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 28th, 2019
I agree with you that when we talk about Medicare for All, we need to talk about actual systems, rather than the fantasy health care regime we could have if only we didn't have to pass it democratically. And so I will start by mostly agreeing with you on another front: we're not getting Medicare for All any time soon.
Oh, we might get something called Medicare for All, but that's not what it will be; it will be Obamacare under an assumed name. The fiscal cost of shifting to Medicare for All would be staggering, at a time when we're already struggling to pay for the entitlements we have. The political cost would be substantial, for the reasons you cite. And the abrupt and severe cuts to provider reimbursements which would be required to make Medicare for All even vaguely affordable would destabilize provider networks and hospital finances in ways that are hard to predict, but hard to doubt, either.
Which is, as I see it, also the problem with a public option. If a public option doesn't cut provider payments to Medicare rates, what's the point? It doesn't really save money on administrative costs, since an option means you can't efficiently collect premiums through the tax code, or streamline reimbursement procedures for doctors and hospitals, who will still have to maintain the capacity to bill multiple insurers under multiple rules. It doesn't really allow you to get the sort of gains that health care wonks have always imagined from centralizing care--universal medical records, better care coordination, and so forth. It doesn't make people more secure, since they've still got to pay their premiums.
A public option doesn't, in short, really seem to bring anything to the party except a government-mandated reduction in reimbursements. And in my estimation, that reduction is going to be extremely problematic, both practically and politically.
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