Medicare for All

Clive Crook says "there are worse things than Medicare for all – and the present system might be one of them":

Medicare for all may be the best cure for the US, by Clive Crook, Commentary, FT: For the past few months, Barack Obama and his allies in Congress have been striding towards far-reaching reform of the US healthcare system... But the Democrats ... are divided.

They agree on several elements. At least to begin with, private employer-provided insurance will remain the norm. ... New mandates, subsidies and a regulated insurance exchange would widen coverage... But controversy surrounds three points: what the reform will cost, how it will be paid for and, especially, what role a new public insurance plan might play. ...

Most contentious is the proposed public insurance option – a government-run plan to compete alongside private insurers to press down on costs and “keep them honest”, as Mr Obama puts it.

Mr Obama is strongly backing the public plan idea and most Democrats in Congress agree with him. A significant minority of more conservative Democrats ... worry that a public plan would crowd out private insurers and that the US would end up with a national government-run health plan: in effect, Medicare ... for ... everybody. Many left-leaning Democrats quietly agree with that prediction, which is why they like it.

In my view, there are worse things than Medicare for all – and the present system might be one of them. Medicare for all would give the US truly universal coverage and better control of costs. It would preserve choice of doctor and hospital, and private insurance for supplementary services could co-exist for those who wanted it. The demise of employer-provided plans would make labour more mobile...

One obvious objection is that Medicare for all would politicise US healthcare... Controlling costs by denying expensive treatments and squeezing suppliers’ incomes is something Medicare for all could try to do, but this is a formula for perpetual political conflict...

A less obvious objection is that a healthy private insurance market is worth preserving. ... If competition is a good thing, competition among insurance providers is a good thing too. Yes, abolishing it reduces one kind of lump-sum administrative overhead, which is all some Democrats seem to care about. But it also abolishes pressures for innovation and other kinds of cost reduction. ... At the very least, one should pause before shutting competition down.

Shutting it down is not the purpose of the public plan, say its Democratic supporters: the public plan is just one more choice. This is disingenuous. ...

As I say, the present system is so bad that Medicare for all might be an improvement. I think the US would do even better to build its reform around competition among intelligently regulated private insurers. But if Medicare for all is what this president and Congress really want, they should come clean, and be out there making the case.