Is Medicare For All The Answer?
Today I read Medicare-For-All Isn't The Solution. I also read nearly everyone's take in the Comments Sections. So, do I agree?The author, Joshua Holland, sees major problems with any 'single payer' model that's ambitious:
* Those with fairly good coverage (and familiar doctors) would be trading a system they like for something else; this is always a hard sell.
* A gradual transition (more than five years, say) would likely be necessary, once victory is had.
* Medicare itself is nearly one third private policies under Medicare Advantage, chosen because the subsidies are sweet; and a quarter of these policies are augmented by extra coverage.
* Politically, it would be a heavy lift, requiring that moderate Democrats in the Senate be on board to be successful.
* European models were commonly formed when healthcare was a fraction of its present size; plus most other systems include a mix of public and private.
* Regarding the question: Why can't medical bills just be paid by the government? Medical bills are commonly reduced by insurers before they pay; so who'd decide what's reasonable? And if doctors and hospitals are told what compensation they're getting, what if doctors quit and hospitals close?
* Serious opposition would move the polling numbers from favorable to negative. Just think of all those who already have health care coverage provided by their employers being asked to pay a large new tax for equivalent coverage.
On the other hand, cutting out the middleman to save money is an idea that's easy to grasp.
Now that most potential Democratic candidates for the 2020 presidential election have come out in favor of Medicare-For-All, the likelihood is that Democrats will advocate for it with little attention paid to its potential problems. The alternatives that might be more likely?
* A public option available on the ObamaCare exchanges. This would be a generic policy without the insurance industry as the middleman. But, the bigger the payer (Medicare), the lower the prices, so the potential savings here might not be as great as desired.
* A gradual, lite, Medicare-For-Those-Who-Want-It. Maybe start with 60-65 year-olds. These would be the sickest of the under-65 crowd, which would mean a lot of extra expense. Who pays the taxes for this kind of step? At least this cohort would be part of a much larger group, so unlike a public option, prices could be bargained down.
* Getting ObamaCare back on track after the Trump presidency. Stabilize marketplaces, expand subsidies for those who can't afford them, invigorate cost-containment structures, and get all states to expand Medicaid.
Where do I come down? I can see the arguments on all sides, though I'm probably on the side of a Hillary Clinton "What's a good first step?" rather than a Bernie Sanders' "What do we want?" But then I'm fairly healthy and have fairly good coverage.
