USA TODAY International Edition
‘ Medicare for All’ is wise next step
Most would pay less for better care
With costs rising painfully, insurance companies denying care and nearly 30 million people still uninsured, America desperately needs an honest health policy discussion. That’s why it has been so disappointing over the past several weeks to watch multiple candidates parrot right- wing attacks on “Medicare for All,” like claiming that it will greatly increase spending on health care or ringing alarms about raising taxes on the middle class.
The truth is the opposite: Medicare for All would sharply reduce overall spending on health care. It can be thoughtfully designed to reduce total costs for the vast majority of American families, while improving the quality of the care they get.
As a pediatrician, I have seen firsthand how our fragmented, expensive system hurts children and families. As a researcher at Harvard Medical School, I have studied the causes of waste and overspending in our system. And as President Barack Obama’s head of the Centers for Medicare and Medicaid Services, I led the existing Medicare system and helped stand up Obamacare. What I saw convinced me that the Affordable Care Act was an essential step forward. But covering all Americans through a single- payer, federal insurance program would now be a wiser path. President Obama has said it himself: It is now time for “good new ideas like Medicare for All.”
The case for Medicare for All is simple. It would cover everyone — period. Done right, it would greatly lower costs and free up money for the opioid epidemic, disease prevention and telemedicine. And it would be simpler, easing the burdens of billing for doctors, paperwork for all health care professionals, and navigating the confusing system for patients and families.
Some candidates have attempted to sidestep the cost debate by promising to spend less and accomplish the same goals. These proposals, such as relying on a public option or expanding Medicare Advantage, which offers private plans within Medicare, provide too few details to allow real cost comparisons. But it is unlikely they’d reduce national health care spending or costs for families as much as Medicare for All.
Misleading myths
Sen. Elizabeth Warren of Massachusetts suggested as much when she claimed in the latest Democratic presidential debate that one alternative proposal, “Medicare for All Who Want It,” would really mean “Medicare for All Who Can Afford It.” Why?
First, these alternative plans retain a costly architecture of private profits and payment complexity. Second, they don’t have the scale of Medicare for All, which is crucial for simplifying billing, improving the quality and safety of care, and removing wasteful spending.
Faced with these facts, opponents of Medicare for All too often revert to myths. The first is that Medicare for All will necessarily increase health care spending. That’s wrong.
The fact is that, without a change,
Americans will spend over $ 45 trillion on health care in the next 10 years. Under Medicare for All, total health care spending would likely be far lower. The cost would depend on many decisions about, for example, payment rates to hospitals and doctors, content of the benefit package and details of price negotiations with drug companies.
The costs are largely under our control; they will depend on how we design the new system. If we made wise choices, I regard it as nearly certain that Medicare for All would save trillions of dollars over the decade compared with our projected spending.
The second myth is that is Medicare for All must raise taxes on middle- class families. That’s misleading. No matter how it is funded, Medicare for All’s cost to families should be compared with what those same families will spend if we do nothing. And that trajectory is looking increasingly painful.
Stop the fearmongering
Health care is taking more and more money from the wallets of workers and families. The average premium for a family of four in 2019 is a staggering $ 20,576 — a toll eating into their wages while their out- of- pocket costs soar. Since 2009, premiums have increased 54% and workers’ contributions to premiums have increased 71%, but wages have risen only 26%.
Fearmongering over “higher taxes” ignores that this money is already coming out of people’s pockets. Right now, these costs amount to a regressive tax that every family pays, whether their wage- earner is a CEO or a secretary. We can discuss whether it’s a good idea to use our money to fund Medicare for All instead of financing private insurance companies. But it is deeply misleading to pretend that this shift is an increase in family health care costs. It is not.
And no one should buy the myth that Medicare for All represents a “government takeover of health care.” It does not. Medicare for All is about paying for care, not providing it. Not one proposal suggests that health care delivery should become a government function ( beyond existing forms like the Veterans Health Administration). It offers Americans, at last, a simple way to assure that they have the coverage they need to see the doctors they want and use the hospitals they choose.
Almost all doctors and hospitals would be in Medicare’s network, and no patients would have to check their insurance card to find out whom they can see and at what cost out of pocket.
A real debate on health care would show that Medicare for All, though not a perfect solution, is the best option we have to get health care costs and quality back on track — and to lift an exhausting burden off American families and businesses.