As the debate over health care heats up during the 2020 election cycle, it is challenging to separate truth from disinformation, memes, and outright lies by a defensive private health insurance industry and its corporate allies struggling to preserve their profits on the backs of patients, families, and taxpayers. Within this debate, the three main alternatives to reform the financing system for U. S. health care are (1) to build on the Affordable Care Act of 2010; (2) to adopt some kind of a GOP plan, not yet finalized; or (3) to adopt a single-payer Medicare for All system, with two such bills in Congress (H. R. 1384 in the House and S-1129 in the Senate).
In reaction to the single-payer bills, centrist Democrats have brought forward several other incremental proposals, such as Medicare Extra for All, that would include a version of the public option that people could buy into and preserve a role for the private health insurance industry. 1
We are now seeing a political battle royal over whether or not private health insurers should continue as a major mechanism for financing health care in this country. Corporate stakeholders and their lobbyists are pulling out all the stops in their own defense.
Here are some of their false claims vs. evidence-based responses:
- Patients want choice of insurers.
We are being told this, but patients really want choice of their physicians and hospitals, not insurers that restrict their choices in so many ways, such as by restrictive and ever changing networks and denial of services. 2
Dr. Don McCanne, health policy expert and family physician of long experience, suggests that we ask this question when considering our three main financing options:
Would you give up the insurance you now have if the new public plan was guaranteed for life, always providing you with your choice of physicians and hospitals, providing all essential benefits including mental health and long-term care, had no out-of-pocket costs whenever accessing health care, and was paid for by taxes that you could afford based on your ability to pay instead of being based on the high costs of care? 3
- Medicare for All would bring socialism and a government takeover.
False. In a socialized system of health care, as in England, the government
employs health professionals and operates hospitals and other facilities under public ownership. Physicians and other health professionals would not be employed by the government and would remain in private practice. Hospitals and other facilities would retain their private ownership and receive global, year-to-year operating budgets.
- Physicians wouldn’t like it.
On the contrary, they and other health professionals would be freed
from the growing bureaucratic burden of dealing with some 1,300 private insurers with their different and changing policies concerning restricted networks, pre-authorizations, and other requirements related to reimbursement. Primary care physicians are now paying more than $99,000 a year per physician just for their billing activities, taking many hours each day from patient care. 4 As a result, more than one-half of physicians are showing signs of burnout and decreasing satisfaction with their practices, threatening quality of care. 5 With Medicare for All, they will gain increased practice satisfaction with less burnout.
- The public doesn’t want Medicare for All.
Untrue. National polls find that as many as 70 percent of Americans support Medicare for All, including 85 percent of Democrats and 52 percent of Republicans. 6 A 2019 report from Gallup News documented that 70 percent of Americans have, over more than 20 years, described the U. S. health care system as being in a state of crisis over its decreased access, uncontrolled prices, and unpredictable quality of care. 7
- Medicare for All would bring rationing.
This false assertion disregards how our current system rations care by ability to pay, not medical necessity. We ration care now by restricting access to care through lack of adequate insurance and unaffordable services and treatments, as documented in a just released study by The Commonwealth Fund. 8 Medicare for All, however, will bring universal coverage to all U. S. residents, regardless of age, pre-existing conditions, or location in the country and eliminate disparities across our population.
- What will happen if employer-sponsored health insurance goes away?
While it is true that more than one-half of employed Americans under age 65 have some kind of employer-sponsored health insurance (ESI), that coverage has become more unreliable with every passing year. Many small employers provide no coverage, and people often lose coverage when they become disabled. ESI is now too unstable to depend on. The average worker has about 12 jobs before age 50, and 66 million people left their jobs in 2018. All of these people lose their health insurance, with many never regaining coverage. 9 Moreover, most employers will be relieved of the burden of providing ESI as they gain a healthier workforce with improved coverage under Medicare for All, and employees will no longer have to cope with losing their health insurance.
- Medicare for All would be too disruptive.
Opponents of Medicare for All use a scare tactic that it will be too disruptive to those with private employer-based health insurance. They avoid telling us, however, how volatile that coverage is, and that more U. S. workers are voluntarily leaving their jobs now than at any time since the quit rate has been recorded. All of these people lose their health insurance. With Medicare for All, individuals will have continuous health insurance not related to their jobs, with much less disruption in their lives.
The passage of original Medicare was seamless in 1965, with a one-year transition and without the use of the internet and computers. Medicare for All will bring reliable, comprehensive coverage for all U. S. residents, as today’s disruption goes away and is replaced by universal coverage that we all pay into and becomes as reliable as Social Security did in the mid-1930s. The single-payer bills in Congress call for a transition period of 2 or 4 years.
- We can’t afford Medicare for All.
False. We cannot afford what we have now—29 million uninsured, 80-plus
million underinsured, uncontained prices and costs soaring, many people forgoing essential care because of costs, and the corporate greed that consumes so much of family and government budgets. Economists at the University of Massachusetts Amherst estimate that Medicare for All will save more that $600 billion a year through big savings in administrative, pharmaceutical, and provider payment spending. Middle class Americans will see savings of up to 14 percent, while 95 percent of Americans will pay less than they do now for health care and insurance.10
In conclusion, for all of these reasons and more, the private health insurance industry in this country has broken the public trust. Corporate greed has become the norm, as illustrated by Humana’s CEO’s compensation of $27.2 million in 2018. Our government is paying some $685 billion a year to prop up the industry, including $3 billion a year in overpayments to private Medicare Advantage for payments to insurers not substantiated by audits. 11, 12 This failing industry should not receive further bailouts from the government at the expense of taxpayers. The industry has had a long run, and has failed the public interest. It is past time to bid goodbye to the U. S. private health insurance industry.
John Geyman, M.D. is professor emeritus of Family Medicine at the University of Washington School of Medicine in Seattle, where he served as Chairman of the Department of Family Medicine from 1976 to 1990. As a family physician with over 21 years in academic medicine, he also practiced in rural communities for 13 years. He was the founding editor of The Journal of Family Practice (1973 to 1990) and the editor of The American Journal of Family Medicine from 1990 to 2003. Since 1990 he has been involved with research and writing on health policy and health care reform. His most recent publications are Struggling and Dying under TrumpCare: How We Can Fix this Fiasco (2019) and a pamphlet, Common Sense: The Case For and Against Medicare for All, Leading Issue in the 2020 Elections (2019)
- Grim, R. The special interests behind Rep. Pramila Jayapal’s Medicare for All are not the usual suspects. The Intercept, February 27, 2019.
- Murad, Y. Majority backs ‘Medicare for All’ replacing private plans, if preferred providers stay. Morning Consult, July 2, 2019.
- McCanne, D. Commentary on reference 23. Quote of the Day. June 28, 2019. email@example.com.
- Tseng, P, Kaplan, RS, Richman, JD et al. Administrative costs associated with physician billing and insurance-related activities at an academic health system. JAMA, February 20, 2018.
- Clinician well-being is essential for safe, high-quality health care. National Academy of Medicine, Washington, D.C., 2017.
- Cortez, Z. The Year for Medicare for All. Common Dreams, January 2, 2019.
- Gallup News, as referenced by Conley, J. New analysis shows why Democrats are wrong to fear bold embrace of Medicare for All. Common Dreams, January 14, 2019.
- Tikkanen, R, Osborn, R. Does the United States ration health care? The Commonwealth Fund, July 11, 2019.
- Bruenig, M. People lose their employer-sponsored insurance constantly. People’s Policy Project, April 4, 2019.
- Pollin, R, Heintz, J, Arno, P et al. In-Depth Analysis by Team of UMass Amherst Economists Shows Viability of Medicare for All. Amherst, MA,
- Schulte, F, Weber, L. Medicare advantage overbills taxpayers by billions a year as feds struggle to stop it. Kaiser Health News, July 16, 2019.
- Ockerman, E. It costs $685 billion a year to subsidize U. S. health insurance. Bloomberg News, May 23, 2018.