The Congressional Budget Office (CBO) released its report as a precursor to scoring “Medicare for All” and it wasn’t good. Although the CBO didn’t score any particular bill, they concluded “the transition toward a single-payer system could be complicated, challenging and potentially disruptive.” A painful understatement. Rand Corporation estimated that Medicare for All would more than triple federal spending to $3.24 trillion in 2019. While it may seem appealing to get what many describe as free and unlimited healthcare, I am quite certain the tax increases aren’t going to feel good to anyone.
And following this release some pundits opined that expansion of Medicaid may be the ticket to lowering costs.
My view of this dynamic is coming into focus. Single-payer with no copays or cost sharing definitely has its advantages over traditional insurance, for which premiums continue to escalate and cost sharing has reached levels where it is simply unaffordable. But we can’t possibly afford unrestricted care. And so, Medicaid becomes open for discussion. Let me say that again – Medicaid. To me that’s pretty terrible. Would you want to encounter the wait times, limited provider access and inferior care which is a hallmark of many Medicaid programs? It is not going to be long at all before Americans cry out for improvements to the lowest common denominator Medicaid program that might develop.
There is a lot of precedence to this. For example, look at the public exchanges. The lower-cost plans in many states were the Medicaid programs sold on the exchanges that crossed into the commercial market. I don’t know a lot of people who were happy with these plans.
Public sentiment may be enough to force some variety of single-payer – I doubt, based upon CBO scoring, that a full-fledged transition would be possible. Moving our system to any public option or single-payer model will produce significant unintended consequences. We need to move very slowly on this. Our present system is extremely fragile. Those that don’t gain an advantage from single-payer are going to be loud protestors.