Medicare for All? How?

One year from Sunday, California will hold its presidential primary election. Democrats won big in the 2018 November midterms by making health care their primary issue. But cracks are beginning to show as the progressive wing tries to coalesce the party behind a Medicare for All platform.

Rep. Pramila Jayapal, D-Wash., unveiled a House single-payer health care bill last week. It’s impossible to assess because, thus far, it lacks a financial plan.

However laudable the goal might be, any proposal must address political reality: The United States will never move toward a single-payer health care system unless it makes good business sense. Any viable plan must achieve the co-equal goals of driving down costs while improving health care outcomes for all.

It’s potentially achievable. But the roll out of the legislation did little to demonstrate that. Instead there were troubling signs that the party’s progressive wing is not on the same page as more moderate Democrats.

Jayapal, a first-year representative, is co-chair of the Congressional Progressive Caucus. Her bill moves faster and is even more progressive than Sen. Bernie Sanders’ similar Senate legislation. That spells trouble for a party that needs to capture enough swing states to win back the White House and the Senate.

Jayapal has 107 co-sponsors for the bill. It’s an impressive number until you consider that the Medicare for All bill introduced in Congress a year ago had 124 co-sponsors.

The House bill would create a government-funded health-care program within two years — two years quicker than Sanders’ proposal.

Jayapal’s plan covers vision, dental, mental health, prescription drugs, substance abuse and maternal care. It would also include hospital care, primary care, long-term nursing care, lab services and medical devices — all without any copays. That last detail is a recipe for wasteful use of health care services that would drive up costs.

Critics say the cost would require raising taxes to unacceptable levels. The libertarian Mercatus Center at George Mason University estimated that Sanders’ Medicare for All bill would drive up federal spending by $32 trillion over 10 years. But opponents fail to mention that the same study projected that overall health spending in the United States would actually decrease over the same time period, which is significant because the bill would add benefits and cover everyone.

Health care spending in the United States far exceeds that of other Western nations and results in far-poorer outcomes than countries with single-payer systems.

It’s imperative that we move toward a more cost-effective system that allows us to remain competitive in the global marketplace. A universal coverage system of some kind is the answer. But it won’t happen until proponents make a compelling economic argument.