"Medicare for All" is, arguably, the rallying cry for progressive Democrats these days. Health care costs were a major issue in the midterm elections and the best way to fix everything once and for all, say progs, is to give all Americans the same sort of coverage given to those of us who are 65 and over. What's not to like about Medicare, say proponents. Seniors love it and it's a proven form a single-payer health care.
Er, no, says a concise and persuasive op-ed in The Wall Street Journal, by Scott W. Atlas of the Hoover Institution. For starters, there is the cost problem:
For California alone, single-payer health care would cost about $400 billion a year—more than twice the state's annual budget. Nationwide "Medicare for all" would cost more than $32 trillion over its first decade. Doubling federal income and corporate taxes wouldn't be enough to pay for it. No doubt, that cost would be used to justify further restrictions on health-care access.
In 2017, Eric Boehm noted at Reason that a single-payer bill passed by New York's state assembly would cost $173 billion annually (the state generates about $71 billion a year in revenue). Even when you factor in savings from people not having to pay insurance premiums and co-payments, there's just no way to raise the revenue on such plans. In 2014, Boehm writes, Vermont had to throw in the towel because it "would have required an extra $2.5 billion annually, almost double the state's current budget, and would have required an 11.5 percent payroll tax increase and a 9 percent income tax increase."
But cost isn't the only problem. Atlas writes that in Great Britain, "a record 4.2 million patients were on England's [National Health Service] waiting lists." And there's this:
In Canada last year, the median wait time between seeing a general practitioner and following up with a specialist was 10.2 weeks, while the wait between seeing a doctor and beginning treatment was about five months. According to a Fraser Institute study, the average Canadian waits three months to see an ophthalmologist, four months for an orthopedist and five months for a neurosurgeon.
In contrast, wait lists are not a major concern in the United States.
Finally, there's also the development of new drugs. Atlas writes:
Single-payer systems also impose long delays before debuting the newest drugs for cancer and other serious diseases. A 2011 Health Affairs study showed that the Food and Drug Administration approved 32 new cancer drugs in the decade after 2000, while the European Medicines Agency approved 26. All 23 drugs approved by both Europe and the U.S. were available to American patients first. Two-thirds of the 45 "novel" drugs in 2015 were approved in the U.S. before any other country.
Most proponents of Medicare for All say they don't want to fully nationalize health care, as Canada has done. Instead, they want to guarantee a basic, accessible, free (or near-free) system. Atlas has an answer for that, too: "America's poor and middle class would suffer the most from a turn to single-payer, because only they would be unable to circumvent the system." In fact, he warns that,
the nations most experienced with single-payer systems are moving toward private provision. Sweden has increased its spending on private care for the elderly by 50% in the past decade, abolished its government's monopoly over pharmacies, and made other reforms. Last year alone, the British government spent more than $1 billion on care from private and other non-NHS providers, according to the Financial Times. Patients using single-payer care in Denmark can now choose a private hospital or a hospital outside the country if their wait time exceeds one month.
Our health care system is definitely screwed up, but that's because we refuse to let markets function with the same sort of effectiveness they do in other parts of the economy. There are ways to take care of people who have pre-existing conditions that don't end up causing costs for everyone to go berserk. We can speed up drug trials without compromising safety, and we also need to rethink how we certify and license doctors, nurses, and everyone else who provides some dimension of health care.
Given the way the Republicans refused to take health-care policy seriously in the wake of Obamacare's passage, it seems unlikely that we'll be moving toward market-friendly solutions any time soon. That's a damn shame and if we do end up with Medicare for All, the bill will be almost incalculable in terms of more than taxes.
Related video (from 2012): Meet Keith Smith, a doctor in Oklahoma who brought market forces to bear on the delivery of surgery.