ICYMI: “Medicare-for-All is a Slogan, Not a Concrete Proposal”

Washington, D.C. – In case you missed it, recent commentary in The Washington Post, The Wall Street Journal and Axios highlights significant unanswered questions surrounding Medicare for All proposals, including how a government-run health care system would be financed and its potential impact on Americans’ existing coverage and access to care. Proposals could require trillions of dollars in federal spending while raising taxes, taking away patient choice and lowering the quality of care.

While Medicare for All promises lower health care costs in theory, supporters can’t agree on how such a system would work in practice. As MIT economist Amy Finkelstein explains, “Medicare-for-all is a slogan, not a concrete proposal.” Without a clear plan to finance and implement these proposals, broad promises of universal coverage and lower costs risk presenting Medicare for All through rose-colored glasses to unsuspecting voters.

The potential price tag is substantial. A 2018 analysis of Sen. Bernie Sanders’ Medicare for All proposal projected $32.6 trillion in federal costs over a decade, while a more recent estimate from the White House Council of Economic Advisers projects $47 trillion in federal costs over a decade. Under that proposal, provider payments would be reduced to Medicare rates, which are more than 40 percent below private insurance rates. The Congressional Budget Office highlights that lower reimbursement could lead to fewer medical professionals and pharmaceutical companies developing fewer new drugs. Such a shift in reimbursement rates and payer mix would place significant financial pressure on hospitals and providers, threatening their financial stability and patients’ access to care.

Public support for Medicare for All declines significantly when Americans consider its drawbacks. KFF polling found that the policy’s favorability drops to about one-third when respondents hear it could raise taxes, to one-quarter when told it could lead to delays in medical tests or treatment and to four in ten when told it could threaten the existing Medicare program. These findings illustrate the gap between Medicare for All’s appeal as a concept and the trade-offs Americans may face under specific proposals. As Democratic consultant Chris Jennings told Axios, “As the poll itself has repeatedly highlighted, there’s the aspirational perception of Medicare for All, and then there is the policy, politics and process of getting it done. And those are two separate issues.” The distinction underscores the importance of clearly communicating what Medicare for All proposals would entail, rather than allowing broad promises of universal coverage to overshadow the practical challenges of implementation.

The consequences could extend well beyond how Americans pay for their care. The Wall Street Journal argues that “Medicare for All would eliminate competition and choice in medical care, limit access, and inevitably lead to tax increases.” The proposal could fundamentally change patients’ ability to choose their own health insurance by restricting the private coverage millions rely on. Under congressional proposals, private insurers would be prohibited from offering coverage that duplicates benefits provided by the government, potentially requiring Americans to give up their existing insurance plans. The Wall Street Journal furtherwarns that“Medicare for All also still means forcing Americans into a government system that millions don’t want.”

Changes to insurance coverage could also affect patients’ ability to access medical services. While Medicare for All proponents promise comprehensive benefits, expanding coverage does not guarantee timely access to medical services. International comparisons cited in The Wall Street Journal show that 17 percent of U.S. patients wait more than two months for a specialist appointment, compared with government-run systems: 48 percent in Canada, 45 percent in France and 43 percent in the United Kingdom.

These delays can have serious consequences for patients. A recent JAMA Surgery study examining more than 2.7 million cancer patients found longer wait times for treatment among Medicaid patients than those with private insurance and noted increased mortality associated with surgical delays. Policymakers should recognize that timely access to care can make the difference between life and death, and even when it doesn’t, it often determines how fully and quickly a patient recovers.

The shortcomings of existing state public option programs serve as a warning about the risks of pursuing an even more sweeping government-run health care system. In Colorado, the Colorado Option has repeatedly fallen short of its premium reduction targets, with state-designed plans more expensive than non-Colorado Option plans for 85 percent of individual-market shoppers in 2026. In 2022 and 2023, aggregate premiums for Washington State’s public option plans were $2 million more than if public option participants had chosen the lowest-cost non-public option. If these government-run plans have struggled to deliver promised savings, a far more expansive option like Medicare for All would pose even greater risks to patients and providers.

While significant questions remain about how Medicare for All would be implemented, policymakers do not need to rely on speculation to understand that it would move the country in the wrong direction. Experiences with state public option programs have already provided valuable lessons about the financial and operational challenges of expanding government’s role in health care, including the implications for costs, provider participation and patient access.

Policymakers should carefully consider the costs and consequences of Medicare for All before pursuing this one-size-fits-all, government-run system. Americans deserve solutions that make health care more affordable without sacrificing the system they currently rely on, but Medicare for All could raise costs, limit patient choice and reduce timely access to quality care. Rather than expanding government’s role in Americans’ health care decisions, policymakers should prioritize practical solutions that build on what’s already working to lower costs, protect patient choice, strengthen employer-provided coverage and keep existing programs stable for the future. 

Read The Washington Post article HERE.

Read The Wall Street Journal articles HERE, HERE and HERE.

Read the Axios article HERE.