The BriefGet Up To Speed
As the nation gears up for the 2020 election, Democrats are promising bold new changes to the American health care system. One idea championed by many on the progressive left is “Medicare for All,” or a single-payer system, which would do away with private health insurance for most forms of care. Advocates of this plan promise that nationalizing health insurance will cut costs by reducing overhead and promote overall health by giving all Americans access to preventive health care. And in doing so, the United States will join the ranks of many other developed nations that have already mandated a national insurance program to guarantee medical care as a basic human right. Their opponents argue Medicare for All is a political non-starter that would force Americans off employer-based plans, reduce incentives for doctors and providers, increase bureaucracy and inefficiencies in the system, and lead to worse care overall, all the while inflating the already swelled federal deficit. Should private health insurance exist? Or is it time for Medicare for All?View Debate Page
Dr. Adam Gaffney
- President, Physicians for a National Health Program
"Two major developments in September upended US healthcare politics. The month’s end saw the failure of a last-ditch blitz by Senate Republicans to dispatch the Affordable Care Act (ACA) via the Graham-Cassidy bill, a painful defeat for opponents of Obamacare, including President Trump. And on 13 September, Senator Bernie Sanders’ single-payer “Medicare-for-All” bill was released, galvanizing proponents of progressive healthcare reform."
"There is an alternative. Over a decade ago, three of us, together with many colleagues, published a detailed proposal for a singlepayer national health program (NHP). Recently, single-payer reform has reemerged in the context of the presidential primaries."
"It would save both dollars and lives compared to our current system."
"By providing a single tier of coverage to all, with automatic enrollment, comprehensive benefits, and no cost-sharing, single-payer provides a distinct, egalitarian vision of universality."
"Gaffney works as a critical care doctor and supports Medicare-for-all for lots of reasons. He thinks it will improve access to medical services and make the United States a more equitable place to live."
"Would Medicare for All break the bank? Proponents contend that it could cover the uninsured - and upgrade coverage for just about everybody else - without swelling our nation's already hefty health care bill. But critics retort that the costs of such an expansion would be exorbitant, even prohibitive. Too often, however, this debate plays out in the absence of good evidence. But our new research, published Tuesday in the Annals of Internals Medicine, may change that."
Radio interview: "Physicians for a National Health Program is a group of doctors and health professionals that advocates for moving to a single-payer health care system. Dr. Adam Gaffney, a pulmonary specialist at the Cambridge Health Alliance and Harvard Medical School, is the newly elected president of that group. He joined us to talk about his push for expanding Medicare for All."
"PNHP president Dr. Adam Gaffney spoke at a Feb. 27, 2019 press conference introducing the Medicare for All Act (sponsored by Rep. Pramila Jayapal)."
"Physicians for a National Health Program President Dr. Adam Gaffney discusses why the U.S. should move to single-payer health care system."
- Co-Founder, Aspiration & Chair, CalEITC4Me
"Aspiration.com co-founder Joe Sanberg discusses how Abigail Disney, the granddaughter of Roy Disney, criticized CEO Bob Iger over his $65 million paycheck."
"In celebration of CalEITC Week, Joseph Sanberg speaks about the California Earned Income Tax Credit and why it’s important for California’s working families."
"Yes, in the year that Republicans discovered a public appetite for a certain real estate mogul, some Democrats believe they need to get more businessmen advancing their causes. To find a face for this movement, look no further than Joseph Sanberg, who delivered a speech at the NewDEAL conference “'We’re coming off this era where capitalism has been kidnapped by this godlessness that treats people like mathematical variables of consumption and production.'"
"The multimillionaire investor says the Democrats’ progressive agenda is best for jobs and economic growth."
"Having health insurance tethered to employment is a terrible idea."
An interview with Joseph Sanberg.
- Editor-at-Large, Reason
In the wake of the D.C. shooting, some lawmakers are pushing for new regulations on firearms. But legislation should never be passed in the heat of a crisis.
"Graboyes, a senior research analyst at George Mason's Mercatus Center, sat down with Reason TV's Nick Gillespie to outline immediate ways to grow the number of hospitals, doctors, and nurses to serve millions of newly insured patients."
"When libertarians dole out blame for the growth of government, perhaps we should take a look in the mirror."
"If single-payer couldn't make it out of Sanders' home state, there's no reason to try it on all of America."
"It will cost way too much, increase wait times, and slow down the development of new drugs."
"Somewhere in the 21st century, both Republicans and Democrats gave up on the idea of paying for your own stuff if you could afford to, replacing it instead with the notion that government can be all things to all people (or, government can be all things to your supporters and screw the other side). And here we are, with a government that will be running trillion-dollar deficits for the next decade or more."
Nick Gillespie critiques Tom Wheeler and the Obama-era regulations.
Nick Gillespie argues that net neutrality regulations are unnecessary government overreach.
Nick Gillespie discusses the repeal of net neutrality with fellow Reason journalists.
With regards to net neutrality regulations, Nick Gillespie argues, “Goodbye fast-moving innovation and adjustment to changing technology on the part of companies, hello regulatory morass and long, drawn-out bureaucratic hassles.”
Nick Gillespie interviews Ajit Pai.
Nick Gillespie critiques Burger King’s recent advertisement, which shows support for the 2015 net neutrality protections.
Tom Wheeler and Nick Gillespie debate net neutrality.
Gillespie and Welch answer the question: What does a libertarian think about the war on drugs and how do we change it?
Gillespie speaking at an SSDP conference on the topic of What Would a Sensible Drug Policy Look Like, and discussing how drug prohibition functions as a structuring event in American life, forcing all sorts of activity to pay hypocritical and misdirected lip service to a Just Say No mentality.
Legalize drugs and then tax sales of them. And while we're at it, welcome all forms of gambling (rather than just the few currently and arbitrarily allowed) and let prostitution go legit too.
Why is it that ostensibly pro-drug movies can never quite deliver the goods, can never quite depict drug use as something other than depraved?
- CEO & President, Pacific Research Institute
"Medicare Part D is one of the government's only successful entitlement programs precisely because it relies on private-sector competition. Adjusting the program could lead to higher premiums for beneficiaries and fewer new therapies. Let's hope the White House and Congress find a smarter way to offset the cost of any budget deal."
"Medicare for All may play well in the Democratic primary. But it'll be a liability during the general election, when health care promises to be among the most important issues for voters. At next week's presidential debate, we'll see if Democrats can get wise to that reality."
"Harris's healthcare plan aims to be a kinder, gentler form of Medicare for All. But it would still put the government in total control of the country's health insurance sector—and deprive more than 217 million Americans of the private insurance coverage they currently have."
"Sen. Bernie Sanders' 2017 Medicare for All bill (S.1804) would guarantee exceptional care to all Americans while reducing health spending by $5.11 trillion. At least that's what a new study from researchers at the University of Massachusetts-Amherst’s Political Economy Research Institute, which is co-directed by Professor Robert Pollin, claims. Sound too good to be true? It is. The study's assumptions are completely unrealistic. Medicare for All would be a disaster for patients and taxpayers alike. An analysis from the Urban Institute pegged the cost of Sen. Sanders' 2016 plan at $32 trillion over 10 years in new federal spending. And Charles Blahous at the Mercatus Center analyzed his 2017 bill and estimated it would cost $32.6 trillion over 10 years, after accounting for lower administrative and drug costs."
"Nearly a quarter of a million British patients have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons. More than 36,000 have been in treatment queues for nine months or more."
"They should be careful what they wish for. Single-payer systems have failed everywhere they've been implemented, from the United Kingdom to Canada. Americans who fall for single-payer's promise of "universal health coverage" at lower cost will instead find themselves facing long waits for subpar care."
"Sally Pipes, president and CEO of PRI and PRI’s health care expert, discusses the future of single-payer health care, which is shaping up to be a hot political issue in the 2020 presidential elections. She also talks about the future of single-payer in California, especially now that both houses and the governor are hoping to eventually bring it to the state."
An interview with Sally C. Pipes and Mark Levin of Fox News.
The taxing power of Congress, which the Supreme Court cited in validating Obamacare, could create better reforms if the law is repealed.
Sally Pipes, the renowned health care expert and president of the Pacific Research Institute. Pipes has a way to replace Obamacares expensive government health care bureaucracies with a market-driven system.
Think of his health plan as a federal HMO.
Last week, a House of Representatives subpanel overwhelmingly approved a measure to repeal a key component of President Obamas 2010 health reform bill. The full House and Senate must ratify the subcommittees vote and scrap the Board from the books. If they dont, Americas seniors could face the prospect of government-rationed health care.
The Food and Drug Administration plan to revoke approval of the drug Avastin for the treatment of advanced breast cancer is the beginning of a slippery slope leading to more and more rationing under the government takeover of health care.
"Fifty years ago, Congress created Medicare and Medicaid and remade American health care. The number of elderly citizens lacking access to hospitals and doctors plummeted. Hospitals, physicians, and state and local governments came to depend on this federal funding. We have a tendency to forget the history of laws that extended the obligations and commitments of the federal government. But the passage of Medicare and Medicaid, which shattered the barriers that had separated the federal government and the health-care system, was no less contentious than the recent debates about the Affordable Care Act."
"Republicans are still in charge of the White House and the Senate, but the “Medicare-for-all” debate is in full swing. Democrats of every stripe are pledging support for a number of variations on the theme of expanding health coverage to all Americans.This week, KHN’s “What the Health?” podcast takes a deep dive into the often-confusing Medicare-for-all debate, including its history, prospects and terminology.
"A glossary for the emerging Democratic health care debate."
"The majority of our health coverage topics are based on analysis of the Census Bureau’s American Community Survey (ACS) by the Kaiser Family Foundation. ACS includes a 1% sample of the US population and allows for precise state-level estimates. Please note that in the past, health coverage data posted to this site had used the Current Population Survey. We have replaced all previously-posted data, including data for previous years, with data based on ACS."
For the Motion
"Yet Sanders and Jayapal and their many colleagues who have come on board now (including 106 co-sponsors) have the best chance to prevail in our modern history. Americans know that the healthcare system is rigged, and they will support a new system that convincingly shows the way to fair and reasonable healthcare costs."
"The main questions is not how much universal health care will cost but how we provide for basic human rights."
"Medicare-for-all needs a better answer to the public’s fears."
"A single payer system works by cutting administrative waste, not doctors' income."
"Can the U.S. afford to expand Medicare to all? The real question is, can we afford not to?"
Against the Motion
"The House bill, in other words, would prohibit ordinary Americans from purchasing any alternative health coverage, except for items such as “cosmetic surgery” or health services that government officials decide are not “medically necessary."
"Do Democrats really want “Medicare for all” which inherently would abolish private health care? Or do they generally want every American to be covered by a system under which some are willing and able to pay for insurance, and others who aren’t have a plan provided to them that protects them from going bankrupt when they get sick?"
"If Democrats back single-payer health care, it could assure Trump’s re-election."
"That is why President Trump has promised to keep what works in our health-care system, fix what’s broken and deliver a better experience for all Americans. Instead of introducing even more government intrusion into the markets, we must strengthen and protect our existing safety-net programs and address the drivers of costs by fostering a competitive and dynamic private market in which plans and providers compete on the basis of cost and quality — not a system that makes promises that can’t be kept and leaves taxpayers to clean up the mess."
""Medicare for All" may sound good to some Americans – until they take a closer look at how it would actually work."
"The health-care debate is moving to the left. But if progressives don’t start sweating the details, we’re going to fail yet again."
"Employer-based health insurance is the most important source of health coverage for the nonelderly, covering about 58% of this population in 2017. The workplace has long been a significant source of coverage for those in working families, although its importance has been declining for a number of years, particularly among those in lower and moderate-income households. This brief presents data from the National Health Interview Survey to examine trends in the share of nonelderly people who receive and are offered coverage through a job."
"Gallup's latest update of its annual Healthcare poll, conducted Nov. 1-11, shows a continuation of the stability in Americans' views of their personal healthcare's quality and coverage since the start of the millennium -- including after the passage of the Affordable Care Act in 2010. The current ratings match or nearly match the averages Gallup has recorded since 2001."
"Centrist Democrats like Joe Biden still aim to gin up mass fear over the prospect of leaving behind predatory insurers and the dizzying array of deductibles, co-pays, exclusions, humiliations, and rationing of care that characterizes our current system."
"Perhaps the most prominent argument offered against single-payer healthcare, at least by those who don’t just call it “socialism” and leave it at that, is that many people say they like their employer-sponsored insurance, which is the largest single source of insurance coverage in America (though it still covers slightly less than a majority of Americans). From a policy standpoint, this argument is bad; there are not many employer-based plans that would be better than Medicare for All, which would have no co-pays, deductibles, or premiums."
"Among those who had employer-sponsored insurance in 2014, only 72 percent were continuously enrolled in that insurance for the next 12 months. This means that 28 percent of people on an employer plan were not on that same plan 1 year later. You like your employer health plan? You better cross your fingers because 1 in 4 people on employer plans will come off their plan in the next 12 months."
"- On the same day that the Congressional Budget Office (CBO) released a report that said 22 million people would lose health insurance if the Senate’s Better Care Reconciliation Act is approved, CBO released two other reports that have flown mostly under the radar. - The other reports compared what private insurance and Medicare fee-for-service (FFS) pay for physician services and also compared what private payers, Medicare FFS and Medicare Advantage plans pay hospitals. - The reports found that private insurers pay much more for physician services than Medicare and Medicare Advantage pays hospitals nearly the same amount on average than Medicare fee-for-services — and much less than private payers."
"Seventy-five percent of employees said they feel employer health plans will protect them for the majority of medical costs. Only 13 percent of Americans believe that enrolling in an employee health plan would be a downgrade in coverage from another health plan."
"You wouldn’t know it to read most of the news coverage, or to listen to politicians, but that is one of the more consistent results in health-care polling: Over and over again, roughly 7 out of every 10 Americans report that they’re fairly satisfied with the quality of their personal coverage."
Federal Debt & The Costs of Medicare for All
"How much would a “Medicare for all” plan, like the kind being introduced by Senator Bernie Sanders on Wednesday, change health spending in the United States?"
"This report describes the primary features of single-payer systems, and it discusses some of the design considerations and choices that policymakers will face as they develop proposals for establishing such a system in the United States. The report does not address all of the issues involved in designing, implementing, and transitioning to a single-payer system, nor does it analyze the budgetary effects of any specific proposal. "
"“The most fundamental goals of Medicare for All are to significantly improve healthcare outcomes for everyone living in the United States while also establishing effective cost controls throughout the healthcare system,” Pollin said. “These two purposes are both achievable.”
"Something interesting is happening in the age of Trump: 63 percent of Americans support a national health insurance plan, or Medicare for All, in which the federal government would guarantee health insurance for everyone in the country."
"The single-payer health insurance proposal known widely as Medicare for All (M4A) cannot be enacted without first answering certain questions. Foremost among these is whether the public would support shifting more than $32 trillion in M4A's first 10 years from private health spending, over which consumers retain some discretion, to federal spending, over which consumers do not."
"It is ironic that Democratic politicians, after defeating the repeal of the Affordable Care Act (ACA) and using health care as a rallying cry to win the majority in the House in 2018, now want to toss out ACA and the U.S. insurance system and replace both with a government-run system."
"Sanders wants taxpayers to save hospitals after he bankrupts them."
Global Health Care Examples
"To better understand one of the most heated U.S. policy debates, we created a tournament to judge which of these nations has the best health system: Canada, Britain, Singapore, Germany, Switzerland, France, Australia and the U.S."
"The only large rich country without universal health care"
"Finland beats the United States when it comes to childbirth on almost every measure. Its maternal death rate is among the lowest in the world, while the United States, at 14 deaths per 100,000 live births, ranks a lowly 46th, firmly in the lowest tier of developed countries. Our infant mortality rate is triple that of Finland. Almost one-third of babies in the United States are delivered by Caesarean section vs. 1 in 6 in Finland. Conditions in even top-notch U.S. teaching hospitals can be challenged, with women laboring in hallways and waiting rooms because there are no rooms available for them."
"Most of the country understands that when it comes to government, you pay for what you get."
"Of course, drawing comparisons between a country like Finland (which has the population of Minnesota) and the entire United States is difficult. No health care system -- rooted as each country's is in both its history and geography -- could ever provide a perfect model for the other."
"Before resigning themselves to socialized medicine, flummoxed legislators should consider the experience of our neighbors to the North."
Industry Coalitions & 2020 Implications
"Less than two months after the 2017 Republican push to kill Obamacare perished overnight on the Senate floor, more than a third of the Democratic caucus gathered in a much smaller room on Capitol Hill to take turns making the case for Sen. Bernie Sanders' new "Medicare for All" bill."
"In the last presidential election, the idea of abolishing private health insurance was confined to the far left of American politics. Now it’s the central argument of the Democratic primary race."
"To capture the full scope of options Democrats are considering to insure all (or at least a lot more) Americans, look at the half dozen or so plans in Congress, which all envision very different health care systems."
"She finally indicated that she'd abolish the private insurance industry."
"The American Medical Association has quit a coalition that's led the health industry's fight against Medicare expansion, the first crack in its opposition to Democratic candidates' proposals."
"Labor leaders dispute candidates’ claims that single-payer will leave their members worse off."
"In 2018, Democrats won the midterm elections on the issue of health care, specifically protecting the Affordable Care Act and its guarantee of coverage for pre existing conditions. It was a hard-earned victory: Passing the ACA was a major reason Democrats lost the House and seats in the Senate in 2010 , and polls showed the ACA was not a winner for Democrats in 2012, 2014 or 2016. Now, the question is: Having won the upper hand on health care, will Democrats give it back in 2020?"
"No issue animated the Democrats’ 2018 congressional campaigns like health care and the promises to expand access to insurance and to lower costs. But as House Democrats sit down to draft their vision of governance in the coming weeks, lawmakers find themselves badly divided on the issue that delivered their majority."
"The GOP wants to show that Democrats are in favor of ‘socialized medicine’"
"A groundswell of support for Medicare for All among prominent Democratic presidential contenders has spooked the industry, with some candidates professing the private health insurance sector may (and even should) eventually be tossed into the dustbin of history."