A lot has been said the past few weeks about Medicare for All. On one side, it’s the end of America’s health care problems. On the other, it’s the beginning of a socialist regime coming to take down America as we know it.
When you boil right down to it, half of the country thinks health insurance is a right, and should be guaranteed by government, and the other half thinks Americans should be free to decide for themselves. But the choice between Medicare for All and the alternative, health care markets, is really a choice between more or less government.
Senators Bernie Sanders, Cory Booker, Kamala Harris, Elizabeth Warren, and Democratic rising star Alexandria Ocasio-Cortez have all backed plans to expand Medicare. While it’s hard to decipher what is politically expedient and what is a core party platform, one thing is for certain, Medicare expansion means taking all of the baggage with it.
Medicare has been on the Government Accountability Office’s (GAO) high risk list since the report’s initial release in 1990 because of its “size, complexity, and susceptibility to mismanagement and improper payments.” Last year, Medicare and Medicaid paid out a combined $89 billion in improper payments. That’s about the size of the Department of Education ($60 billion) and the Department of Energy ($29 billion) combined. Now, imagine adding every American to Medicare. You could probably guess that if its “size, complexity, and susceptibility to mismanagement and improper payments,” are already an issue, that problem would greatly increase.
There’s also the sentiment that Medicare is the gold standard of health care. However, according to Gallup, only 43% of Medicare beneficiaries rate the program satisfactorily. In comparison, over 77% of Americans with private health insurance rate the quality of their health care as “excellent” or “good.” Further, a whopping 53% of Medicare beneficiaries are pessimistic that the Medicare program will be able to provide adequate healthcare coverage in 20 years.
Seniors and beneficiaries must read the news, because the Social Security and Medicare Trustees concur with their outlook of the program. The Trustees’ most recent report projected Medicare’s hospital insurance fund will be depleted in 2026 – three years earlier than expected.
Many supporters of the Medicare for All movement assume the quality of our health care system would remain unchanged, if implemented. But if Canada’s single-payer health care system offers any foresight, it will not.
Last year, the Fraser Institute released a report showing that wait times in Canada were rising, hitting all-time highs. Dr. Matthew A. Plant said in the Huffington Post last year, that in Canada, “Everyone has access to free medical care that is ‘good enough.’ If you want to pay for better health care, you can’t. That’s why those who can afford to, tend to go down to the U.S. for care if they have anything serious happen to them. You can have the greatest doctors in the world, but if the bureaucrats that run the system are making them treat patients with one hand tied behind their back, are they going to be delivering the best possible care?”
The U.S.’s doctor shortage is also something to consider, as doctors get reimbursed 40% less from Medicare than private insurance. One could only assume if doctors, who spend decades in school and training, are forced to take a 40% cut across the board, it would make the field much less appealing.
Finally, and perhaps most importantly, there is the cost to consider. “Free” health care isn’t really free. According to the Urban Institute, a Medicare for All plan could cost $32 trillion over 10 years. Doubling Americans’ taxes wouldn’t even cover the costs of such a program, says another study. “The problem with health-care costs is that they rise faster than wages, GDP or most anything else … You wouldn’t just need to raise taxes. You’d need to raise them again and again and again, because every tax increase would soon be outpaced by Medicare’s growth,” says Ezra Klein, former journalist for The Washington Post.
With over $110 trillion in unfunded liabilities and a $21 trillion national debt, Medicare expansion would only add to the economic burden of future American generations, and leave our health care system with more question marks than before.
The alternative to single-payer health care, is of course, health care markets. Markets have worked in many facets of our economy, yet they have eluded the health care industry. Pursuit founder and former Senator Tom Coburn advocates for an “open, competitive and transparent market” that would allow consumers to choose coverage that is right for them:
“In almost every area of the economy – with the exception of health care and education – every generation of Americans, and especially millennials, expect the right to shop and exercise choice…Competition fuels innovation and provides more options people want to buy. That’s how markets work. The problem is not that health care markets have failed. The problem is that they have never been tried.”
With all of the free market’s upside, it too carries baggage. There would still be millions of uninsured Americans, whether they chose that path themselves or simply cannot afford to pay for health insurance, and there’s no guarantee a market would stave off rising health care costs.
There’s no question the United States has severe issues with its health care system, but anyone caught in the middle of the debate should understand that the real choice is between more or less government. High quality care for most, or middling care for all. That seems to be the choice Americans have moving forward.