" mean? Some insist it means that the federal government will pay for every dollar of every health care need of all Americans (no private insurers). But others say that it might have gaps that private insurers could fill in. Some say it might have cost sharing or even premiums, others say it won’t. Some point to the existing Medicare program, which is kind of like Obamacare's Marketplaces but with a public option. All of these and other ideas have been called "Medicare for All.”
2. Shall we suspend the laws of politics for this discussion? That is, are we talking about what would be "best" for the country in some ideal world? Or are we talking about the "best" we can get given political realities? There is a huge difference between these two.
My preference: all types of Medicare for All are up for debate, and we include political reality. Including politics is important because if you ignore it, you end up comparing our current, politically compromised system with some ideal that is unlikely or impossible. That's apples to oranges.
Putting this together, the most I see happening in the foreseeable future is a public option and, even there, perhaps only by some states. It is conceivable that in those states, the public option could crush private plans and then it would become a single payer in those states. That's for the market to sort out.
Nationally, it's hard to see substantial movement without a massive Democratic wave. Let's keep in mind that the Democrats controlled the presidency and both congressional houses in 2009-2010 and Obamacare is what they were able to pass. Even a public option didn’t survive. One need not be happy with that, but it does put the possible in perspective.
To those who think a national Medicare for All program that does away with private coverage is politically possible, I suggest thinking about the following. It would eliminate health plans on which a majority of Americans rely and many want to keep. It would wipe out a ~$1.5 trillion industry (health insurance). Though shifting to public financing would do away with premiums, it would require a large tax increase. Any one of those would be unprecedented. All three at once? No way.
Finally, it's instructive to look at existing Medicare, which reflects decades of political compromise and is relatively stable and very popular. It has a public option in competition with private plans (Medicare Advantage). It's not perfect, but it's a structure we have some experience with. A good place to start is to ask, what's wrong with that?
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