Medicare For All -- Aren't You For It?

A Look Under The Hood

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Ok, let's see why not all 2020 hopefuls are on board the Medicare-For-All bandwagon:

Not that this is the definitive study--it's only one estimate, but it gives us an idea of how much $$ it would take to transition from a private insurance system into one in which everyone signs up for Medicare:

(link)

At the link you'll find a chart that shows, over a ten year period, Medicare-For-All costing 32 trillion more than what public healthcare spending would cost if we kept our current, private insurance system.

This would be 2 trillion less (doing away with insurance companies, even while adding many more customers) than if we continued as is, with private coverage for most, and government coverage for the rest.  So, 2 trillion less spent, but covering all.  Sounds good, until you look further.

To get to that 2 trillion less, a switch takes place.  We trade all private insurance, co-pays, out-of-pocket expenses, everything, for coverage that includes everyone in the country, paid for with a very large tax increase.

Importantly, this switch includes all employer healthcare benefits, which is a major chunk of total healthcare spending.  But would companies automatically give you a raise equal to the money they'd been spending on you for healthcare?  No.

Sure, those with limited means would pay less in taxes than would those with larger incomes.  And if every business automatically shifted their healthcare spending to their employees as wages, hey, not such a gigantic lift.  But wouldn't businesses, especially the 50% with the worst bottom lines, find it convenient to limit that transfer (if they realized they had a one-time chance to get out of debt, for example)?

And, there's more bad news: the medical industry takes a hit when paying for Medicare, and especially Medicaid.  The healthcare industry makes this up with higher charges to non-Medicare/Medicaid patients.  So, the industry would get a lot less income.  Sure, there'd likely be cutbacks that could be made.  But many healthcare businesses, especially in rural areas, are already going belly up.  With lower income, there'd simply be all the more reason for a huge number of hospital closures, despite the number of patients rising.

Even if the number of closures wasn't that huge, a fear-mongering goldmine would still be there.  For the young and healthy: not a problem.  But the infirm, elderly and financially vulnerable (not to mention Conservatives trending Moderate) would find the uncertainty very threatening--this, even though those over 65 would see no changes.

Which brings us to the central problem with Medicare-For-All: it's scary for too many people.  Sure, the 10 - 20% who don't now have healthcare, and would get it, are deserving and would vote accordingly.  But, they wouldn't get it if a majority votes for president and senate based on an unwelcome tax increase.  As it is, winning will mean appealing to moderate Democrats in the Midwest.  We're talking about areas of the country under economic pressure that Trump was able to appeal to with his economic populism.  Much higher taxes?  Are you kidding?

A much more likely alternative to Medicare-For-All is the consolidation of ObamaCare (which keeps getting more popular), the offering of a 'Public Option', then Medicare for those 55 to 65, then another step along the way, like Medicare-Buy-In for all.  At that point the plunge to single payer would be much less disruptive and part of a gradual change that everyone could see coming and had grown accustomed to.