Medicare-for-all: Too costly and for too little care

Last week, The Hill reported that the Congressional Budget Office is refusing to score a Medicare-for-All bill now before the House. That’s probably because the CBO doesn’t think it’s going to get a vote anytime soon — despite growing support from Democrats, 123 of whom have now signed on as cosponsors.

The lack of reliable numbers from the CBO is hobbling the debate — which should be, like all policy discussions, essentially a cost-benefit analysis. We don’t know the costs. We do know the promised benefits: universal coverage. What is missing from the debate is the benefit we really want: care. Can we get it with Medicare-for-All?

{mosads}The CBO should put pencil to paper on House Bill 676 – Medicare for All, code for single payer healthcare, which has been shown to reduce access to care.

Let’s start with costs. The best estimate we have now is from Charles Blahous of Mercatus Center at George Mason University. He puts the price tag of single-payer healthcare at $32.6 trillion over ten years. 

This would double what we spend annually on healthcare, more than $3.3 trillion in 2017. According to Dr. Blahous, the additional cost of single payer would consume essentially all tax revenue, leaving nothing for education, infrastructure, defense, etc. Even worse, he wrote, “doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the [Medicare for-All, single-payer] plan.” Can you imagine a politician getting elected who admits Medicare-for-All will double your tax bill?

To achieve the cost of “only” $32.6 trillion, Blahous calculated that the federal government would have to cut doctor reimbursements to 40 percent of private insurance payments, which are already negotiated down below usual and customary prices.

Put simply, this means physicians would be paid a salary they simply will not and frankly cannot afford to accept, not with medical student loans averaging more than $183,000 at graduation and 60-70 percent overhead costs for a primary care doctor’s office. Doctors will simply retire or find more remunerative, non-clinical work in research or administration.

This is already happening in Great Britain, which often cited as the model (or at least the justification) for Medicare-for-All. The National Health Service is experiencing severe doctor shortages and doctors going out on strike, as it faces increasing demand from an aging population.

The net effect of single payer in the U.S. will be many fewer care providers – even as 323 million Americans are clamoring for their promised “right to health care.” Wait times for care went up with Obamacare. With Medicare-for-All, they will be interminable.

It’s all about rationing. In single-payer systems, the government saves money not by more efficient administration, but by controlling both the budget and by limiting allowable treatments. In other words, they ration care by restricting allocations to facilities (resulting in too few operating rooms or burn units), reducing payment schedules (resulting in fewer physicians available to treat patients), and delaying or denying treatments that are very expensive. It is easy to get an inexpensive antibiotic but you wait forever to receive costly cancer chemotherapy or heart surgery. 

When my British mother broke her hip at age 78, she was scheduled for surgery 27 months in the future and would have to remain immobile in bed till then. For a woman of her age, that was a death sentence. She would have joined other unfortunates in single payer systems who experience death-by-queuing.

In Canada, thoracic surgeon Ciaran McNamee sued the Alberta Provincial Trust claiming a series of patient records showed that limited budget allocations caused Canadians to die waiting in line for care.

In the U.S., we already have a single-payer health care system, called the Veterans Administration Hospital system. A 2015 internal audit of the VA reported, “307,000 veterans may have died waiting for care.” Death-by-queueing happens right here — to our service men and women.

Of course, Medicare-for-All supporters don’t want us to look at the VA. Instead, they invoke the brand name of a popular program — Medicare. That’s deceptive; Medicare is a benefit that millions of American workers earned through a lifetime of contributions into the system. Single-payer health care, as proposed in HB 676, would be much more like a universalized Medicaid, with all the accompanying problems and inefficiencies.

Perhaps the CBO is right; it’s not very likely that a Medicare-for-All scheme will get to the House floor in the near future, because as Americans learn more about it, support drops. Americans are an independent bunch. When they realize Medicare-for-All means government bureaucrats — not families — make the final decisions about their health and even their lives, they’ll promptly reject it. 

Dr. Deane Waldman, MD, MBA, is a retired pediatric cardiologist and Director of the Center for Health Care Policy at the nonprofit Texas Public Policy Foundation.