The Threat of Medicare for Some

Shutterstock | Diane Kirkendall

If you’re an insurance executive who’s afraid that Democrats will actually pursue viable healthcare reform, you’re having a great week.

Presidential candidates and prominent progressive policy wonks decided to publicly back off of their demands on Medicare for All and demonstrate that they aren’t prepared to actually fight for healthcare reform.

It’s a dangerous moment for the Medicare for All movement, and candidates need to know they’re not fooling anyone.

Beto O’Rourke, the former Congressman who reportedly raised close to $6.1 million in 24 hours after announcing he’s running for President, gave an odd, garbled answer about why he’s changed his mind since his recent run for Senate, and on second-thought, doesn’t actually support Medicare for All.

Then, The Atlantic ran a piece from Ezekiel J. Emanuel, a physician and academic arguing that the insurance industry has a lot of lobbying power and political influence, so we shouldn’t bother trying to pass Medicare for All.

Next, Senator Kirsten Gillibrand, another high-profile Presidential candidate who has been supportive of Medicare for All, said that she thinks the best way to get to single payer is through a public option that people will gradually shift into.

Everyone seems to have the same recommendation: Medicare for America, the plan from Reps. Schakowsky and DeLauro that is essentially a public option with bells on.

O’Rourke specifically endorsed their bill, Senator Gillibrand described something very similar to it, and Dr. Emanuel actually helped to write (a fact that, along with the speaking fees he has collected from the health insurance industry, is not disclosed for the first 10 paragraphs of his Atlantic piece).

To be fair to Medicare for America, it improves on public options of past. It’s largely based on the plan cooked up at the Center for American Progress (CAP), that would create a public option that offers a fairly robust coverage plan, automatically enroll people without employer sponsored insurance, automatically enroll newborns, and allow employers to buy-on and shift their employees onto a public plan.

It would however, charge premiums to enrollees, and includes deductibles for out of pocket spending for enrollees above a certain income level.

CAP calls it “Medicare Extra for All”, although a more accurate name would be “Medicare for Some”.

There are a lot of reasons that Medicare for Some is weaker than Medicare for All. First off, it’d be even more expensive than our current system. It doesn’t eliminate the massive expense that the for-profit insurance system ads to our system through inefficient claims and appeals departments, marketing budgets, and bloated salaries. It also leaves in place the administrative burden on doctors and medical providers, who are spending about 20% of their revenue dealing with the multi-payer system.

While it would theoretically ensure everyone has health insurance, it wouldn’t ensure everyone could afford to access care (people on employer sponsored insurance are the largest driver of the growing underinsured rate). It would create a two tiered system where people are paying different rates for different quality of care, and doctors could easily choose not to participate in the public system and only see patients with private insurance.

Finally, it’d weaken the public system’s ability to negotiate rates from pharmaceutical companies and medical providers, and add additional expense into the public system.

The main argument for supporting Medicare for America over Medicare for All seems to be political feasibility. Which is patently ridiculous.

There’s no reason to think that the insurance industry would simply roll over and accept Medicare for America. They would fight just as hard to kill it, and they’d use the exact same talking points to do it.

Worse, if it passed, Medicare for America leaves the health insurance industry in place and allows them to maintain their political power. Which means they’ll spend the next years undermining the system until it’s either significantly weakened or completely repealed.

It’s also more complicated than Medicare for All, provides less benefit to the average person, and so is more difficult to sell to the public.

And finally, if you believe, like Senator Gillibrand apparently does, and Beto O’Rourke apparently used to, that single payer is the optimal solution, you shouldn’t cave before you even get to the negotiating table.

Instead of giving in to the industry spin, and moving the starting line back, candidates should go all in on Medicare for All. There’s only one thing that has a louder megaphone than the healthcare industry’s PR team: a Presidential campaign.

These candidates have an incredible platform to demonstrate to the American people the truth about Medicare for All:

  1. The commercial insurance system is a disaster that’s leaving millions uninsured and millions more underinsured.
  2. Employer-sponsored insurance is keeping wages low, hindering economic growth, and making us less competitive.
  3. Everyone can have better insurance with comprehensive coverage that will allow them to see any doctor of their choosing.
  4. No one will ever face financial disaster from being ill or get another surprise medical bill.
  5. And the whole thing will cost trillions less than we’re currently paying.

Demanding anything less than Medicare for All is a free gift to the insurance industry.

Dylan Dusseault is the Executive Director of Business Initiative for Health Policy.