Congress not ready for ‘Medicare for All’

Now that the 2018 election has swung control of the U.S. House of Representatives from right to left, some progressive Democrats are pushing for a vote in the new Congress on Medicare for All, a national healthinsurance program that would cover all Americans without charging premiums, deductibles or co-payments.

They seem to have the public on their side, at least conceptually: Exit polls on Nov. 6 found that health care was the leading issue for those casting ballots, and this summer, a poll by Reuters-Ipsos found that 70 percent of Americans — including 52 percent of Republicans — favored the idea of Medicare for All.

Some moderate Democrats have pushed back, noting that such a vast expansion of Medicare doesn’t stand a chance of passing the Republican-controlled Senate, let alone being signed into law by a president who campaigned against it (with characteristic hyperbole) in the weeks leading up to the midterm elections.

There could be political consequences too. Forcing newly elected House members from formerly Republican-held districts in the Midwest to take a tough vote on a government-run health insurance system could lead Democrats back into the House minority.

A “single-payer” system would accomplish several things the Affordable Care Act cannot: providing fully portable coverage to all Americans, eliminating the threat of ever-rising premiums and slashing the administrative costs and paperwork burdens of the current system. Bringing all Americans into one risk pool would also spread risk and cost far less than the ACA does.

Critics of any version of single payer have focused on the enormous tax increase that would be required to make the switch, as much as $32 trillion over 10 years.

How do we want to pay for health care? The current system involves a mix of taxes and premiums paid by individuals and businesses, and it rations care to some degree according to one’s ability to pay. The House Medicare for All bill and the more detailed proposal by Sen. Bernie Sanders, I-Vt., would be financed mainly by income-based taxes, putting more of the burden on high-income individuals and corporations.

A more fundamental question is who should be eligible for coverage. If the system extends only to citizens and green-card holders, that would leave roughly 11 million residents uninsured, posing challenges to public health and to the hospitals and clinics that care for these patients.

Then there’s the question of how much to pay for medical treatments and services. A single-payer system puts the government into the position of deciding what treatments, medical devices and drugs are worth and how much doctors, nurses and lab technicians should earn.

If the values are set too low, that could deter investment and lead to shortages of treatments and services. If they’re too high, rising health care costs will swamp the federal budget.

And who decides what treatments get covered? The House bill proposes simply to cover “medically necessary” treatments, devices and services.

The complexities involved in shifting to single payer shouldn’t stop Congress from exploring it. Countries around the world take this approach for good reasons. But getting from where we are today to the universally affordable and available health care system we want will take more than symbolic votes and catchy slogans.