John
Merline, Opinion contributor Published 3:15 a.m. ET March
7, 2019 | Updated 1:45 p.m. ET March 7, 2019
There's nothing like
Medicare for All in other industrialized nations. Not one offers soup-to-nuts
government-paid insurance with no copayments.
“We have got to figure out how we pay for it.
It’s unrealistic in how we pay for it today.” That was how former
Virginia governor and potential presidential candidate Terry McAuliffe
characterized Medicare for All, even as he was announcing his support for
it.
McAuliffe is certainly right about the
unrealistic part, although otherworldly would be a more appropriate
description.
Put simply, there is nothing like Medicare for
All anywhere in the industrialized world.
Medicare for All proposals, like
the House version introduced last month by Rep.
Pramila Jayapal, D-Wash., would offer everyone living in the United States
comprehensive coverage — doctor visits, hospital care, prescription drugs,
preventive care, pediatrics, rehab, mental health, dental, vision, diagnostic
tests, long-term care, abortions — with no deductibles and no copayments.
As a result, virtually all of the more
than $360 billion Americans spend each year out of pocket for health care would
disappear overnight.
So, too, would insurance premiums, since
Medicare for All would outlaw any private insurance plan that covers any of
these same benefits. Those pesky insurance company hassles would disappear,
too.
Sounds great, doesn’t it? Who wouldn’t like to
see any doctor you want with no limitations, get every test and treatment
you need, never pay a dime out of pocket and never have to deal with
an insurance company?
Jayapal says, “This is not a particularly
ambitious plan, in the sense that so many others have done it.”
Actually, no industrialized nation has tried
anything so sweeping. Not one provides soup-to-nuts government-paid
insurance that covers everything without any cost-sharing from patients. None.
And even so-called single-payer systems rely on some forms of private insurance.
Take Canada’s single-payer program, which is
one of the closest models to Medicare for all and is also called Medicare.
It doesn’t cover vision, dental, long-term care or prescription drugs. As
a result, two-thirds of Canadians buy private plans. And about 15 percent of the nation’s health
costs are paid out of pocket.
In the United Kingdom, nearly 11
percent of Brits buy private insurance, despite the country’s single-payer
National Health Service. They do so, as the Commonwealth Fund put it, to
get “more rapid and convenient access to care” than
they can through the government-run program.
Other countries pay
out of pocket, we can too
Britain is actually moving in the opposite
direction of Medicare for All advocates. As the NHS suffers chronic
shortages, lengthy delays and treatment denials, the
country's private health care market has been growing rapidly. It reached
nearly $12 billion in 2017 and is on track to
reach close to $14 billion over the next four years. Out-of-pocket
spending accounted for 15 percent of the British health care budget
in 2017. That’s up from 9.4 percent in 2009.
Countries that Democratic socialists like Sen.
Bernie Sanders, I-Vt., have lauded as role models also don’t have anything like
Medicare for all. In Denmark, consumers pay 13.7 percent of the health
costs out of pocket. In Norway, it’s 14.6 percent. In Sweden, 15 percent. In
Finland, 20.4 percent.
Even in communist China, citizens pay 32 percent of their health bills out of
pocket.
Medicare for All backers say that even
though it has never been successfully implemented anywhere and would
provide “free” cradle-to-grave coverage, their plan will cut national health
spending $2 trillion over the next decade by reducing
overhead, cutting drug prices, and slashing payments to doctors and hospitals.
Those promised savings are as unrealistic as
everything else about Medicare for All.
Private insurance overhead costs account for
less than 7 percent of health costs, so even if you were to eliminate
it altogether, without adding new paperwork costs on the government side, you’d
save a relative pittance. Plus, it overlooks the fact that Medicare and
Medicaid are already big drivers of overhead costs for doctors and hospitals, problems that would likely get
worse if Medicare were the only game in town.
It's like running
on a platform of flying pigs
Slashing payments to doctors and hospitals is
a sure way to drive providers out and force hospitals to close.
And despite all the hoopla over drug prices,
prescription drugs account for less than 10 percent of the nation’s health care
bill — the same share as in 1960, according to official government data.
There’s also the inconvenient fact that every
new government health program — including the original Medicare program — cost
far more than expected. The average per-enrollee Obamacare subsidies are
11 percent higher than what the Congressional Budget
Office initially thought. And newly eligible
Medicaid enrollees cost 49 percent more than expected.
Finally, there’s the claim that this massive,
hugely disruptive, untested plan could be implemented in two
years. Remember, it took the federal government almost four years just to build Obamacare’s
healthcare.gov website. And it crashed and burned on launch.
What’s truly otherworldly about Medicare for
All, however, is the fact that so many prominent politicians and presidential hopefuls are jumping on board
without acknowledging, or maybe even realizing, how remarkably unrealistic
it is.
John Merline, a former editorial writer
for USA TODAY, has covered health care reform for more than three decades.
Follow him on Twitter: @IBD_JMerline
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