Medicare for All

Should the Government Provide Health Insurance to All Americans? A Soho Forum Debate

Gerald Friedman of the University of Massachusetts says yes, while the Pacific Research Institute's Sally Pipes says no.

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The COVID-19 pandemic makes it all the more urgent for the U.S. to install a system of Medicare for All.

That was the topic of an online Soho Forum debate held on August 19, 2020. Arguing in favor of the proposition was Gerald Friedman, a professor of economics at the University of Massachusetts and the author of the book, The Case for Medicare for All. He went up against Sally Pipes, president of the Pacific Research Institute and author of False Premise, False Promise: The Disastrous Reality of Medicare for All. Soho Forum Director Gene Epstein moderated.

The Soho Forum runs Oxford-style debates, meaning the audience voted on the proposition before and after the presenters' remarks. The winner is the person who moves more votes in his or her direction. At the start of the evening, 20 percent of the Zoom audience agreed that the pandemic furthered the case for Medicare for All, 60 percent were against, and 20 percent were undecided. At the end of the debate, 27 percent agreed with the proposition, 73 percent disagreed, and no one was left undecided. Because she gained the most votes, Sally Pipes was declared the winner.

The Soho Forum, sponsored by the Reason Foundation, is a monthly debate series at the SubCulture Theater in Manhattan's East Village. Debates will remain online until New York allows public events again. For information on how to watch and vote in the next online Soho Forum debate, go here.

Produced by John Osterhoudt.

Photo: Molly Adams/Flickr; Jeff Malet Photography/Newscom; U.S. Pacific Fleet/Flickr; Bob Owen/ZUMA Press/Newscom; Vanessa Carvalho/ZUMA Press/Newscom; Official U.S. Navy Page/Flickr

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  1. Absolutely not.

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  2. Socialism fails every time it’s tried.

    1. It’s never been tried.

      1. It’s been tried, convicted and should have been hanged.

    1. Rein it in there, bud.

  3. Who approved that clickbait headline?

    Any time you see the words, “Should the government provide”, ask yourself if the “journalist” understands what they are typing.

    1. No need to ask, really.

  4. We Koch / Reason libertarians should consider supporting government-run healthcare if it would lead to more immigrants coming here.

    #ImmigrationAboveAll

  5. i’m on board with figuring out something so people who genuinely have bad health luck don’t go broke trying to get well.

    but schemes like Bernie’s “anyone can see a doctor (provided you can get an appointment…) for anything you want at any time and not pay anything out of pocket” should be recognized as absurd without much thought.

    1. Which is the reason people should buy their own insurance.

    2. I’d support universal care for children up to the age of 18 or 25 or whatever. It doesn’t really matter where the age cut off is because so little money is spent on health care for teens and twenty-somethings. I’d even support it for lifetime care for conditions that were developed before that age cut off.

      But I’d only support this if government otherwise got completely out of the health care/insurance industries. No more subsidies or regulations. No more Medicaid or Medicare. Just take care of kids, the only truly innocent people out there. If something happens to you after 25 or so, you’re old enough to be responsible for your own insurance. If you choose to not carry any, that’s on you.

      1. The problem is that the very concept of insurance requires most people to pay for it and never use it. If you take out the young healthy people who have little to no healthcare expenses the insurance companies won’t be able to cover the expenses of the people who need a lot of healthcare without raising premiums

        I agree that less government regulation is the solution, such as allowing insurers to sell policies across state lines, and ending the employer-insurance link, where your employer chooses your insurance provider rather than you.

        1. Health insurance companies in a free market will price premiums based on the risk pool of the individual, considering things like age, health history and current condition. Younger, healthier people will naturally pay less because the insurance company expects to have to pay less to cover them. “Good” insurance is about charging people according to their risk. That way it makes sense to cover yourself for unexpected and serious illnesses / injuries, but it does not make sense to cover yourself for things that are minor or are likely to happen.

          So, yes premiums for older, sicker people will go up because young, healthy people will no longer be forced to subsidize them through guaranteed issue and community rating.

    3. We already have a solution to that – it’s called ‘get up off your ass and pay for their bills yourself’.

      But you don’t really want a solution to *that* problem – you want a solution to the ‘how do I get other people to pay for the things I want’ problem.

      1. There’s a problem with that though; there are legitimately cases where someone can’t possibly have been expected to pay for it.

        I have a friend who was working part time jobs while putting himself through college, one of which was delivering pizza. His employer did not provide health insurance, and since he was paying for school and a place to live on meager income he couldn’t afford to buy his own. I suppose he could’ve prioritized insurance over college, but that likely dooms him to a lifetime of pizza delivery.

        One day he was delivering a pizza and someone t-boned his car. This sent him to the ER where a litany of tests were performed, all of which were covered by the insurance of whoever t-boned him. One of the tests was some kind of brain scan, which revealed a tumor. The prognosis was that he needed almost immediate brain surgery to deal with the tumor. He had surgery, and several months in the hospital of recovering from it, none of which he had coverage for.

        The results were several hundred thousand dollars in debt, and the ongoing health complications from his brain surgery have meant he can’t really work consistently. He’s nearly blind in one eye, and randomly gets debilitating headaches that take him out for days on end.

        What was my friend supposed to do differently that would’ve given him the insurance needed to cover his brain tumor? If he had insurance, would they pay for his living expenses from now on after a tumor (which was no fault of his own) left him with lifetime disability?

        I don’t think Bernie’s system is the answer, but I don’t think anything under our existing system does much for people like my friend either. It’s an ultra rare and specific situation, and yet he’s basically fucked for life because of bad luck.

        1. Sadly, until we end scarcity there is no policy that will solve all of those types of problems.

          1. I don’t expect any system to be perfect, there are always going to be cases where people can see that the system didn’t work. We can find thousands of examples with the NHS and other socialized systems.

            I’m mostly just highlighting that “you made bad choices/didn’t work hard enough” are not always adequate explanations for why someone is in a bad spot.

            1. Everyone already knows that.

        2. There are plenty of good paying blue collar jobs that don’t require a college degree. His bad luck shouldn’t be the basis of government policy.

          1. I never said it should be. It’s a response to “get off your ass and pay your bills yourself”.

            I fail to see how my friend was sitting on his ass waiting for a handout when he got fucked.

        3. I believe charity *would* cover that, except (1) too many people are too proud to even enquire about it, let alone ask for it, and (2) the government sucks up so much of people’s money in the form of forced charity that people fall into the habit of expecting government to take care of everything, and donate to charities is bottom of their list when Uncle Sugar ought to be taking care of it.

        4. There’s a problem with that though; there are legitimately cases where someone can’t possibly have been expected to pay for it.

          That’s not what I’m saying. What I’m saying is that there is already a solution to this and that is for people who are concerned about this problem to get off their arses and PAY FOR IT.

          There’s no need to ‘wait for a solution’. Its already there. Take some of your money and give it to the people you think deserve to have their medical bills covered by others.

          But when people say “I’m on board with figuring out something so people who genuinely have bad health luck don’t go broke trying to get well.”, what they’re really saying is ‘I’m on board with forcing other people to do what I won’t do on my own.’

          What was my friend supposed to do differently that would’ve given him the insurance needed to cover his brain tumor?

          What did *you* do for your friend? Are you contributing to paying off his hospital bill? If not, why would you say that I should be on the hook for part of it? Yes, its not his fault. Not at all. Its not my fault either. And I have my own friends and family – that I contribute money towards their medical care already.

          1. Just to be clear, Fat Mike – I wasn’t saying that people who have unexpected medical bills should just suck it up because its their fault they didn’t prepare.

            What I was saying is that people who say that other people should be covering those bills need to pony up first – lead by example, be the change you want in the world, etc.

            Instead its always “I wish *someone* (ie government) would ‘come up with a solution’ (ie, use force to take money from people) to make this thing I want to happen happen because I’ll be damned if I’m going to be the only”.

            That applies as much to medical care as it does to space exploration, overseas military adventurism, ‘affordable housing’, etc.

            1. . . . pay for their bills yourself’.

              . . . pay your bills yourself”.

        5. Didn’t colleges offer reasonable insurance plans for students at one time? Did that stop? When I started working our one company plan was high deductible/ catastrophic insurance. The deductible was $1000 dollars, the monthly premium $4. The deductible included everything but the premiums. With inflation everything would have been $10,000
          deductible, $40 premiums approximately now. Later in the decade the government got involved, HMO’s were introduced (They were originally free premiums) and costs started spiraling out of control.

        6. That sucks. Sorry to hear about your friend. Sometimes people draw the short stick in life. It sucks, but there’s always hope.

          If I were in his position, the first thing I would probably do is to file for bankruptcy. As I understand it, unsecured medical debt is dischargeable.

          Income, both short and long term, would be my second priority. A family member of mine who found herself unexpectedly between jobs was able to bridge the gap by writing freelance articles and transcripts through online services. It didn’t pay great, but it paid the bills. Longer term, maybe he’s still eligible for pell grants. A two year certificate from a juco could pay dividends. Maybe something in the medical field. High demand in those professions. And might be conducive to his disability working indoors without strenuous activity.

          1. Whether it’s your friend a family member, it’s always tragic when someone close to you has unexpected medical issues. But, I am also curious why humans, with 7.5 billion of us on Earth, are so intent on spending so many of our finite resources to save human lives. In fact, I think our current population is straining our planet’s carrying capacity and I wonder if we’d be better off just accepting our natural fates. I think we should at least have open dialogue about what’s best in the long term for all of us.

            1. ? Was this meant to be reply to my comment? Because that’s a complete 180 from the tenor of my statement.

              There’s really no evidence that the human population is anywhere near the carrying capacity of our environment (and K isn’t static anyway). You could certainly make the argument that we’re out-competing other species (thereby reducing the K-value for those populations), but that’s a completely different discussion.

              Anyway, I don’t think you’ll find much receptivity on a libertarian site for collectivist arguments in favor of population control, whether passive or active.

          2. You’re right about medical debt being cleared in bankruptcy. That was the path my Dad had to choose after an illness even with insurance. The insurance company covered exactly what it said it would, but he didn’t really have any savings and the coinsurance sunk him. But that’s what bankruptcy is for. It’s meant to cover people who, for whatever reason, get so in over their heads that they have no hope of financial recovery.

            And bankruptcy has the benefit of being already built into the system. All our major institutions know they’re going to lose some percentage of their expected revenue to bankruptcy filings and it’s just priced into their services. No need to keep tacking on new, huge bureaucracies to handle things like this.

        7. One thing to consider is that maybe he couldn’t budget for health insurance because government interference in the health care and insurance markets has driven up the price of all plans Otherwise, he may have been able to afford a relatively simple catastrophic plan that would have covered the tumor.

    4. It was figured out 200 years ago it’s called the free market.

      1. “It was figured out 200 years ago it’s called the free market.”

        And we just need the government to get out of the way so it can thrive!

  6. No, nine, nyet, non, méiyǒu…..

  7. you have to be a goddamn moron to want government run health insurance.

    Government-regulated health insurance is bad enough!

    The answer, like all social welfare issues, (assuming libertopia will never exist) is to give money to people who can’t afford something that most people fine unacceptable to live without.

    Food, health insurance, etc. Here’s a check, no go to the market and get what you need.

    Under no circumstances should the federal or state government ever be involved in the provisioning of said necessities.

    1. Under no circumstances should the federal or state government ever be involved in the provisioning of said necessities.

      And that principle should be extended to education.

      1. no question about that. If i had to rank the importance, i’d put education at the top of the ‘get government out of the provisioning part of the game’ list.

        1. And yet the rest of society puts education right near the top of the essential services list. “Free” day care for 12+ years has a lot of value for parents.

          1. Just to be clear, I’m willing to accept a world where some basic necessities are determined and the tax policy is to give CASH money to the very poorest who can’t afford those things. And education would fit the bill.

            Just as long as government is out of the *provisioning* game we have a HUGE win for liberty with a change like that. It’s good enough for me.

    1. “Although the study must undergo the rigors of peer review before it is published in a scientific journal”

      The SF Gate, however, has no such standard before publishing.

    2. Then the Democrats, being the Party of Science, must be at fault too.

      1. They are at fault regardless of the science.

  8. I say yea because I think it’ll be more efficient and cheaper overall if we cut out the insurance industry.

    1. “efficient” and “cheap” are not words that come to mind when I think of centralized government programs.

    2. “I say yea because I think it’ll be more efficient and cheaper overall if we cut out the insurance industry.”

      Sarc or stupidity?

      1. Stupidity. You saw the username, right?

    3. Do you feel this way about all other forms of insurance? Car insurance? Homeowner’s / renter’s insurance? Mortgage insurance?

      Why would a government monopoly on insurance be more efficient? There would be no competitive pressure to keep prices down or to maintain a certain level of service. The pressure would be even less direct than it is now. Complaining to your Congressman only works when things are so bad that a critical mass of people are writing in. Look what it took to just start reforming the VA!

    4. You have not been paying attention.

    5. Of all the stupid things you’ve written today, this is the latest.

      1. It is certain there is more to come.

    6. While you’re at it, let’s get rid of prices, money, cash registers, bank accounts, the whole kit and kaboodle. Think about it: how much more efficient would an economy be if money, prices, etc were simply not a fact of life.

    7. Well, I got some bad news for you, my Lord:
      This proposal doesn’t get rid of the insurance industry; it just confiscates it.
      You get the cost savings of the Post Office with the efficiency of the VA. The only winners are the unions and the politicians.
      After your next attitude adjustment, by whatever your favorite method is, contemplate this; if no one could financially contribute to a political campaign, what would the political parties actually put in their platforms?

  9. Forcing people to universally provide something that isn’t universally wanted: that’s violence.

    1. Forcing people to provide something that is universally wanted is also violence. That’s what force is.

  10. Would we want the government to provide food, clothing, housing, electricity, water, internet to all Americans?

    1. Would we? No. But there are the AOC’s of the world who disagree.

    2. There’s a giant chunk of Americans getting free food, housing AND medical provided by the government. They are also getting utilities and internet provided at greatly reduced prices subsidized by the government tax schemes.
      Not subsidized: transportation, clothing and tattoos.

      1. No there aren’t.

        There’s a giant chunk of Americans *getting free money* from the government to spend on food, housing, medical, etc.

        There’s a massive difference between the government giving you money – even if earmarked for specific expenses (like SNAP is) – and the government *providing* those things.

        The former is bullshit. The latter is recipe for mass death.

  11. Of course not. I find the entire medical industry to be inept and immoral. I shouldn’t be forced to participate in it in any way.

    Does everybody suddenly trust big Pharma and the govt? Even with Trump in charge?

    1. Nobody’s forcing you to use big phamra’s drugs.

      1. And I don’t. And I shouldn’t have to pay for it for anybody else.

  12. Which side is Reason on?

    1. Almost certainly not the libertarian side.

    2. rolls 1D20 – Anyone but Trump
      shakes magic 8 ball – Anyone but Trump
      reaches into Maggie’s bag of scrabble tiles – Anyone But Trump

      1. A soothsayer with no chicken bones?

        1. No tea leaves either, I’m afraid. But I know what they would tell me.

        2. PETA at work – – – – –

  13. Government in many places is currently not protecting people from rioters… excuse me, that’s “mostly peaceful protesters”, but I’m supposed to believe they will competently manage my health care?

    1. Weren’t they talking just two or three months ago about denying health care to anyone that attended a protest? Am I to believe that partisan politicians won’t use health care as another lever for their politics?

      1. Like your health access card is your democrat party registration?

  14. I could see government providing healthcare to all, right after they provide me with my therapy unicorn. There never seems to be enough free shit to go ’round for all the people who want free shit. Funny how that works, isn’t it?

    1. Not even shit is free; the sewage bills are going up all the time.

    2. I need a companion dragon.

  15. Should government provide vouchers to all citizens for the purchase of healthcare? That’s a discussion I’d be interested in.

    Should government feed the fat, rotting, over-regulated, corruption-riddled leviathan that passes for U.S. healthcare? Are you fucking kidding me?

  16. Under medicare for all, BLM will turn hospitals into hotels for party aparatchiks and conservatives and libertarians will be left dying in the streets. And they will come out and kick us and say, “Medicare for all means for ALL, idiot.”

    They deny it will be weaponized politically, but all the vituperative rhetoric that I see online suggests otherwise. They can’t wait to deny funding to red states and other shenanigans (because “Trump denied ventilators to blue states when they needed them most”). They say, “Other countries don’t discriminate based on politics.” Of course, but only because they are on their best behavior, waiting for us to enact it so that they can politicize their programs. That may sound outlandish, but it’s the same story with gun rights. Many of the mass shootings around the world were tailored to a US audience (remember the German shooter speaking English on his rampage). Their goal is to undermine our gun rights so that we can’t come to Europe’s defense when the bolsheviks take over (because we’ll be in the same predicament). Of course, they failed miserably on guns, but the fight against medicare for all will be more challenging.

    1. As long as we can come to our own defense against the Bolsheviks.

  17. I prefer a socialized system that combines the best of all systems.
    1: england, I get to decide who gets medical priority based on if I agree with what they say
    2: Cuba, people that show interest in anything medical are taken by the state and trained to be doctors regardless of what they want
    3: tiwan, all medical professionals are worked into the ground until they are so burned out they are nearly useless
    4: Canada, make it illegal for medical professionals to quit

  18. First, I have to say that I think government should disassociate from all things health care. But, in all of the grand plans to have the government running our health, they are all focused on “health insurance” and not health care. So, if we aren’t going to have a free market, then why still have private, corporate care services at all. How about just nationalizing all health care facilities and employees? I wonder. Probably, even in the Democratic world still need some room for cronyism.

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  20. How many people on here would be opposed to free Federal clinics and free catastrophic health insurance if we could de-regulate health care, switch over to pay your way or HSAs, tort reform, and insurance over state lines?

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  22. Which of the fifty states provides government-run health care for all?

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