As we move forward toward the 2020 elections, one of the things being proposed is a “Medicare for All” plan to replace the Affordable Care Act. Medicare for All was originally proposed by presidential candidate Bernie Sanders in 2017. This has also been championed by Alexandria Ocasio-Cortez, a freshman representative from New York City. This plan lowers the age to qualify for Medicare to age 50. The reasoning behind this is people ages 50-65 are older, not as healthy and require more care; therefore, they are more expensive for employers to insure. Ultimately, the goal of the Medicare for All, as it has been undergoing metamorphosis, is to eventually eliminate health insurance companies (as the age where people were covered is continually decreased to age 40, etc.) until eventually all were covered. In addition, drug company profits would fall considerably because the government would control health insurance and, in theory, have more bargaining power. In addition, doctors and hospitals would have to take pay cuts.
In 2018, Kenneth Thorpe at Emory University estimated this plan (just to lower Medicare to age 50) would cost $2.4 trillion per year, while the Urban Institute calculated $2.5 trillion a year. The Committee for a Responsible Federal Budget estimated an annual cost of $2.8 trillion which is 20% of the gross national product of the U.S. This is twice the health care portion of the GNP of other nations (although the US has a much larger population (Ghilarducci, 2018) and about 2-3% higher than the current rate.
Essentially, Medicare for All is a single payer system where the government controls health care and consumers ultimately have no choice; what is available to them is controlled by the government. Additional information about this plan indicates that all private insurance plans would be eliminated under some proposed versions.
It is important to note that other nations such as Australia, the United Kingdom (UK) and even China who tried to institute a “universal” single payer option all went back to also offering a private insurance option. Even Germany, who is touted as a model for health care, used a multi-payer system and has both public and private options.
When the government controls health care and there are no other options, there is a potential capacity problem. This is experienced in the UK and other health care systems where instead of waiting three days to three weeks to see a specialist, the patient may wait three months or more. In a universal public system only, certain procedures and care are not available because the benefit of all outweighs the benefit of the many. This may be fine in theory, but when it directly affects a loved one who cannot get a specific cancer treatment or a transplant because it is not authorized, this presents a very different perspective.
On April 1, 2019 Forbes reported that the UK’s system which is essentially like Medicare for All is collapsing. Over 250,000 British patients are waiting more than 6 months for planned treatment and over 36,000 have been waiting for treatment 9 months of more in the public system. In addition, 25% of cancer patients in the US did not start their cancer treatment on time even though their physician submitted an urgent referral. This is further reflected in cancer survival rates: in Britain the five year breast cancer rate is 81% compared to 89% in the US, while the five year survival rate for prostate cancer in the US is 83% compared to 97% in the U.S. (Pipes, 2019). There is another aspect this this; the UK population was 66 million in 2017, while the U.S population is 326 million or 5.3 times that of the UK. This also means more taxpayers; however, according to the Tax Policy Institute (2019) only slightly more than half of American pay taxes. This is compounded by the aging of the Baby Boomers and underemployment of younger generations who now live with parents and become adults at age 27 or older.
It is important that U.S Citizens educate themselves about the potential effects of health policy since it directly affects them and their families. Medicare for All may sound wonderful at first blush, but citizens need to realize it could result in a much different level of care, increased waiting times, and higher taxes. These potential ramifications are not emphasized in the popular media. However, more conservative organizations such as the Heritage Foundation have addressed potential issues that could occur. This issues may be something citizens are willing to accept, but they should not blindly accept what they are told without examining it for themselves. As this proposal continues to be evaluated by health policy experts, American citizens owe it to themselves and their fellow citizens to examine the potential ramifications objectively and realistically, rather than emotionally and idealistically.
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