Medicare For All: Accept No Substitutes
This week, Sen. Bernie Sanders (I-VT) introduced the Medicare for All Act of 2019. A companion bill of the same name has already been introduced in the House by Rep. Pramila Jayapal (D-WA). That’s good news for the country. Unfortunately, these bills are facing opposition from what, for some people, will be an unexpected direction.
I don’t mean Republicans. They’ve already lost the health care debate, in one sense, now that large majorities of voters support Medicare for All. The real threat may well come from its Democratic friends. They’re the people who say they support Medicare for All’s “goals,” but claim to have found a better way to achieve them.
Intentionally or not, Medicare for All’s “frenemies” are sowing confusion about it. Among them is Ezekiel Emmanuel, who argues, “At least four different approaches to health reform could truthfully carry the Medicare for all label.”
Why would that be so? The term was crafted by Sanders, Jayapal, and their allies to describe a single-payer system, administered by the government, with no copayments or deductibles, and without the participation of private insurers.
To be sure, the idea’s frenemies have added to the chaos. A variety of watered-down alternatives to Medicare for All have been proposed, most with names that sound like “Medicare for All”: “Medicare X,” “Medicare Extra for All,” “Medicare for America” … (I’m still waiting for a proposal called “I Can’t Believe It’s Not Medicare for All!”)
These plans are Medicare for All decoys. They claim to resemble Medicare for All, at least in their outcomes, but they’re not. Each depends on some naive combination of employer cooperation, insurance company goodwill, “smart shopping,” and Rube Goldberg-like fiscal contraptions. Each would continue to force working Americans to spend thousands of dollars on premiums, copays, and deductibles, at a time when most families say they’d have trouble finding $1,000 to cover an emergency.
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