You don’t have to be a news junkie to know that the concept
of Medicare for All is going to be
front and center between now and the 2020 elections.
The challenge so many of us face is deciding where we personally
stand on the concept. It’s very complicated and has tremendous ramifications
for the future of our country and our selection of candidates in 2020.
We all know our healthcare system is broken and is only
getting worse; we know something needs to be done; and we feel for those who
can’t get reasonably priced health insurance, or decent medical care, or who
are the victims of predatory billing practices. There’s something morally
compelling about the possibility of providing for the medical needs of the
entire population. That’s why I’ve concluded that if we can, we should.
Medicare for Some
To understand the concept of Medicare for All, we should first do the obvious: understand
Medicare as it is now, which I’m going to refer to as Medicare for Some.
Just as those who supported the creation of Medicare
believed every person over 65 had a right to decent medical care, those who
support Medicare for All believe that any person, regardless of age, has a
right to decent medical care. That’s hard to argue with. So, if we can, we
What Led to the Creation of Medicare?
Social Security was introduced decades before Medicare to
address the national disgrace and human tragedy of older Americans finding
themselves out on the street late in life.
Prior to Social Security, people tended to work until they
couldn’t. Once Social Security became law, the right to retire at age 65 become
engrained in the national psyche. Unfortunately, retirement meant giving up
medical insurance, because it was almost always tied to employment. Thus, we
had a fast and growing retirement age population without medical coverage at
the very same time that medical science was providing many more late-in-life
medical options. The result was a moral imperative that led to Medicare.
Now, more than 50 years on, we have a much broader and
younger population facing similar challenges. The potential of modern medicine
offers increased life-saving and quality-of-life improving possibilities, while
affordable medical insurance is becoming increasingly hard to come by. With the
cost of healthcare skyrocketing at twice the rate of inflation and insurance
companies increasingly failing to honor their commitments, the result is a new moral
imperative in which we now need to figure out how to provide medical insurance
for everyone, not just seniors. Extending the concept from Medicare for Some to Medicare
to All makes perfect sense. That’s why I think that if we can, we should.
If We Can, We Should
To consider Medicare
for All, the first question I ask myself is whether Medicare for Some
works. If it does, then there is every reason to believe that Medicare for All will work, too. If Medicare for Some doesn’t work, then it
would make sense to question whether it will work for All.
Of course, there’s great debate about whether Medicare for Some works, and it’s mostly
a matter of conjecture and opinion. There’s lots of data, but it gets twisted,
misused, and is genuinely conflicting.
Some believe it’s working just fine, while others believe
Medicare has created incredible distortions in the overall healthcare market,
causing the price of everything to be higher than it should be. In other words,
I don’t believe there’s a good way to evaluate the success of Medicare for Some using objective
criteria that the broader electorate will accept. It’s a polarizing issue, to
say the least.
So, to answer the question of whether Medicare for Some works, I propose a different way of looking at
the question. Rather than talking about why Medicare does or doesn’t work,
let’s be positive. Let’s assume that Medicare works well. And for those who say
that Medicare for All will be
different, and better, let’s give them the benefit of the doubt and assume
they’re right. That leads us to the second question which is:
Why, if Medicare for Some works, and Medicare for All will work, won’t we extend the same concepts to other parts of the
economy? After all, if we can design and manage a better healthcare system,
ensuring prices are reasonable, access is universal, value is high, and
innovation will continue, why can’t we also have a better, fairer, more
efficient system of agriculture, food production, and food distribution by
applying the same principles? And why can’t we have a better automobile
production and distribution system? And for that matter, a better system for
Think about what we could do if we could better manage
automobiles, food production, and housing. We could solve the problem of
climate change by forcing the switch to electric cars, eliminating CO2-producing
cattle herds, and ensuring every home was smaller and had solar panels on the
roof. It just makes good sense. If we can, we should.
Food, housing, and addressing climate change seem right up
there with medical care when it comes to moral imperatives. So, if we can, we
Just remember that America’s healthcare system is equivalent
in annual financial throughput to the fifth largest economy on the planet
(currently Germany). If we can engineer an economy the size of Germany’s for
the better, we should.
So, in evaluating Medicare
for All, instead of trying to reason your way through whether it will work
or will not, just assume it will, and instead think about why we wouldn’t apply
the same principles to every other marketplace, all of which are smaller than
the healthcare market.
Of course, you already know it’s been tried before, so
perhaps we can learn from the success of prior efforts at providing food,
shelter, and medical care. I think there used to be a name for it, and it