While the United States has the best health care money can buy, many Americans cannot afford it. Many Americans are underinsured or not insured and even the insured might face denial of coverage. Americans, as their response to the execution of a health care CEO, are aware of this. Most politicians, with the exception of people like Bernie Sanders, have put their faith in the fact that people forget quickly and have done nothing to address this problem.
A lack of insurance puts the health of the uninsured at risk and health care institutions suffer financially. Medical bankruptcy also occurs at an alarming rate. Because of these problems, there have been proposals to extend Medicare to all Americans.
On the positive side, this would provide everyone with health insurance. This would benefit those without insurance and would also help the finances of healthcare institutions. As the system already exists, it would mostly be a matter of scale. This would come with serious challenges, but they are obviously not insurmountable. While there are clear advantages to expanding Medicare, a rational assessment requires looking beyond the positive aspects and, as much as possible, without the filters of ideology.
An obvious concern is the cost of such an expansion. Those who already pay for insurance would not suffer any financial impact from the switch, unless the cost of Medicare was significantly higher than what they are paying now. As the cost could have negative impacts on the economy and individuals, it needs to be assessed rationally.
A second concern is the impact on the health insurance industry. While some might be tempted to think that only the CEOs would suffer, the insurance industry is made up of a range of people who depend on their jobs to survive. Switching to Medicare for all would eliminate the private health insurance industry and put people out of work directly and indirectly. Somewhat ironically, those on the right who oppose Medicare expansion usually see firing workers as a positive thing while those on the left express concern for workers. One possibility is that former insurance workers could be retrained and hired to work for Medicare, assuming that it is not swept away in the current zeal to destroy government agencies and programs that protect and benefit non-billionaires.
It is also worth considering other economic aspects. While it should not be assumed that this cost will be too high relative to the benefits, this cost needs to be considered. Again, while it is appealing to think that eliminating private insurance would only harm evil CEOs, the effects on others should be considered. But given the tremendous harm Americans suffer from the current system; its replacement would certainly do more good than harm.
A third concern is fraud. While fraud does occur with private health insurance, Medicare is sometimes 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. 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. While the right advances the narrative that it is poor people who defraud the government, the evidence is that it is the wealthy. This does make intuitive sense: if the poor were as good at committing fraud as the right claims, they would no longer be poor. But even with the inevitable fraud, an expansion of Medicare would be superior to the existing system, which siphons money from Americans into the accounts of CEOs.
A fourth concern is usually advanced by conservatives, namely that the elimination of the for-profit motivation will 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. And the motivation provided by the for-profit approach is to profit more, and that typically involves worse rather than better medical care.
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 that could be addressed. The rest of the world