Democrats’ ‘Medicare for All’ Idea is Horribly Misleading

The proper comparison isn't to Medicare but another government health program that isn't faring so well.

It is very likely that the Democratic presidential candidate in 2020 will end up campaigning on something he or she calls “Medicare for all.” And no wonder: a recent poll finds that 70 percent of Americans support “Medicare for all.”

Here’s a very brief description of that term from progressive rock star and Democratic Congresswoman-elect Alexandria Ocasio-Cortez:

Anyone who has any experience with Medicare knows that is not what Medicare is. Traditional Medicare covers relatively little: those who use it aren’t reimbursed for vision and dental services, for example. Also, without purchasing a MediGap supplemental plan, Medicare comes with deductibles and copays. Traditional Medicare is not “free at the point of delivery” and monthly premiums are automatically deducted from recipients’ Social Security checks. Millions of seniors have opted out of traditional Medicare and instead receive Medicare Advantage, which more resembles traditional private health insurance.

Even some progressives acknowledge that “Medicare for all” isn’t what many on the left think it is. “The more you look at it, the more ‘Medicare for all’ is, well, misleading,” New York‘s Ed Kilgore wrote last year. In fact, Kilgore said, Medicare isn’t at all what Democrats actually want, which is single-payer health insurance.

There is a simple reason why Democrats prefer to use the term “Medicare for all” over “single-payer”: it polls better.

But if “Medicare for all” is not the right way to describe a single-payer plan, what is? Would the troubled VA system work as the proper analogy? The answer is no. The VA is more like the UK’s National Health Service, a single provider of health care services paid for by the government. (Though ironically, a recent reform of the VA expanded its reliance on the private sector to deliver health care to vets.)

The proper comparison is to another existing government health care program: Medicaid. Medicaid, which is funded jointly by the federal and state governments, insures millions of low-income patients, children, and the disabled, or an estimated 20 percent of all adults. There are no monthly premiums and no deductibles (though there can be small copays for pharmaceutical drugs).

The Medicaid program is the closest America has to “single-payer,” in that one payer, Medicaid, pays for health care services. But you will not find many single-payer proponents touting the Medicaid system, which was expanded in most states with the passage of the Affordable Care Act. That is because Medicaid has created unsustainable costs for many states and is in need of reform.

My mother is disabled, with congestive heart failure, COPD, and insulin-dependent diabetes, and must take a battery of medications in order to live. She is on Medicaid. I have been helping her navigate her benefits and it’s certainly been an eye-opening experience.

My mother has had problems getting some of her medications filled because Medicaid requires prior authorization for many of them, whereas under private health insurance that wouldn’t be a problem because she would simply call her doctor and make an appointment. Yet on Medicaid she’s had problems even finding a doctor, since most doctors will not take Medicaid. Ultimately, my mother had to pay a substantial sum out of pocket to a doctor that does not take Medicaid just to get refills on her life-saving medicine.

Other problems persisted. My mother had difficulty getting her insulin filled because Medicaid does not cover the type of insulin she uses. She was forced to rely on insulin samples from her doctor, some of which were expired and made her ill, until she was able to get a refill when her Medicare Part D coverage kicked in.

My mom’s terrible experiences with Medicaid are hardly unique. While there isn’t a study that’s tracked doctors’ participation in Medicaid over time, a 2013 survey from the CDC showed that only 68.9 percent of doctors were receiving new Medicaid patients, compared to 84.7 percent of private insurance patients and 83.7 percent of Medicare patients. Another 2013 survey from Oregon showed that outcomes between those on Medicaid and those who were uninsured were not statistically different.

Fiscally, Medicaid is in desperate need of reform. It is a driver of our unsustainable national debt and is wreaking havoc on state budgets. Expanded Medicaid spending is forcing state governments to choose between raising taxes and cutting other services.

We already know the future if single-payer health care is implemented in the United States: worse quality of care, decisions made by unaccountable bureaucrats instead of doctors, and unsustainable spending and debt.

Yet opposing that future doesn’t mean conservatives can just say no. The problem of affordable health care is a serious one. For example, in 2019, my health insurance premiums will be $40 more than my car note.

Conservatives need to promote alternatives such as direct primary care where patients pay monthly fees to their family doctors in exchange for service. Health insurance should be reserved for truly emergency and catastrophic cases.

As long as conservatives continue to defend the status quo—or the pre-Obamacare era—single payer is all but inevitable. And judging from America’s ongoing experiment with Medicaid, that would be a disaster for both the nation’s finances and wellbeing.

Kevin Boyd is a freelance writer. He has been published at The Federalist, IJ Review, the New York Observer, the Atlanta Journal-Constitution, and the National Interest. You can follow him on Twitter @TheKevinBoyd.

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63 Responses to Democrats’ ‘Medicare for All’ Idea is Horribly Misleading

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  1. Dan Stewart says:

    If Medicaid is so bad, why doesn’t your mother just buy private insurance? … Right, because she can’t afford it, and apparently you can’t afford to buy it for her.

    I don’t know how much your “car note” is per month, but my health care plan for a family of five cost more than $24,000 a year.

    I wonder how many of the tough-talking commenters here can afford to write that check every month?

    Health insurance costs way too much in the US and needs change radically. Maybe we should radically increase the supply of health care providers — that might bring down the price.

  2. James from Durham says:

    I’m British and I am not wealthy. I know that if one of my kids gets sick, I can take her to the doctor without worrying about what we must do without for the next 6 months. When my wife had a medical emergency 10 years ago, if we were Americans we would have been destitute. Why don’t you people care about your own families? It’s beyond understanding. Maybe conservatives don’t care about this stuff, it’s just the money and politics…

    Does caring for my family make me a socialist?

  3. TruthTeller says:

    There seem to be some general misunderstandings about healthcare in the UK. Just because we have an NHS does *not* mean that private healthcare and private insurance doesn’t exist. It does, and some people use it and also use the NHS when it suits them. Doctors continue to take private patients if they want to.

    All these examples of people not getting treatment need the additional detail “and they couldn’t afford to go private either”. But then it doesn’t look so simple when comparing UK and US.

    If you think the US system doesn’t also have its own “death panels” deciding when to fund or not fund treatment, you’re the one who’s being naive, far more so than any young leftie Democrat.

  4. mrscracker says:

    James from Durham says:
    “I’m British and I am not wealthy. I know that if one of my kids gets sick, I can take her to the doctor without worrying about what we must do without for the next 6 months. When my wife had a medical emergency 10 years ago, if we were Americans we would have been destitute. Why don’t you people care about your own families? It’s beyond understanding.”

    My brother lives in the UK, too so I hear what you’re saying. I’ve never heard him complain about the NHS. My cousins in Canada like their system, too. But to be fair, the US has a much, much greater population. So a Canada-style healthcare system might or might not work in the States.

    If I remember correctly, before the advent of Obamacare, approx. 15% of Americans were uninsured for healthcare.
    We have Medicaid & a state sponsored health insurance for children whose parents don’t qualify for Medicaid. You paid premiums for that on a sliding scale per income level. I’ve heard that the children’s program has been messed up now. And of course private insurance, though not perfect back in the day, has been impacted too.
    We didn’t have an ideal healthcare system before Obamacare but only 15% of folks weren’t covered. I’ll never figure out why the powers that be didn’t just find a solution for those 15%.

  5. MM says:

    “What does that imply?”

    That the decision to seize over a $1 trillion, and waste over $100 billion of it, and eliminate what’s left of the private health care sector, half of which is already non-profit, does NOT depend on a handful of anonymous opinions in a self-selecgted forum.

    Thank goodness.

    Wreck something, as opposed to reform, that’s working for over a hundred million taxpayers, they tend to hit back hard at the ballot box and in the courts. The ACA is a small example of that.

  6. mrscracker says:

    Dan Stewart says:
    “… but my health care plan for a family of five cost more than $24,000 a year.”

    Just to mention, my daughter’s family of 6 (soon to be 7, Lord willing) uses a healthcare sharing plan that works for them & has been very affordable. It’s a part of Solidarity Health Share:

    “Health care sharing ministries provide a way to pay for health care costs that is different than traditional health insurance.

    As a member of a health sharing ministry, you pay a Monthly Share Amount. This monthly share is then used to pay for the health care needs of other members. When you have a health care need and if you have met your Annual Unshared Amount, other members will pay for your health care needs…”

    (And she told me that the cost for a C-section delivery through health sharing was 1/5th of what it would be through regular insurance.)

  7. JeffK says:

    That fact that you have family members in the UK, and in Canada, and they both don’t complain about their healthcare, is a huge statement in itself. If you listened to Faux News you would think that everybody in both countries hates their healthcare, and are screaming for a system just like ours.

    Of course, that’s not true, but I bet 90% of Faux News viewers think it is. And that’s probably the reason our healthcare system sucks. That, and the greed of the Health Care Industrial Complex likes the way things are, and the bought politicians that do their bidding.

    My experience working for a Canadian company, and spending years in Canada, tells me the same thing. But then again…. Faux News, the MIC, politics, and conservatives in general.

  8. MM says:

    “And that’s probably the reason our healthcare system sucks.”

    Most Americans disagree with this, and did so even before Obamacare:

    As proposed, there’s no evidence Medicare For All would be better than the current system, which is already 50% government, 25% private non-profit, 25% private for-profit.

    Taxes on workers would be higher and the quality of their health care would be lower, no doubt about that.

    Plus, there’s already a growing shortage of doctors, nurses, and certain specialists around America. As proposed, Medicare For All wouldn’t make that situation better. Quite the opposite.

  9. mrscracker says:

    Yes, my family in the UK & Canada are pretty happy with their healthcare but not all British or Canadians agree with them. There can be issues. As the British population ages & there are fewer young people entering the workforce I think UK healthcare troubles will grow.
    Our news outlets may skew Americans perception of Britain & Canada but British media doesn’t always portray American society correctly either. We could all take a little more time to learn about each other.

  10. JeffK says:

    And Good Morning to you, Mrscracker.

    The fact that your family members are ‘pretty happy’ with both the UK and Canadian medical delivery systems says a lot. Sadly, though, many members of the conservative right will read right over your comment and disregard it, only to return to their Faux News world view, which is that ‘the American medical system is the best in the world, now leave it and me alone’.

    The news/entertainment industry does in fact distort a tremendous amount. They play to everybody’s preference for information that confirms their ideas and biases. That’s why everybody should consume information from a variety of sources across the political spectrum. And this includes government, and academia. Trouble is, most don’t have the time nor inclination to do so.

    About 20 years ago I was a Faux News junkie. O’Reilly and all that. But Faux got more and more extreme, until their point of view was totally inconsistent with how I saw the world. Particularly O’Reilly, with his over the top dismissal of even considering pot legalization.

    The more I looked at his positions critically, the more I realized I disagreed with almost everything he said. And then I started to do the same with everything Faux News, which led me to dropping them as a reliable source of information. They were masters as conveying opinion as news.

    But Faux was something different. It took a long while, however, to realize they were certainly not ‘Fair and Balanced’. So now my go to is MSNBC. Certainly biased, but the quality is better, in my opinion (and boy I bet I get blasted over that one!).

  11. MM says:

    60+ comments, and not a convicing argument for the Medicare For All proposal, the original topic.

    Having read up on it, for anyone who currently has a private health care plan that they’re satisfied with, and that’s most all private sector workers, M4A would truly be a system that sucks.

  12. JeffK says:

    According to Gallup “Most Americans say the U.S. healthcare system is troubled: Nearly three-quarters of ***employed*** Americans (73%) say the healthcare system is “in a state of crisis” or “has major problems” in Gallup’s most recent survey. There is little difference between American workers’ attitudes on the healthcare system and the overall U.S. public, among which 71% say the system is “in a state of crisis” or “has major problems.””

  13. FairPriceRx says:

    I do not support Democrats in this matter. Although in General I approve of the methods of democracy. I really like Medicare. While the bill has not yet been submitted, it is not possible to answer the question fully. However, it is already clear that the implementation of the new program will require large financial expenses, and this is identical to the increase in taxes. Ho Sanders and his supporters are trying to convince the public that despite these pitfalls, Americans will no longer have to pay health insurance premiums and resort to any additional payments. So I think there’s nothing wrong with Medicare. Look how many people are grateful to this project. You can’t just say they’re misleading us.

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