Is Medicare for All, all that?

Last week’s Democratic debates got all the candidates and much of the country talking about health care, and that’s a positive regardless of your politics.

A Pew Research Poll earlier this year found that while the economy was the top priority for Americans, health care was a close second. A Gallup Poll determined that 45 percent of adults are concerned that a major health event could lead to bankruptcy.

Our level of satisfaction with the health delivery system often depends on our personal experience.  An individual who has had life-saving cancer surgery will have a far different view of health care than someone whose insurance company had denied a procedure or prescription.

To say the least, the health care debate is complicated.

The Medicare for All plan floated by several of the Democratic presidential candidates has some traction.  A Marist Poll conducted last month found that most Americans still don’t like the idea—54 percent—but four in ten Americans believe they would be better off with a national health insurance program with no private insurance.

One of the appeals of Medicare for All is the simplicity; everybody has access to any care they need, including medical, dental, vision and long-term, and they pay nothing out-of-pocket.  Providers have a single source (the federal government) to deal with.  No hassles with insurance companies.  And everybody is covered. Cradle to grave.

But simpler does not necessarily mean better or cheaper.

A 2016 research report of Bernie Sanders single-payer plan by the Urban Institute determined that federal expenditures on health care would increase by about $32 trillion between 2017 and 2026. The report also found that Sanders’ tax proposals would only cover about half the cost, meaning taxes would have to be much higher than Sanders predicts.

The Urban Institute is a non-partisan, but left of center think tank, so I also looked at research by experts on the right.  A study by the Mercatus Center at George Mason University, which is funded by Charles Koch, reached a similar conclusion.

Their report puts the ten-year price tag at nearly $33 trillion. “Doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan,” Mercatus concluded.

Mercatus also found that if health care is “free,” more people are going to use it more often. That could increase wait times for doctor visits and procedures.  Canada’s socialized health delivery system is popular—74 percent say they receive excellent or very good care from their regular doctor—but it is also beset by long waits.

Another significant issue in this debate is whether we are willing to give up private health insurance through our employers.  According to the U.S. Census Bureau, 56 percent of the population had employer-based insurance in 2017.

Employer provided health care has been a stalwart of the labor movement for years. How willing will unions be to give up benefits they fought for, and in some cases sacrificed salary improvements for?

I’m only scratching the surface here, but I do want to join in the debate about what our health delivery system should look like and try to get beyond the talking points. I look forward to reading and hearing your comments today and during the presidential campaign.






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