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Is Medicare for All Actually the Best for All?

With the 2020 presidential elections quickly approaching, the national debate on healthcare has begun to intensify as the cries for relief from the mounting healthcare costs that are crippling Americans are escalating. Among the public’s 2019 priorities for the next presidential candidate, healthcare costs are ranked the second highest priority, with 69% of those polled citing this as their top priority, a stark contrast from years prior. Keeping that in mind, many on the left have radicalized behind the idea of a single-payor structure, asserting that ‘Medicare for All’ is the answer to everyone’s problems. Except maybe the federal budget.

Since Bernie Sanders started campaigning on the issue in the 2016 presidential campaign, Medicare for All has evolved considerably. Progressive candidates and lawmakers have capitalized on the notion that healthcare needs a major shift, considering Americans currently pay around $10,000 per person per year in health outlays, which is significantly higher than other high-income countries, and there are many who question whether we pay greater costs for more use of better healthcare. All in all, the cost of healthcare is crushing working-class families, costing around $28,000 per year for a typical family of four covered by employer-based health insurance. We’re at a breaking point and something’s got to give.

So, how realistic is it that Medicare for All ever actually gets off the ground? First, funding would need to be made available. An overhaul such as this could cost more than $30 trillion over a 10-year period. Further, the program would need to be funded to make payments sustainable for all healthcare providers—today, nearly all hospitals would go bankrupt under current Medicare payment rates. The “Full Monty” approach program would ban private insurance, meaning it would essentially displace nearly 177 million people from their existing health insurance plans. How would we offset the employer tax implications? This displacement of 156 million with employer-based health insurance also means employers lose the significant tax deduction, resulting in bottom lines being impacted. And from there, it’s just a domino effect, and these are just two of the domino in a long line.

Our current system may be flawed, but Medicare for All isn’t a policy that is feasible in the current electoral landscape. The implications of such a theoretical solution have yet to be fully thought through or resolved. With the House majority Democrat and the Senate majority Republican, nonpartisanship is hard to come by these days, much less in service of an overhaul of the healthcare system. Betting on inertia is the safe bet.

Instead, we need to have a conversation about how electoral politics are shaping healthcare policy as a whole. We’re starting to look at cost differently. Rather than analyzing cost in terms of the total cost of care (thinking value), we’ve fixated on fees for service prices. Further, to that point, health plans and some employers have started to cherry-pick price when comparing costs of care in the interest of each party’s motives. Take the RAND 2.0 Report, for example. The report asserts that private insurance pays higher than Medicare allowable. Yet the sample size is less than 20% of the total hospitals in the country and is built off of figures from only two private insurance companies.  

Rather than focusing on just pharmacy or procedure costs, we need to delve deeper into the total costs that drive healthcare costs before arriving at a solution. The challenges we face today with our current healthcare system are deep and complex. In order to even begin seeking solutions that are equally as complex, we must agree on what problems we’re trying to solve. People are quick to assume a very polarizing “yay” or “nay” response to the question of whether they support Medicare for All or not. What’s missing at that point is any in-depth analysis of the feasibility of this bill, and if any viable alternatives exist in parallel to the current system.

Any overhaul, specifically in the sense of altering the Affordable Care Act to patch the holes that have been found since its implementation, should bring together those necessary special interests to improve the current system. Perhaps we should all take a step back to carefully weigh the pros and cons of each prior to determining what our healthcare system really needs. However, if the current trajectory remains status quo, lawmakers are going to have their decisions dictated by the electorate.

July 16, 2019
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