Five Facts About Medicare For All

As the House Committee On Rules prepares to hold a hearing next Tuesday, April 30, on “Medicare for all” legislation, here are five key facts to keep in mind regarding this proposal to completely eliminate the foundations of American health care – including the Affordable Care Act (ACA), Medicare and Medicaid – and start from scratch with a one-size-fits-all system:

Let’s start with the bottom line:

• “There’s no possible way to finance [Medicare for all] without big middle class tax increases,” as Marc Goldwein, CRFB’s senior vice president, explained to The Washington Post.
• National polling by the Kaiser Family Foundation indicates that six in 10 Americans oppose Medicare for all once they learn it forces families to pay more in taxes.

While the Medicare for all bill introduced in the U.S. House notably “doesn’t include a price tag or specific proposals for financing the new system,” independent analyses conducted by both the liberal-leaning Urban Institute and the libertarian-leaning Mercatus Center at George Mason University estimate that even a less expansive Medicare for all program would cost taxpayers approximately $32 trillion over 10 years.  NBC News reports that such a system “requires a massive new source of tax revenue.”

The Washington Post reports that Medicare for all “would require tax hikes on middle class families,” a fact on which analysts agree.  In fact, the Mercatus Center warns that “doubling allfederal individual and corporate income taxes going forward would be insufficient to fully finance the plan,” while the centrist Committee for a Responsible Federal Budget (CRFB) found that enacting Medicare for all “would mean increasing federal spending by about 60 percent (excluding interest)” and “would require the equivalent of tripling payroll taxes or more than doubling allother taxes.”

Speaking to The Washington Post on Medicare for all and other costly proposals, Jim Manley who as a senior member of former Senate Majority Leader Harry Reid’s (D-Nev.) staff played a key role in passing the Affordable Care Act (ACA), offered this warning:

“Democrats have to be careful here: If they’re going to pay for these programs, the math suggests middle-class taxpayers are going to be hit,” said Jim Manley, who served as an aide to former Senate Majority Leader Harry M. Reid (D-Nev.).  “And that’s not what Democrats have traditionally stood for.”

Already, high costs and unaffordable tax hikes have doomed similar plans to implement single-payer health care on the state level:

• The New York Times editorial board acknowledged recently that “[i]n Vermont and Colorado, legislators dropped bids for a state-run single-payer system when it became clear that people would not support the tax increases needed to sustain such a program.”  Roll Call reported that Vermont’s Democratic governor, who campaigned on a platform of single-payer health care, later admitted that the 11.5 percent payroll tax and 9.5 percent income tax that were proposed to finance the system were too much for taxpayers to accept: “The final bill was too much for the state to bear, he said.  ‘The biggest problem was money,’ Shumlin said at Harvard.  And he couldn’t promise lawmakers that they wouldn’t need to hike taxes again later to accommodate rising health care costs.  ‘I couldn’t with a straight face turn to them and say, no, we’ve got this figured out,’ he said.”
• In a recent interview with The Atlantic, Democratic New York Governor Andrew Cuomo was blunt about the political and fiscal realities of implementing a single-payer health care system in the Empire State, saying “no sane person will pass it,” and “you’d double everybody’s taxes” to pay for it.

Today, roughly 90 percent of Americans are covered – more than at any time in our nation’s history.  U.S. Census data indicate that more than 217 million Americans benefit from private coverage – including 180 million who receive coverage through their employers and 10 million who shopped forcoverage through the marketplaces last year.  More than 20 million seniors are enrolled in the popular Medicare Advantage program.

Notably, public opinion research shows that a majority of Americans are satisfied with their coverage and care.  “Perhaps the greatest political danger for Democrats is that Medicare for allwould disrupt coverage” for every one of those Americans, Bloomberg notes.

• Medicare for all would eliminate all of this, along with traditional Medicare and Medicaid, and force each and every American – young or old, sick or healthy – into a one-size-fits-all system run by Washington.
• Medicare for all would shift health care decisions away from patients and doctors and put them in the hands of Washington politicians and bureaucrats.
• For Americans, Medicare for all means more politics in their care and fewer choices when it comes to their coverage and treatments.

And to make matters worse, serious questions are arising about how Medicare for all would impact children, as Bruce Lesley of First Focus on Children notes that it “would actually repeal Medicare, Medicaid, CHIP, and private health insurance coverage options for children and other populations and move them to an entirely new health care or single payer system.”

Lesley aptly notes that “[w]hile some progressive health reform advocates and the media are criticizing those that do not sign up for [Medicare for all] as being vague or not bold, I would argue the opposite.  In fact, the truth is that this approach is the one most lacking in the way of details.”

A new national survey by the Kaiser Family Foundation finds that a majority of Americans want elected leaders to focus on “targeted actions” to improve and build upon what is working and fix what isn’t, and not on scrapping our existing health care system in favor of starting from scratch with Medicare for all.

In fact, Kaiser finds that most Democrats and Democratic-leaning independents “say they want Democrats in Congress to focus their efforts on improving and protecting the ACA,” while previous national polling by Kaiser reveals that Americans don’t support Medicare for all once they understand what it would mean for them.

Earlier this year, Kaiser found that “net favorability [for Medicare for all] drops as low as -44 percentage points when people hear the argument that this would lead to delays in some people getting some medical tests and treatments. Net favorability is also negative if people hear it would threaten the current Medicare program (-28 percentage points), require most Americans to pay more in taxes (-23 percentage points), or eliminate private health insurance companies (-21 percentage points).”

At the ballot box last fall, very few winning candidates in the House seats that delivered Democrats the majority endorsed Medicare for all proposals.  In fact, not one of the 11 Democratic candidates who won in House districts where a majority of voters supported Republican presidential candidates in the past decade ran on a platform of support for Medicare for All, and 74 percent of allHouse Democrats who won seats in Republican-leaning districts did not support Medicare for All.  Instead, the party netted 40 seats and took the House majority largely on a platform of protecting Americans with pre-existing conditions and other policies aimed at improving and building upon our current health care system.

As one Democratic strategist put it to The New York Times: “Most of the freshmen who helped take back the House got elected on: ‘We’re going to protect your health insurance even if you have a pre-existing condition,’ not ‘We’re going to take this whole system and throw it out the window.’”

“[A] majority of those [Democratic Members] who flipped their seats from red to blue focused on strengthening the 2010 health care law and protecting coverage for people with pre-existing medical conditions,” Roll Call reports, noting the significant “risks for any politician that proposes dramatic change and uncertainty in a system that is central to Americans’ well-being.”

Given these facts, it is no surprise that a growing chorus of leading Democrats is sounding alarm bells on the high costs and political risks associated with Medicare for all.  As the Washington Post notes, these Democratic leaders are worried by such proposals, which “require middle class tax hikes that will prove hurtful for economic growth and the party’s political fortunes.”  For example:

• House Speaker Nancy Pelosi recently exclaimed to Rolling Stone: “And by the way, how’s it gonna be paid for?”
• Democratic Congressional Campaign Committee (DCCC) Chairwoman Rep. Cheri Bustos said to The Hill that “the $33 trillion price tag for Medicare for all is a little scary,” and later doubled down on those comments in an interview with CNN.
• The Washington Examiner notes that “Rep. Frank Pallone, D-N.J., who chairs the Energy and Commerce Committee, also has drawn attention to the cost.”
• President Barack Obama “warned a group of freshman House Democrats … about the costs associated with some liberal ideas popular in their ranks, encouraging members to look at price tags” in what was widely seen as “a cautionary note about Medicare-for-all,” The Washington Post reports.
• As the House Medicare for all bill was rolled out, “[k]ey players whose support would be vital to the success of Jayapal’s bill were muted, while a group of moderate House Democrats called for instead improving the Affordable Care Act and expanding existing private channels of health coverage,” The Washington Post reported.
• The Hill reports that “[c]entrist Democrats who helped their party win back the House majority with victories in key swing districts last fall are sounding the alarm that the liberal push for ‘Medicare for all’ could haunt them as they try to defend their seats and keep control of the House.”

This helps explain why, as The Washington Post reports, even as hearings are expected in the House Rules and Budget Committees, which do not traditionally have jurisdiction over health care legislation, “the major [House] health committees are staying away from the legislation and leadership hasn’t said they will hold a vote on it.”

5. With 90 Percent Of Americans Now Covered And Most Satisfied With Their Care, We Have More Affordable, Less Disruptive Ways To Expand Access

The Partnership for America’s Health Care Future believes that every American deserves access to affordable, quality health care.  And while there has been significant made progress towards this goal, there is still more that can and should be done to expand access and control costs.

It is important to note that our leaders already have powerful tools available to help them achieve this.  For instance:

• One important step would be to expand Medicaid in the remaining states that have not yet expanded the program, which would increase access to millions of Americans.
• Another would be to expand available federal subsidies so that Americans of all income levels can choose market-based coverage that fits their needs.
• Additionally, we can make important progress stabilizing premiums to control health-care costs by using proven tools such as reinsurance.

These are just some of the steps our elected leaders can take to improve and build upon what is working today, rather than scrapping our entire health-care system to start over with a one-size-fits-allgovernment-run program that would make families pay more through higher taxes, eliminate patients’ choices and control, and push Americans, a majority of whom are satisfied with their coverage, off their current plans.

Together, we can bring down costs and extend coverage to millions more Americans.  But one-size-fits-all Medicare for all is the wrong way forward.