The Trouble with “Medicare for All”

It was another busy – and partisan – week in health care news.

Vermont’s self-proclaimed socialist, U.S. Senator Bernie Sanders, stood with over a dozen of his Democrat colleagues to roll out his widely-covered “Medicare for All” bill. (As the sister of a soldier who has endured the gauntlet of government-run health care for the military, I didn’t really have to wonder why he didn’t dub it “VA Care for All.”)

His rationale?

“Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is ‘Medicare for All.’”

U.S. Senator Jeff Merkley (D-OR) quickly took to the airwaves in support of the bill:

“…it’s the right plan because American working people are just absolutely stressed by the complexity of our fractured health care system. Either they qualify for Medicaid, but they’re – they get a little bit of boost in their income. Now they don’t. How do you get on the exchange in the middle of the year? Does your employer cover just you? How do you cover your children? Will they qualify for the Children’s Health Insurance Program? It’s a constant gauntlet of application, rejection, re-application. And then you’re just not sure that the insurance company will actually pay for your health care when you are sick or injured. … And so it’s time to have less stress, more coverage, cheaper price.”

Failing to note the irony that nearly all the “complexity” he mentioned was driven by government-run health programs, when pressed about why he would support a plan that has no chance of attracting any Republican support, Senator Merkley explained:

“Republicans decided to oppose any improvements to our health care system. … They’re not about good health care for Americans.

Meanwhile, on the other side of the aisle, South Carolina’s own U.S. Senator Lindsey Graham made headlines, unveiling a new plan to “repeal and replace” Obamacare and panning Senator Sanders:

“If you want a single-payer health care system, this is your worst nightmare. Bernie, this ends your dream of a single-payer health care system for America.”

Describing Senator Graham’s plan, the Wall Street Journal‘s editorial board opined:

Sen. Graham and Sen. Bill Cassidy (R., La.) this week unveiled a bill that would start to unwind ObamaCare. The legislation repeals the individual and employer mandates and the 2.3% medical device tax. The bill replaces money spent on tax credits and Medicaid expansion with block grants to states, which would allow Governors to experiment with insurance reforms. Another selling point is that a rejiggered formula will divvy up federal dollars more equitably, as states such as Massachusetts and California haul in an outsize share under current law.

Block grants are certainly progress: The Obama Administration’s Medicaid expansion enrolled working-age, childless adults above the poverty line, and the feds footed most of the bill to bait states to participate. The program reimbursed at a much lower rate for the disabled and children, the traditional Medicaid population. This has resulted in some states under-covering the most vulnerable.

Graham-Cassidy is less ambitious than the Senate’s ObamaCare replacement that failed over the summer, and we could go on at length about its limitations. But the proposal at least takes most decision-making out of Washington and puts a spending cap on Medicaid and ObamaCare. Reform-minded Governors would have the chance to create showcases for insurance-market innovation.

Conservatives can – and undoubtedly will, as we are wont to do – quibble about this provision or that in Senator Graham’s bill. But its underlying philosophy of getting dollars and decisions out of Washington and treating states fairly is exactly right.

It puts the principle of competitive federalism to work: if Senator Merkley wants a “Medicare for All” system in Oregon, Oregon should be free to attempt – and pay – for it.

(A reality-check would surely follow. As Senator John Barrasso (R-WY), himself a medical doctor, noted, “Bernie Sanders’ home state had … a similar plan. They realized they would have to double the taxes collected on the people of that state to pay for it because it was so financially expensive.”)

Many of the problems in our current health care system have been caused – or at least dramatically exacerbated – by misguided, one-size-fits-all Washington paternalism. The solution will never be found in more of the same.

Back-to-basics ideas like Direct Primary Care are already creating “less stress, more coverage, cheaper price” right here in South Carolina. Will we allow these kinds of affordable, community-based innovations to flourish and grow? Or will we succumb to Bernie’s siren song of “free,” Washington-controlled health care?

Let’s hope for the sake of our health – and our wallets – that Americans remember Margaret Thatcher’s prescient admonition: ‘The trouble with socialism is that eventually you run out of other people’s money.”