Three Key Points On Medicare For All

MEMORANDUM

To: Interested Parties
From: Lauren Crawford Shaver, Partnership for America’s Health Care Future
Re: Three Key Points On Medicare For All
Date: June 11, 2019

As the U.S. House Committee on Ways and Means prepares to conduct a hearing tomorrow that will “cover Medicare for all and ‘other potential pathways to universal coverage,’” the rhetoric of those in favor of a one-size-fits-all health care system continues to run counter to reality.  For those paying attention to tomorrow’s proceedings, here are three key points to keep in mind.

1) The Push For ‘Medicare For All’ Is Stalled:

While proponents of Medicare for all continue to claim that momentum is growing behind their proposed one-size-fits-all government-run system, news reports reveal that the opposite is true.

• “The ‘Medicare for All’ push is hitting serious obstacles in the U.S. House in the face of resistance from Democratic leaders concerned that replacing the private insurance system would generate backlash from voters who like their coverage,” and “the effort appears unlikely to go much further” as the legislation “hasn’t gained much support since its release in February,” Bloomberg reports.
• Assessing the extent to which Senator Bernie Sanders’s (I-Vt.) agenda is “stalled,” The Washington Post notes that “[o]ne of his trademark proposals — Medicare-for-all — has attracted fewer co-sponsors in Congress than two years ago.”
• POLITICO reports that “House Democratic leaders, who worry Medicare for All could hurt the party with moderate voters, have allowed hearings on the plan, but they haven’t committed to floor votes.”
• A former Washington bureau chief for The Dallas Morning News, meanwhile, points out the “retreat by others [in the 2020 Democratic field] from stressing the more liberal policy positions Sanders has championed, like Medicare for all…”
• CNN reports that Medicare for all “may not even be what their party wants,” as polling data reveal that most Democrats and Democratic-leaning independents would prefer our elected officials focus instead on improving and building upon what works in American health care, and “there’s still an appetite for improving the current system in the progressive wing of the party.”
• And while Medicare for all would eliminate the popular Medicare Advantage program, along with employer-provided and other private coverage, Bruce Japsen writes at Forbes that new data from the Kaiser Family Foundation show that “[s]eniors in progressive U.S. states are choosing private Medicare Advantage plans more so than the national average even as the politicians who want to represent them talk about getting rid of the insurer’s role in health coverage … The move toward privatized Medicare plans in Democratic-leaning states like these comes as many candidates for the party’s nomination for President are pushing a single payer version of ‘Medicare for All’ that would bring an end to the private insurer’s role.”

2) Americans Don’t Want To Pay More To Wait Longer For Worse Care:

Polling shows that many Americans don’t know what Medicare for all is – and when they learn what it means for them, majorities oppose it.

• When it comes to perceptions of Medicare for all among the American public, Eric Levitz writes in New York Magazine that “[a] recent Kaiser Family Foundation survey found that 56 percent of Americans favored Medicare for All — until they were told the policy would ‘require most Americans to pay more in taxes,’ at which point support plummeted to 37 percent.  The credibility of this finding is buttressed by the failure of movements for single-payer health care in Vermont and Colorado, where aversion to tax increases fueled opposition.”  The same poll found that 70 percent of Americans oppose Medicare for All when they learn it would “lead to delays in some people getting some medical tests and treatments,” while 60 percent oppose it when they learn it would threaten the already at-risk Medicare program and 58 percent oppose it when they learn it would eliminate employer-provided and other private coverage.
• Examining the failed effort to implement a Medicare for all-style system in Senator Sanders’s home state of Vermont, Roll Call reported that Peter Shumlin, the state’s Democratic former governor who campaigned on a platform of one-size-fits-all health care, later admitted that the 11.5 percent payroll tax and 9.5 percent income tax 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 …  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.”
• And while calling out Sanders’s “misleading” rhetoric, fact-checkers for The Washington Post note that “[a]ccording to a study from the Urban Institute (and a follow-up paper), Medicare-for-all would still add $32.6 trillion to national health spending over 10 years.  The study goes on to state that Sanders’s proposed tax increase would be insufficient and that additional revenue would be needed.”
• The Washington Post’s fact check also notes that “providers warn [Medicare for all] could significantly hurt their ability to provide adequate, widespread care.  A recent report from the Congressional Budget Office reinforces this concern: ‘Such a reduction in provider payment rates would probably reduce the amount of care supplied and could also reduce the quality of care.’”  The CBO cautioned recently that under Medicare for All, “patients might face increased wait times and reduced access to care,” and such a system “could also reduce the quality of care,” while “[t]he number of hospitals and other health care facilities might also decline as a result of closures, and there might be less investment in new and existing facilities.”
• This warning was echoed in a report by POLITICO, which notes that Medicare for all “would all but end private insurance and regulate hospitals in a vastly different way, dramatically changing operators’ business model and costing community hospitals as much as $151 billion a year, according to one estimate published in JAMA,” all while “slashing hospitals’ pay rates and putting up to 1.5 million jobs at stake … It’s a concern that’s left Medicare for All advocates walking a fine line, arguing for a dramatic reshaping of the health system while trying to avoid a brawl with their hometown health systems.”

3) So-Called “Moderate” Fallback Proposals – Like “Buy-In” Or “Public Option” Systems – Would Ultimately Lead To The Same Bad Results:

As Medicare for all “falters,” some elected officials and 2020 presidential hopefuls are turning to so-called “moderate” fallback proposals – often branded “public option” or “Medicare buy-in.”  In reality, these proposed government insurance schemes would lead to the same result Americans reject: a one-size-fits-all health care system run by Washington.

• As The Wall Street Journal reports, government insurance systems like these represent “stepping stones to single payer,” a fact acknowledged even by supporters of such proposals.  In fact, one U.S. Senator who supports such an approach recently admitted it would bring about the “slow death” of employer-provided and other private coverage and serve as an “on ramp to a single-payer system.”
• And this holds true on the state level, where as some governors consider implementing similar government insurance systems, Modern Healthcare reports that even supporters of such schemes and health policy experts acknowledge that a one-size-fits-all government-run system is the end goal: “Opponents warn that state public-option proposals are just a way station on the path to a federal single-payer system, which advocates don’t necessarily deny.  ‘There’s no question the endgame is single-payer,’ said Dr. Roger Stark, a health policy analyst at the conservative Washington Policy Center in Seattle.”
• Meanwhile, recent studies have laid bare the negative impacts a new government insurance system would have on providers and patients throughout the country.  One study, prepared by KNG Health Consulting for the American Hospital Association and the Federation of American Hospitals, found that “[f]or hospitals, the introduction of a public plan that reimburses providers using Medicare rates would compound financial stresses they are already facing, potentially impacting access to care and provider quality.”  Another study, conducted by Navigant, found that government insurance systems such as “buy-in” or “public option” could force hospitals to limit the care they provide, produce significant “layoffs” and “potentially force the closure of essential hospitals.”

While those arguing in favor of Medicare for all and other government-run systems will do their best to distort these facts before, during and after tomorrow’s Ways and Means hearing, those covering the proceedings shouldn’t let their rhetoric distract from reality.  With roughly 90 percent of Americans now covered and a majority satisfied with their coverage and care, our leaders should be building and improving upon what is working, not putting forth destructive proposals to upend Americans’ care and start from scratch with a one-size-fits-all government-run system.