Medicare-for-All: Why We Should Say Yes, Not “Yes But”
by Merton Bernstein and Theodore Marmor
Health Affairs Blog
August 28, 2008
Many health policy experts regard Medicare-for-All as a model for reform of America’s indisputably troubled and costly medical arrangements. They express admiration for its administrative efficiency and the resulting savings that could pay for extending coverage, perhaps to all. For example, in a June 2008 Health Affairs article, Commonwealth Fund authors said: “Compared to a Medicare-for-All approach, our [Building Blocks] framework does not achieve the simplicity, consolidated risk, administrative overhead, and provider payment net savings of covering nearly everyone through Medicare.”
Sometimes even Medicare-for-All admirers succumb to the “yes but” syndrome, as in “yes, but Medicare-for-All is politically impractical.” For example, after praising Medicare-for-All, The Health Care Mess concluded that “political reality compels us to ask whether there are not other ways” (besides Medicare-for-All) and answered that question “yes.” Princeton economist Paul Krugman, who had extolled Medicare-for-All in 2006, put a foot in the “yes but” camp in 2007. He welcomed the Edwards, Massachusetts, and Schwarzenegger plans to compel individuals to select from among insurance plans, thereby forgoing Medicare-for-All’s economies. The Edwards and Obama plans required a Medicare-like plan as one option. Krugman argued that such a plan’s lower cost will eventually crowd out more expensive private plans. This overlooks private insurance’s history of cutting prices to gain market share, later returning to double-digit boosts. Also, the Massachusetts program actually is not universal; it omits children, among others, and it is having real trouble meeting its costs. The California legislature as well rejected the “Governator’s” plan as too costly.
Though the political “yes, buts” surrounding Medicare-for-All prove groundless, they deserve discussion. However, the “yes, buts” should not preempt discussion of Medicare-for-All’s substantive advantages, as they all too often do. For example, the May/June 2008 issue of Health Affairs, a 200-page-plus compendium on health reform and expanding coverage, does not contain a single article devoted to Medicare-for-All. In this post, we first describe the advantages of Medicare-for-All, then demonstrate that the evidence behind the political “yes, buts” is exaggerated and flawed.
http://healthaffairs.org/blog/2008/08/28/medicare-for-all-why-we-should-say-yes-not-yes-but/
Professor Bernstein and Professor Marmor are amongst the most qualified and experienced experts on both health policy and the politics of Medicare and social insurance in general. We need to listen to what they have to say. Be sure to click the link above to read their full message.
Everyone knows that the U.S. health care financing system is in critical condition, and that we once again are entering a political window in which reform is possible. Never has it been more important to understand all of our options.
Yet where are we? Those controlling the serious dialogue on reform (e.g., Health Affairs) have limited the options to proposals that would merely tweak our dysfunctional, fragmented system of financing health care, leaving the private insurance industry as the dominant player in health care misfinancing. Perpetuation of our current system will further expand our almost unbearable costs, and leave us far short of the goal of ensuring that every single individual receives the health care that she or he needs.
Health policy is not rocket science. We know precisely what will work. Most in the policy community (including politicians), who believe that we must seize this opportunity for reform, largely agree that a universal, single payer, Medicare-like program would be the most efficient and effective model of reform. And their response?
Yes but… (UNSPOKEN: let’s not even bring that into the discussion).
Talk about health policy malpractice!
