Published on FORBES.com |
Democrats have been pulling levers for decades to exert greater and greater government control over our health sector. But the more government gets involved, the more dysfunctional the market becomes. The left now contends that the mess can only be solved with a complete government takeover. They believe their moment has come.
Americans are indeed frustrated and angry with the current system. Care costs far too much. Millions are priced out of the insurance market. And even those with insurance say premiums and deductibles are so high they might as well be uninsured, with surprise bills that can bankrupt them.
People are hurting, and they feel powerless—like cogs in the $3.6 trillion health sector with little ability to impact choices or even know what care costs.
But it is hard to see how consumers would be more empowered when dealing with a single government payer. In a country that values diversity, will one massive program with one list of benefits and set of rules work for everyone?
The Democrats think that it not only will work, but it will be utopia.
The House Rules Committee held a hearing this week on a Medicare for All bill, introduced by Rep. Pramila Jayapal and more than House cosponsors, that would eliminate all private health insurance and almost all existing government programs, replacing them with a new Medicare for All program more generous than any on the planet.
Everyone would be able to see any doctor any time. No premiums, no deductibles, and no copayments. Hospitals and emergency room care would be free, as would dental, vision, audiology, women’s reproductive health services, maternity and newborn care, long-term services and supports, prescription drugs, mental health and substance abuse treatment, laboratory and diagnostic services, dietary therapies, transport, and more.
Arguing against this approach, as Prof. Chuck Blahous of George Mason University and I did as witnesses, was a Sisyphean task.
Medicare for All would cost an additional $32 trillion in government spending over 10 years, Blahous estimates. Can we afford that?
Two economists called by the Democrats said this new system will be more efficient and affordable and could even save money. An emergency-room physician on the panel, Farzon Nahvi, argued it would save money because people would get primary care rather than showing up in a hospital ER at later stages of their illness.
The back and forth went for nearly six hours before the Rules Committee hearing, ably chaired by Rep. Jim McGovern (D-MA) with ranking Republican Tom Cole (R-OK). Democrats called five witnesses; the Republicans were allowed only two—Dr. Blahous [click for testimony] and me [click for testimony].
Needless to say, the Q&A was very one-sided, especially because the nine Democrats on the panel directed most of their questions at their witnesses who made a number of sweeping claims about Medicare for All that we don’t believe are grounded in reality.
Americans want more, not fewer choices in health coverage, yet Medicare for All would put them all on a single government program. When government officials are making decisions about what services will be covered, how much providers will be paid, and how much citizens must pay in mandatory federal taxes, consumers will have even fewer choices and less control than they do today. It will reduce access to new technologies, stifle innovation, and result in a near-doubling of the tax burden.
The very real problems with Medicare for All cannot be overstated, but the Left has answers for pretty much everything. I capture the essence below of some of their responses to show what we are up against:
Vermont and Colorado recently tried to create single-payer systems for their states, and they both crashed when voters saw that they would lose their current coverage and that their taxes would soar to the point they would crush their economies.
They weren’t on a big enough scale, proponents argue. You need to have everybody in for it to work.
But what if 173 million people don’t want to give up their job-based insurance? What if 60 million seniors like their current Medicare and Medicare Advantage plans and don’t want the program abolished?
Never fear. The new coverage will be so much better and more comprehensive that they be happier and will thank us.
But sweeping away all private health insurance and most public programs in two short years with an untested new government-run system never has been done before on the planet.Experience shows programs like this reduce access to new technologies, stifle innovation, and result in a near-doubling of the tax burden.
Don’t worry. America can do great things. This is the richest country in the world, and no one should go without care. We are up to the challenge to show the rest of the world how to create a rational, fair, comprehensive social safety net.
But isn’t Medicare itself going bankrupt already? The Medicare Trustees recently reported that Medicare had a cash shortfall of $363 billion in 2018. It paid out $740 billion but collected only $377 billion in taxes and premiums. Medicare’s annual deficits are responsible for one third of U.S. federal debt.
Medicare for All will get costs under control by getting payments to doctors and hospitals more in line with those of other countries and getting rid of the greed and profit in the insurance and pharmaceutical industries.If all the money flowing through the health sector today were put into one program, the U.S. could more than afford to cover everyone with this comprehensive plan.
But what about the cuts in payment rates to doctors and hospitals of 30 to 40%? Haven’t government actuaries said this would seriously jeopardize access to care as many providers are forced to closer their doors or drastically curtail services?
We can afford it all by wringing the greed, profit, and waste out of the current system. Doctors will be happy to practice in this new world, free of bureaucracy and paperwork.
But does our system have the capacity to expand free coverage to everyone—including undocumented residents?
Yes, said Dr. Doris Browne of the National Medical Association, because the Medicare for All bill includes money to train new medical professionals and alleviate the physician shortage.
What about the part of the bill that gives regional directors a quarterly budget to cover all health costs? In other countries, global budgets inevitably lead to rationing, waiting lines, and lower quality. Patients are stuck in ambulances for hours in London waiting for the emergency room. And once patients are admitted, they can be warehoused in hallways for days, with some dying before a hospital bed becomes available.
If they need more money, Congress can appropriate it. There is so much administrative waste in the system, we can more than compensate.
But how can there be less bureaucracy. The bill says that Washington would make the decisions about what services will be covered, how much providers will be paid, and how much citizens must pay in new mandatory federal taxes. The HHS secretary would determine the national health budget and set prices, determine benefit eligibility and appeals processes, rule on capital expenditures, health professional education, and set up a new system of “uniform reporting standards.” How would all that work?
It may take a little more than two years, but we could do it. Medicare is the right platform because so many others in the health sector use it as their benchmark for payment.
But haven’t we heard promises like this before—if you like your doctor, you can keep your doctor…if you like your plan you can keep your plan…and the average family will save $2,500 a year in premium costs? None of that happened.
Republicans thwarted ObamaCare at every turn. The M4All comprehensive plan will allow us to control the system to deliver on these promises.
***Get ready, folks. Supporters believe they are on a track to finally put the entire health sector under government control. Americans are angry at the current system. Building on their momentum, House Democrats are planning to hold additional hearings on Medicare for All before the Budget Committee and Ways and Means Committee. They are going for it.