Black Jet Theory – Volume 2020-16 – Is Medicare For All / Single Payer Inevitable?
August 21, 2020 by Marshall Snipes
The government today provides health insurance to one-third of the insured population through Medicare, Medicaid, and government employee programs.[1] In addition these government programs pay for 41% of all healthcare costs.[2] Some would argue that the government already runs the payment side of the healthcare system in the United States, so why not admit it and make the move to a single payer system? Wouldn’t that be more efficient than the convoluted payment system we have today?
Before we go on, lets define Medicare For All and single payer. Most use those terms interchangeably and so we will here as well. “Single Payer national health insurance is a system in which a single public or quasi-public agency organizes health care financing, but delivery of care remains largely in private hands.”[3] The Medicare for All Act of 2019, H.R. 1384 (Act) is currently pending in Congress to convert the American system to a Medicare for All system. However, the Act includes many other provisions that have been unacceptable in the past, abortion, illegal alien coverage and so on.[4] The Act has 118 co-sponsors, not surprisingly all Democrats.[5] As with any government program, the fear is the strings that would be attached to receiving government funds.
The debate seems to center on whether healthcare is a right or a privilege. Those who believe it is a right are well organized and have a plan. Those who believe it is a privilege don’t seem to agree on a healthcare reform plan. Many believe a free market system is achievable once the buyer and seller of healthcare services are linked economically. As economist Milton Friedman said, “no one spends someone else’s money more frugally than they spend their own”.[6] It doesn’t seem there is any momentum towards a free market from either side of the aisle. Institutionally, healthcare providers, insurance companies, and Big Pharma are against it and collectively they have a lot of political clout. Anything that threatens the status quo of a $3.6 trillion industry is likely to face serious opposition. The Centers for Medicare & Medicaid Services (CMS) projects that by 2028, National Health Expenditures will grow to an astounding $6.2 trillion and will represent approximately 20% of the U.S. economy.[7]
If you don’t believe every citizen has the “right” to health care, then you have to have a strategy to take care of the poor out of our “national conscience”.[8] President Ronald Reagan in 1981 said, “We will continue to fulfill the obligations that spring from our national conscience. Those who through no fault of their own must depend on the rest of us, the poverty-stricken, the disabled, the elderly, all those with true need, can rest assured that the social safety net of programs they depend on are exempt from any cuts.” [9] We have to agree as a society whether we want a single payer system, a free market system or the current hybrid system that exists today. Much has been written about single payer and free market systems. Single payer advocates point to coverage for all and lower costs. Free market advocates point to lower costs and a better allocation of our health care resources. Both are right, either system could lower cost.
The questions become: (1) Do the negatives of a single payer, government-controlled system that would seem to stifle innovation and technological advances, outweigh the negatives of a free market system that in healthcare has not been achieved to date? (2) How would a free market system function in the current environment of insurance company and employer involvement? One issue is clear – if we don’t make the choice between the two alternatives, then by default we chose to limp along with our current hybrid system. Tinkering around the edges of “reform” will cause costs to continue to rise and the health status of our citizens to decline.
In recent polling, the “Public is more likely to favor than to oppose a National Medicare-For-All Health Plan by a 56% to 41% margin.”[10] How the question is asked makes a difference. According to a recent poll, when the term Medicare For All is used, the results are supportive by a margin of 63% to 31%.[11] However, when the question is asked do you favor socialized medicine, the results are 46% for and 44% against.[12] Coverage for all Americans and simplification of the healthcare system are the two most important reasons voters give for supporting Medicare for All.[13] In another recent poll, “69% of registered voters surveyed support providing Medicare to every American.”[14]
The point is this – the devil is in the details. The more the government is involved the more healthcare looks socialistic and the less likely Medicare For All will become a reality. The less government is involved the more the healthcare system looks like the free market which to date has not been achieved. Given the favorable public sentiment towards Medicare For All, one is likely to conclude that Medicare For All is inevitable.
The Black Jet Theory[15] would imply that the answer to the inevitability question is probably yes, but not anytime soon. To answer the question, we must look at where the two Presidential candidates stand on the issue. Joe Biden, the Democrat nominee for President, according to his website, has a robust plan to add on to the Affordable Care Act with more government requirements built into the existing healthcare system.[16] Remember in the debates, he disagreed with Bernie Sanders and Elizabeth Warren regarding Medicare For All. He said it was too expensive. Subsequent to his presumptive nomination, he formed a series of task forces to bring the progressives into the finalization of his position. During the primary campaign, Biden campaigned for a “public option” rather than Medicare For All backed by Sanders. Medicare For All would presumably dismantle the Affordable Care Act.
Don’t bet on Biden dismantling President Barack Obama’s signature accomplishment. Biden’s task forces recommended “to protect, strengthen, and build upon our bedrock health care programs, including the Affordable Care Act”[17]. And in fact, Biden’s website doesn’t mention Medicare For All or Single Payer. Common sense would tell us that Biden would not be excited about Medicare For All. Even if the Democrats win the White House and attain a majority of the Senate and the House, don’t look for Medicare For All anytime soon.
Of course, if President Donald Trump is re-elected and absent a veto proof Congress, Medicare For All has no chance at all. The President has been consistently against Medicare For All throughout his campaign and his Presidency, and he backed the so-called Repeal and Replace legislation, to reverse the Affordable Care Act.
However, if candidate Biden becomes President Biden, all bets are off when the power of the progressive movement invades the White House.
Don’t take my word for it, think for yourself.
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[1] Britannica ProCon.org. Should All Americans Have the Right (Be Entitled) to Health Care? Last Updated 2/14/19. Retrieved August 11, 2020. https://healthcare.procon.org.
[2] National Health Expenditures by Type of Service and Source of Funds, CY 1960-2018. Table 3 National Health Expenditures: Levels and Annual Percent Changes, by Source of Funds: Selected Calendar Years 1960 – 2018. Retrieved August 17, 2020. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical
[3] About Single Payer. Physicians for a National Health Program. Retrieved August 11, 2020. https://pnhp.org/what-is-single-payer/
[4] Ibid
[5] United States Congress website. H.R. 1384 – Medicare for All Act of 2019. Retrieved August 11, 2020.
https://www.congress.gov/bill/116th-congress/house-bill/1384/cosponsors?searchResultViewType=expanded
[6] Friedman M. How to Cure Health Care. The Public Interest Winter 2001. Retrieved August 17, 2020.
https://www.thepublicinterest.com/2001/01/01/how-to-cure-health-care/
[7] Centers of Medicare & Medicaid Services. NHE Fact Sheet. Retrieved August 17, 2020. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet
[8] Snipes M. Health Care in Perspective 2016 Volume 2 Number 1 – January 10, 2016.
[9] Reagan R. Address to the Joint Session of Congress February 18, 1981. Retrieved August 20, 2020. https://www.reaganlibrary.gov/sspeeches/21881a
[10] Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage. Kaiser Family Foundation published May 27, 2020. Slide No. 3. Retrieved August 10, 2020. https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/
[11] Ibid. Slide No. 5
[12] Ibid. Slide No. 5
[13] Ibid. Slide No. 8
[14] Poll: 69 percent of voters’ support Medicare for All. The Hill. April 24, 2020. Retrieved August 10, 2020.
https://thehill.com/hilltv/what-americas-thinking/494602-poll-69-percent-of-voters-support-medicare-for-all
[15] Snipes M. The Black Jet Theory is “the notion that most of what currently happens, when viewed through the filter of common sense and critical thinking, leads to a different conclusion, than the widespread view of current thinking by those who control the dissemination and content of information (academia, the media, politicians and other “experts”). Black Jet Theory – Volume 2020-1, May 1, 2020. Article upon request [email protected].
[16] Joe Biden website. Retrieved August 11, 2020. https://joebiden.com/healthcare/
[17] Ibid.