Medicaid for all

Following the lead of Bernie Sanders, many Democrats advocate “Medicare for All.” It’s a smart move. Most old folks, including me, are very happy with the insurance Medicare provides. Many non-old folks realize this and wish they had coverage as good.

But Wesley Smith argues that Sanders is actually offering Medicaid for all. Medicaid is a troubled health insurance program for the poor and, thanks to expansion, some who are not poor.

Smith writes:

[A] close look at Sanders’s bill (S-1804, “The Medicare for All Act of 2017”) shows that it has much more in common with Medicaid — the health-insurance welfare program for the poor — than it does Medicare so beloved by seniors.

How so? For one thing, “Medicare for All” promises “free” health care, meaning no out-of-pocket costs for patients. Medicaid provides that benefit now. But Medicare doesn’t. Beneficiaries under Medicare are responsible for about 50 percent of their health-care bills, according to Smith.

That’s one reason why “Medicare for All” is astronomically expensive. Another reason, the main one, is that it would cover 300 million people compared to the 44 million or so covered by Medicare. Sanders’ bill is projected to cost $32 trillion in its first ten years. Meanwhile, says Smith, Medicare is scheduled to go broke in 2028.

Sanders’ proposal also differs from Medicare because it outlaws all private health insurance. Unlike Medicaid, Medicare permits a thriving private supplemental-insurance industry.

Supporters of Sanders’ legislation might counter that, with no out-of-pocket expenses, there is no need for supplemental insurance. Indeed, they might tout the fact that “Medicare for All” provides free health case as an improvement over actual Medicare.

There are obvious problems with this line of argument, though. As Smith points out, total government control of health-care insurance means total control of what will and will not be covered. Rationing — either by invidious discriminatory categories (such as age or “quality of life”) or long waits for care — is a hallmark of all socialized systems. “Medicare for All” would be no exception.

Indeed, Smith points out that “Medicaid itself is a mess with many doctors refusing to participate due to low payment schedules and beneficiaries often fac[ing] lines and delays in treatment.” Things would be even worse if every American were forced into such a program.

And Sanders’ program wouldn’t just cover every American. It would cover “every individual who is a resident of the United States.” In other words, illegal immigrants would be entitled to full health-care coverage as soon as they established a residence here.

Republicans need to make these points, and make them forcefully. Otherwise, “Medicare for All” might well become a winning issue for Democrats in the coming election cycles.