That’s a compelling sales pitch. However, the reality is that Medicare for All would outlaw private health insurance and force all Ohioans onto a single government-run plan. And contrary to what its proponents might suggest, Medicare for All would lead to worse care for state residents at higher cost.
Even the idea’s supporters don’t seem to know what it entails. According to polling from the Kaiser Family Foundation, two-thirds of Medicare for All supporters believe they’d be able to keep their private insurance under a single-payer healthcare system.
Sen. Sanders’s bill, of course, would ban private plans outright.
That might not sit well with the 260,000 Ohioans who purchase a private plan through the Affordable Care Act’s exchanges. Almost three-quarters of all enrollees like the plan they have now.
Outlawing private insurance coverage wouldn’t go over well with the nearly 6 million state residents with employer-sponsored coverage.
More than seven in 10 people with job-based health insurance are satisfied with their plans. That makes sense. Employers compete for employees, in part, by offering generous health insurance. Workers benefit from the great coverage, and employers benefit by being able to attract and retain quality workers. By forcing everyone onto the same insurance plan, Medicare for All would take that bargaining chip away from employers and employees alike.
It’s no surprise that overall support for Medicare for All — which usually hovers around 50% — drops to just 37% when people realize it would eliminate private health insurance. Support drops to just 26% when people learn single-payer would lead to delays in care.
Delays are endemic to single-payer programs like Medicare for All. That’s because the government plans to pay hospitals and doctors below-market rates as part of its bid to keep spending under control — to deliver the savings Sen. Sanders promises.
Medicare and Medicaid pay less than private insurers do. A single-payer plan would extend those low payment rates to all patients. Providers today charge privately insured patients more to make up for low reimbursements from public plans. They wouldn’t be able to do that under Medicare for All. The result would be budget deficits for 90% of hospitals, according to one study from FTI Consulting.
Providers would have little choice but to restrict access to services — if they’re able to keep their doors open at all. That would only exacerbate barriers to care in Ohio, where one in four rural hospitals is already at risk of closing.
Patients would face long waits for subpar treatment. That’s exactly what happens in other countries with single-payer health care. In the United Kingdom’s National Health Service, there are more than 6 million people currently waiting for hospital care. Thousands have been waiting for more than two years.
Similarly, under Canada’s single-payer system, patients face a median wait of nearly six months from the time they’re referred by a general practitioner to receipt of treatment from a specialist. For certain procedures, like hip and knee replacements, patients can expect to wait nearly a year.
Under Medicare for All, American patients would experience similar fates. That was the conclusion of Phillip Swagel, director of the Congressional Budget Office, who recently testified before Congress that single-payer would increase “congestion in the healthcare system, including delays and forgone care.” Those delays and forgone care would cost Americans a lot of money — more than $30 trillion over a decade.
Less than 10% of the American population is uninsured. In Ohio, that share is less than 7%. There are far more cost-effective ways to expand access to affordable coverage. For example, the additional subsidies provided by the American Rescue Plan Act have helped more than 3 million Americans secure coverage through the Affordable Care Act’s exchanges for less than $10 a month. Because of the cost-saving measure, exchange enrollment here in Ohio increased by nearly 30% since last year.
Extending the subsidies permanently could continue to make private health coverage affordable for thousands of Ohio residents. The Affordable Care Act has also driven down coverage inequities, especially in states, like Ohio, that have expanded Medicaid. That’s a testament to the power of building on the parts of our healthcare system that are working. Lawmakers should focus their efforts there — in reality, unlike Medicare for All.
Janet Trautwein is CEO of the National Association of Health Underwriters.
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