There’s nothing like Medicare for All in other industrialized nations. Not one offers soup-to-nuts government-paid insurance with no copayments.
“We have got to figure out how we pay for it. It’s unrealistic in how we pay for it today.” That was how former Virginia governor and potential presidential candidate Terry McAuliffe characterized Medicare for All, even as he was announcing his support for it.
McAuliffe is certainly right about the unrealistic part, although otherworldly would be a more appropriate description.
Put simply, there is nothing like Medicare for All anywhere in the industrialized world.
Medicare for All proposals, like the House version introduced last month by Rep. Pramila Jayapal, D-Wash., would offer everyone living in the United States comprehensive coverage — doctor visits, hospital care, prescription drugs, preventive care, pediatrics, rehab, mental health, dental, vision, diagnostic tests, long-term care, abortions — with no deductibles and no copayments.
As a result, virtually all of the more than $360 billion Americans spend each year out of pocket for health care would disappear overnight.
So, too, would insurance premiums, since Medicare for All would outlaw any private insurance plan that covers any of these same benefits. Those pesky insurance company hassles would disappear, too.
Read more commentary:
Sounds great, doesn’t it? Who wouldn’t like to see any doctor you want with no limitations, get every test and treatment you need, never pay a dime out of pocket and never have to deal with an insurance company?
Jayapal says, “This is not a particularly ambitious plan, in the sense that so many others have done it.”
Actually, no industrialized nation has tried anything so sweeping. Not one provides soup-to-nuts government-paid insurance that covers everything without any cost-sharing from patients. None. And even so-called single-payer systems rely on some forms of private insurance.
Take Canada’s single-payer program, which is one of the closest models to Medicare for all and is also called Medicare. It doesn’t cover vision, dental, long-term care or prescription drugs. As a result, two-thirds of Canadians buy private plans. And about 15 percent of the nation’s health costs are paid out of pocket.
In the United Kingdom, nearly 11 percent of Brits buy private insurance, despite the country’s single-payer National Health Service. They do so, as the Commonwealth Fund put it, to get “more rapid and convenient access to care” than they can through the government-run program.
Other countries pay out of pocket, we can too
Britain is actually moving in the opposite direction of Medicare for All advocates. As the NHS suffers chronic shortages, lengthy delays and treatment denials, the country’s private health care market has been growing rapidly. It reached nearly $12 billion in 2017 and is on track to reach close to $14 billion over the next four years. Out-of-pocket spending accounted for 15 percent of the British health care budget in 2017. That’s up from 9.4 percent in 2009.
Countries that Democratic socialists like Sen. Bernie Sanders, I-Vt., have lauded as role models also don’t have anything like Medicare for all. In Denmark, consumers pay 13.7 percent of the health costs out of pocket. In Norway, it’s 14.6 percent. In Sweden, 15 percent. In Finland, 20.4 percent.
Even in communist China, citizens pay 32 percent of their health bills out of pocket.
Medicare for All backers say that even though it has never been successfully implemented anywhere and would provide “free” cradle-to-grave coverage, their plan will cut national health spending $2 trillion over the next decade by reducing overhead, cutting drug prices, and slashing payments to doctors and hospitals.
Those promised savings are as unrealistic as everything else about Medicare for All.
Private insurance overhead costs account for less than 7 percent of health costs, so even if you were to eliminate it altogether, without adding new paperwork costs on the government side, you’d save a relative pittance. Plus, it overlooks the fact that Medicare and Medicaid are already big drivers of overhead costs for doctors and hospitals, problems that would likely get worse if Medicare were the only game in town.
It’s like running on a platform of flying pigs
Slashing payments to doctors and hospitals is a sure way to drive providers out and force hospitals to close.
There’s also the inconvenient fact that every new government health program — including the original Medicare program — cost far more than expected. The average per-enrollee Obamacare subsidies are 11 percent higher than what the Congressional Budget Office initially thought. And newly eligible Medicaid enrollees cost 49 percent more than expected.
Finally, there’s the claim that this massive, hugely disruptive, untested plan could be implemented in two years. Remember, it took the federal government almost four yearsjust to build Obamacare’s healthcare.gov website. And it crashed and burned on launch.
What’s truly otherworldly about Medicare for All, however, is the fact that so many prominent politicians and presidential hopefuls are jumping on board without acknowledging, or maybe even realizing, how remarkably unrealistic it is.