Healthcare in America — On the Sidelines – Medicare for All Sounds Simple

The healthcare plan currently being proposed under the name Medicare for All sounds wonderful. Universal coverage. No premiums. No deductibles. No copays for most covered care. One system for everyone.

The problem isn’t necessarily the goal. The problem is the size of the change.

The current House and Senate bills are not simply an expansion of Medicare or a public option. They would create a national single-payer system and largely replace employer insurance, individual insurance, Medicaid, CHIP and the ACA marketplace. Private insurers would generally be limited to supplemental coverage. The proposed transition is remarkably short—roughly two years.

Think about what that means. Private insurance companies aren’t simply going to say goodbye to the enormous premium business they have built. They would have to transform their businesses almost overnight. Employers would redirect money they currently spend on health insurance. Employees would redirect what they currently pay. Government programs would be absorbed or replaced. And then the federal government would have to become the payer for virtually everybody.

The funding proposal follows the same basic philosophy: redirect the enormous amount of money already being spent on healthcare while adding new taxes and other federal revenue. Supporters argue that eliminating much of the insurance bureaucracy and negotiating prices could make the system less expensive overall. Critics argue that the tax increases and transition costs would be enormous. Those are important arguments, but they are almost secondary to the practical question: Can you actually move an entire country from one healthcare system to another in two years?

Then there is politics.

The current Medicare for All legislation is overwhelmingly a Democratic proposal. There is no Republican support for it, which means it begins with essentially no bipartisan foundation. And politics matters. A senator or representative isn’t necessarily eager to vote for a massive restructuring of one-sixth of the American economy if the other party gets to claim the credit for it.

Interestingly, Hakeem Jeffries, who previously sponsored Medicare for All legislation, now says he does not support the current proposal. Asked about it recently, he said it is not legislation he currently supports, while continuing to argue that America needs to find a way to fix its broken healthcare system. His public comments have instead emphasized restoring and strengthening existing programs, including the Affordable Care Act and Medicaid.

Of course, his critics immediately accused him of selling out to the insurance industry. That is politics talking. You don’t have to agree with Jeffries to understand what he is saying: fix what we have before we attempt to replace everything we have.

And that brings me back to the reason I started this series in the first place.

Healthcare is not a campaign slogan. It is not one program. It is not one insurance card. It is an enormous collection of hospitals, doctors, pharmaceutical companies, insurers, employers, government programs, patients, regulations, subsidies and billions of dollars moving in thousands of directions every day.

There is no magic phrase—“Medicare for All,” “Repeal Obamacare,” “private insurance,” or anything else—that makes all of that disappear.

And there is one more thing voters need to remember: campaign promises are not legally binding.

A candidate can promise you virtually anything to get your vote. Once elected, they still have to get legislation through Congress, find the money, write the regulations, negotiate with the people affected and somehow get the system to work.

So when somebody promises to fix healthcare, don’t just ask whether it sounds good.

Ask how.

Where does the money come from? Who pays? Who gets paid? What happens to the people and businesses already in the system? How long does it take? What happens during the transition? What happens when something goes wrong?

If the person making the promise can’t give you a reasonably good answer to those questions, they may have a great campaign slogan.

They may not have a healthcare plan.

The answer to America’s healthcare problem isn’t going to come exclusively from the left or the right. Ultimately, it will come from the people demanding something more useful than a slogan: specifics.