Opinion: Medicare for all, quality care for none

Janet Trautwein
"Americans who have private health insurance have demonstrated that they're not interested in losing their coverage for VA-style health care."

Medicare for All has emerged as a defining issue in the race for the White House. Several contenders for the Democratic nomination for president have expressed support for expanding Medicare to cover all Americans.

But the idea may not play as well with the voting public. Medicare for All would take away the existing health insurance coverage of tens of millions of Americans -- and deprive them of any say over their health care. And in exchange for sacrificing control of their health care, Americans would pay trillions of dollars in new taxes.

Consider Sen. Bernie Sanders's Medicare for All Act, the purest manifestation of the idea. It would do exactly what its title says — enroll all Americans in a new government-run health plan.

No one would have a choice in the matter. The bill would outlaw private insurance coverage. The more than 150 million people with employer-sponsored insurance plans, the 20 million people who purchase coverage on the individual market, and the 20 million people with privately administered Medicare Advantage plans would all find themselves in a new, one-size-fits-all government plan.

Assuming responsibility for the healthcare bills of the entire country would be incredibly expensive for the federal government. Experts peg the cost of Medicare for All at roughly $32 trillion over its first decade. Even doubling what the federal government takes in corporate and individual income tax revenue would be insufficient to cover that tab.

The massive tax hikes needed to come up with that kind of cash are deeply unpopular. Six in ten Americans oppose Medicare for All once they learn it will require tax increases.

And that initial $32 trillion cost estimate may be low. The bill envisions paying healthcare providers at Medicare's existing rates, which are 40 percent lower, on average, than those for private insurance.

Doctors and hospitals can't simply absorb those kinds of pay cuts. Many healthcare facilities, especially those in rural areas, will close their doors, unable to cover their costs under the new payment schedule.

The result will be a healthcare system where everyone has insurance coverage — but not access to care.

That's exactly how things work at the government-run Veterans Health Administration. The VA effectively guarantees coverage to military veterans. But in many cases, vets have to wait months for care.

According to a 2017 audit of 12 VA facilities in North Carolina and Virginia conducted by the agency's inspector general, one-third of veterans had to wait more than 30 days for a primary care appointment. The average wait for this group was 51 days.

These wait times were significantly longer than the VA's own electronic scheduling system showed. In some cases, that was because VA staff manipulated the data to make waits appear shorter than they were — or simply disregarded national guidelines.

The millions of Americans who have private health insurance have demonstrated that they're not interested in losing their coverage for VA-style health care.

Ensuring that everyone has access to health insurance is a laudable goal. But we can more easily achieve it by building on what works in our current system and fixing what doesn't. Seventy percent of those with employer-based plans are happy with their coverage.

Medicare for All is not the only way to ensure universal access to health insurance. In fact, it's the most expensive, most complicated, most disruptive way there.

Janet Trautwein is CEO of the National Association of Health Underwriters.