Medicare as it Exists Today would be Eliminated and Health Care would be Rationed Medicare for All is not based on Medicare
By Dr. Merrill Matthews
WASHINGTON D.C. (Texas Insider Report) One of the major policy debates of the 2020 presidential race will be Medicare for All." It even has its own acronym: M4A.
But almost nothing its backers claim is true:
- Medicare for All will not save money
- Nor be more efficient
- Nor provide better care
- Nor reduce waste.
- Just look at the Veterans Administration which the government has run for nearly 100 years.
Medicare for All is a euphemism for a government-run single-payer health care system in which a government plan replaces private health insurance.
Proponents have latched on to the Medicare for All name as a marketing ploy because most seniors like their Medicare coverage.
However Medicare for All is not based on the Medicare program. Medicare as it exists today would be eliminated and replaced by a different government-run system.
Many Democrats have long supported single-payer health care including Barack Obama Nancy Pelosi and Harry Reid. They were once reluctant to admit it. No longer.
M4A will almost certainly be part of the 2020 Democratic platform. Indeed most of the Democrats who have announced a presidential bid now claim to prefer a single-payer system similar to the Medicare for All legislation proposed by Vermont Senator Bernie Sanders and a bill in the House that includes more than 100 Democratic cosponsors.
But while M4A proponents wont tell you about a single-payer systems numerous problems we will.
The Failing Health Insurance System Is Obamacare
Democrats claim M4A is necessary because health care costs too much and the private insurance system isnt working. But that system" theyre criticizing is the Affordable Care Act crafted and passed by only Democrats which was supposed to provide excellent coverage with a wide range of affordable options.
If Obamacare had worked the way Democrats promised there would be little need for Medicare for All. Democrats are now shamelessly asking voters to trust them to fix all the health care problems that they said Obamacare would correct but didnt.
How Single-Payer Systems Control Health Care Spending
M4A proponents point out that single-payer countries spend less on health careoften much lessthan the U.S. But thats not because those systems are more efficient.1
Rather in those countries politicians set the health care budget. The country is only allowed to spend a predetermined amount on health care.
Suppose a family spends $400 a month on food. But a job layoff or unexpected expenses force it to cut back to say only $200 a month.
No one would consider a 50 percent top-down cut in the food budget efficient or a model for anything. And while the family may survive on the reduced amount it likely wont be able to have what it enjoyed at $400 a month.
Thats essentially what happens in most countries with government-run health systems.
A government-set global budget" for health spending is not the same as cutting waste or operating more efficiently. Indeed when bureaucrats arbitrarily impose budget and price controls they often increase waste and inefficiency.
If You Like Your Employer-Provided Health Coverage You Cant Keep It
President Barack Obamas if you like your health plan you can keep it" claim became Politifacts 2013 Lie of the Yearquite an accomplishment for a president.2
But thats not even an option under the full Bernie" single-payer plan. All traditional health insurance would go away including the roughly 180 million workers and their dependents with employer-provided coverage.3
According to the Employee Health Benefits Institute 81 percent of workers with health benefits are satisfied with them.4 Those employees would lose that coverage under M4A.
Some Single-Payer Countries Allow Opt-Outs
Many U.S. single-payer advocatesincluding Sanders the new House bill and the group Physicians for a National Health Programwant everyone to be in the single-payer system. They believe that if allowed higher-income people would opt out of the national plan reducing the pressure on Congress to keep the government program adequately funded.
It doesnt have to be that way. In Great Britains single-payer system known as the National Health Service people are allowed to opt out and buy private health insurance and pay private physicians. About 10.5 percent of the public takes that option even though care through the NHS is essentially free.
While some Democrats would prefer a more limited Medicare for More" buy-in option that would allow private insurance to continue most of those driving the Democratic agenda believe everyone must be in the socialists health care paradise to prevent a two-tiered health care system.
Care Will Be Rationed
All government-run health care programs ration care. Some rationing is subtle some is blatant. But they all do it.
When the government pays for health care it must compete against other claims on government funding such as welfare defense and education. As a result there is never enough money to go around. NEVER!
So politicians look for subtle ways to limit health care spending that affect smaller populations to free up money for other claims on government funds.
That means cutting at the margins at least initially: the very old the very young and the very sicki.e. people who typically dont vote.
Thus a 65-year old might be able to receive a pacemaker but perhaps not at 75 or 85. An otherwise healthy teenager hurt in a car accident might receive significant resources while a premature infant with only a small chance to survive might not.
It may sound cruel but it makes sense. Given a zero-sum game where a dollar spent on one patient is a dollar that cant be spent on another maximizing the benefit is likely the best way to decide who receives how much.
Another way to ration is through waiting. For years the Vancouver-based Fraser Institute has published an annual list of waiting times in Canada.
Ironically among single-payer systems waiting lines can be a feature not a bug. When famed Canadian pediatric orthopedic surgeon Dr. Walter Bobechko invented a spinal clamp for children with scoliosisknown as the Bobechko clampthat would help them leave the hospital in a few days rather than several weeks he claimed hospital management criticized him.5 Those quicker departures opened up beds sooner creating additional costs for the hospitals limited budget. Dr. Bobechko eventually left Canada to practice medicine in Texas.
The U.S. by contrast generally has an open-ended health care spending system even for the two largest government-run programs Medicare and Medicaid.
However because both programs impose price controls patients may be denied certain therapeutic optionse.g. more expensive medical devices or pharmaceuticalsand doctors offices may limit their Medicare and Medicaid patient loads creating longer waits to see a doctor.
While there is already rationing for both Medicare and Medicaid patients it is often limited and subtle. Under M4A rationing will be open and explicitand widespread.
The Government Decides Which Treatments You Can Have
Government-run health care systems decide how to allocate funds in two primary ways: cost vs. benefits or political power. If bureaucrats believe a new drug or medical device is too expensive compared to the benefits they likely wont cover iteven if that is the best option for some patients.
Or the government may force patients to try the least-expensive options first known as step therapy" or fail first" before trying a more expensive therapy. Indeed that approach is already being proposed by Medicare as a way to save money.
Finally diseases the media and prominent politicians care about most are likely to receive more funding than those less fashionable.
The same people who designed Obamacare with all of its problems now want the public to trust them with creating a whole new health care system.
Yes there are problems with the current health insurance system problems made worse by Obamacare. But if patients dislike it when an insurance company gets between them and their doctor wait until a bureaucrat plays that role.
Dr. Merrill Matthews is a resident scholar with the Institute for Policy Innovation.
1. Bradley Sawyer and Cynthia Cox How Does Health Spending in the U.S. Compare to Other Countries?" Peterson-Kaiser Health System Tracker Dec. 7 2018. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-relative-size-wealth-u-s-spends-disproportionate-amount-health
2. Angie Drobnic Holan Lie of the Year: If you like you health care you can keep it" Politifact Dec. 12 2013.https://www.politifact.com/truth-o-meter/article/2013/dec/12/lie-year-if-you-like-your-health-care-plan-keep-it/
3. Americas Health Insurance Plans Employer Health Costs Rise Slowly" Aug. 2 2018. https://www.ahip.org/chart-employer-health-costs-rise-slowly/
4. Lisa Greenwald and Paul Fronstin The State of Employee Benefits: Findings From the 2018 Health and Workplace Benefits Survey" Employee Benefit Research Institute EBRI Issue Brief No. 470 Jan. 19 2019. https://www.ebri.org/docs/default-source/ebri-issue-brief/ebri_ib_470_wbs2-10jan19.pdf?sfvrsn=c5db3e2f_2
5. Graham Rockingham Painful Surgery and Months in a Body Case May …" United Press International June 19 1981. https://www.upi.com/Archives/1981/06/19/Painful-surgery-and-months-in-a-body-cast-may/5109361771200/