Some pundits have taken to warning supporters of Medicare for All that it is a gift to Republicans in the general election. Supposedly, Medicare for All would dismay the vast majority of Americans who are broadly satisfied with their employer-provided insurance.
And as Representative John Delaney declared in the first of the two Democratic debates, if you got rid of other forms of insurance and reimbursed hospitals at Medicare rates, hospitals would soon go broke because private insurance pays hospitals higher rates and in effect subsidizes Medicare. As Jeff Greenfield observed in a piece for Politico, Delaney made that point in the first debate taking a shot at Bill de Blasio, but the real targets are Elizabeth Warren and Bernie Sanders.
Sounds plausible, but let’s think a little harder. The premise is that if we enacted Medicare for All, we could simply cover everyone under existing Medicare and not change anything else in the system. But that’s not how the actual reform would work.
For starters, we’d have to rid the system of much of its commercialism—all the other middlemen who add costs, and not just the insurance companies. Secondly, we’d have to change the way physicians and hospitals are compensated, to get rid of the incentives to raise costs. Third, we’d retain the right of people to purchase supplementary insurance.
Somehow, all of the nations with universal health insurance manage to achieve these feats. Hospitals get enough funding to deliver good care; consumers have ample choice; doctors have decent compensation and much less arduous conditions of practice; no parasitic entrepreneurs get filthy rich off of other people’s suffering; and the entire system operates at far less cost.
In short, the transition to Medicare for All or some other variant of single-payer does present policy imperatives as well as a tricky political narrative. But neither challenge is insurmountable.
People would end up with better, cheaper, and more reliable insurance. And you can’t get to Medicare for All without reforming other aspects of our broken system. As the techies like to say: That’s not a bug; it’s a feature.
The argument that we can’t get to Medicare for All without massive damage to the health system or the health of the Democratic Party is simply a red herring. Shame on the opportunistic Representative Delaney. And the pile-on pundits need to dig deeper and think harder.