The current health-care system needs improving, not dismantling — by Republicans or by Democrats. That’s why I have proposed a mixed-model universal plan that would guarantee health-care coverage through a government plan but would leave Medicare alone and leave private insurance available for those who wish to buy it, with limited tax credits if they opt out of the new plan entirely. The plan would also close the loophole that prevents the government from negotiating drug prices, an essential step for lowering costs.
Medicare-for-all legislation proposed by Sen. Bernie Sanders (I-Vt.), one of my opponents for the Democratic nomination for president, would basically make private insurance illegal; the federal government would pay all health-insurance costs. That sounds good — if you really, really like the government — but there is one fundamental flaw: Overwhelming evidence shows that, under Medicare, the government doesn’t pay the true costs of health care. According to data from the Urban Institute, Medicare pays providers 89 percent of costs, with higher reimbursements from private insurance companies making up the difference.
Over time, the government’s not paying the cost of health care would become a significant problem. In a free-market system — which would still exist even under Medicare-for-all — health-care providers are not going to pursue or maintain a business model that loses money. This year, the New York Times reported that Medicare-for-all would mean “some hospitals, especially struggling rural centers, would close virtually overnight, according to policy experts. Others, they say, would try to offset the steep cuts by laying off hundreds of thousands of workers and abandoning lower-paying services like mental health.”
Moreover, lower reimbursement rates and a lack of competition (remember, there is only one payer: the federal government) would mean there is no market incentive to innovate, develop new treatments or expedite care. Over time, that would be bad for patients and for medical innovation. Medicare-for-all would clearly lead to a decrease in both health-care access and quality.
But the impact would go beyond hospitals. It’s remarkable that this never seems to get talked about during these debates, but under Medicare-for-all, 150 million Americans would lose their current health insurance and be forced to switch to something new. These are people who have employer-based coverage, union coverage or private plans they pay for fully. Gallup polling data indicates that about 70 percent of those with private insurance are happy with their coverage. The coverage works for tens of millions of Americans, and it is one of the most valued things in their lives; Medicare-for-all would take it away.
Medicare-for-all might be popular as a slogan or as a tagline. But it is political suicide. If the Democratic Party emerges as the party that closed hospitals and made millions of people shift out of a health-care plan they like, the electoral cost will be severe. People on both sides of the debate recognize that Medicare-for-all is a significantly more disruptive policy change than the Affordable Care Act. But when the ACA, which was a good law and smart policy, affected people’s existing coverage options and led to higher prices for some, Democrats paid a significant political price. Medicare-for-all would guarantee that this disruption affects 150 million Americans.
It has been baffling over the past few years to watch so many Democrats rush to embrace Medicare-for-all, and it has been disappointing and sad to see many of them now try to equivocate on their position. The Sanders bill is crystal clear in what it would do, and Sanders, to his credit, is upfront about what he believes. But a lot of other candidates are trying to play it both ways with complicated and strange answers. We need to just drop this thing.