Why Doesn't 1787 Support Medicare
for All, Single-Payer, or a Public Option?
As we move forward, it is absolutely critical that we forget ideology and just do the math. First, let’s address the elephant (or, in this case, donkey, ha ha, get it?) in the room: Medicare for All, single-payer, and/or a public option.
First, let's get our terms squared away:
Medicare for All
Single - Payer
Public Option
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All Americans would be covered under the government-sponsored insurance program that currently serves Americans 65 and over.
A term typically used to describe a system run by the federal government: Everyone gets health care from one insurer, and the system is generally paid for by taxes.
This is sort of a mix between single-payer and what we have now (where only certain citizens qualify for programs run by the government). With a public option, more people could qualify for government-run programs (i.e. Medicare or Medicaid) if they wanted to. These could replace private insurance plans for people, but private insurance plans would still exist.
The Reasons for 1787'S Decision
Every one of these alternatives would demand massive middle-class tax increases. Anyone who says differently is being dishonest. Very few things in this world are free, and health care certainly isn’t. If you are getting “free” health care, you are paying for it through increased taxes. That’s just a fact. Taxing the rich is not enough to cover this divide. Not even close.
The reason taxes would have to increase is that these plans are just insanely expensive. According to a study led by Charles Blahous — who was a senior economic adviser to former President George W. Bush and a public trustee of Social Security and Medicare during the Obama administration — the Medicare for All plan Senator Bernie Sanders released in 2018 would increase federal spending by around $32.6 trillion over its first 10 years. That's TRILLION, with a T.
In 2016, the Urban Institute looked at then-presidential candidate Sanders' proposal and found that: "In total, federal spending would increase by about $2.5 trillion (257.6 percent) in 2017. Federal expenditures would increase by about $32.0 trillion (232.7 percent) between 2017 and 2026 (read the entire report here)." To put this into perspective, overall spending in the FY2019 U.S. Budget — literally everything we spend money on - is $4.4 trillion.
These options would disrupt all private insurance contracts, which would affect employer coverage for over 156 million people.
Patient choice would decrease big time, and doctors’ salaries and hospital revenue would drop significantly.
Believe us when we say that we DO NOT want this to happen without careful thought and bringing everyone into the conversation. There is no question that we must control costs, and payments to doctors and hospitals are certainly not immune from hard choices. But these decisions must be strategic and part of a much broader plan. The last thing we want to do is instigate a slew of unintended consequences by pulling the rug out from underneath everyone all at once.
For example, cutting doctors' pay will most likely incentivize them to choose higher-paid specialties over lower-paying jobs in primary care. This one act alone could lead to fewer available doctors for the sickest patients, plus mean longer wait times for appointments and less time with the doctor when you finally get one. A reduction in doctors' pay is certainly not off the table — we just need to be super careful that issues like these are part of a smart strategy...and be VERY mindful of #TheButterflyEffect!