While the United States has the best health care money can buy, it is also fraught with problems. One of the most obvious problem is that many Americans cannot afford to buy that health care—many lack health insurance and others lack adequate insurance despite Obamacare. This lack of insurance has at least two major negative impacts: the health of the uninsured is at risk and health care institutions suffer financially. Another effect is that of medical bankruptcy; though probably not as widespread as the left claims it is still worthy of concern. Because of these problems, it is hardly surprising that some Democrats and others on the left have proposed expanding Medicare to cover all Americans.
On the positive side, such an expansion would provide everyone with health insurance. This would benefit those without insurance and would also help health care institutions financially since medical services would eb paid for. Also, since the system already exists, it would not need to be created from scratch: the state would mostly just need to scale up the existing system. As would be suspected, such a system is also ideologically appealing to the left. While there are clear advantages to expanding Medicare to cover everyone, a rational assessment requires looking beyond just the positive aspects and, as much as possible, without the glasses of ideology.
Perhaps the most obvious concern is the cost of such a program. Those who already pay for insurance would, presumably, not feel any financial impact from the switch—unless the cost of Medicare for all was significantly higher than what they already pay for insurance. Which it might well be. There are numerous plans for paying for the expansion, but it seems fair to say that many of them are distorted by ideological concerns and wishful thinking. Such an expansion would obviously be expensive—but also obviously not beyond the ability of people to pay for it. As always, the main issue is who will be footing the bill. The cost could have various negative impacts on the economy and individuals, and these need proper consideration.
A second concern is the impact on the health insurance industry. While some might be tempted to think that only the fat cats of the industry would lose out, the fact is that the insurance industry is made up of a range of people who depend on their job to survive. Switching to Medicare for all would effectively eliminate the private health insurance industry and put many people out of work through the direct and indirect effect of this elimination. It is also worth considering the other economic aspects of this elimination, such as on the stock market. While it should not be assumed that this cost will be too high relative to the benefits, this cost needs to be properly considered.
A third concern is fraud. While fraud does occur with private health insurance, Medicare has proven to be a cash cow for fraudsters. In 2014 about 10% of Medicare’s total budget was lost to fraud. Expanding Medicare to everyone would turn the cash cow into a cash herd—which is something to be worried about. Fraud could and should be addressed even if Medicare is not expanded, but the cost of fraud must be included in the calculations used to assess the merits of expanding Medicare.
A fourth concern is usually advanced by conservatives, namely that the elimination of the for-profit motivation and providing care to all will somehow ruin the quality of health care with socialism. One reply is to note that health care will remain for-profit: Medicare for all does not nationalize health care institutions, just the insurance industry. That said, it could be argued that with one entity paying all the bills costs will increase and quality will decrease—but what is needed is evidence for these claims. If they are true, then this would be a problem.
While Medicare for all is a popular idea, it would be unwise to let its appeal blind people to a rational assessment of the costs and benefits of such a plan. It might turn out to be a good idea, but that is not a matter to be settled by political slogans or ideological posturing.