# The dangerous politics of Medicare For All **URL:** \ **Category:** Politics & Elections\ **Created:** [July 31, 2019, 11:19am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922 "2019-07-31T11:19:12Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [July 31, 2019, 3:52pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/21 "2019-07-31T15:52:52Z")
> [@SlackerInc](#): > > Right, but I’m not talking about what will happen in future negotiations, but rather what was already won in previous ones. Those Cadillac health plans (which as you note are unfortunately tax deductible) will go poof when MFA takes effect, but will not necessarily be instantly replaced with a pay increase of the same size. And because of that tax deduction, if employers even give their employees the amount they were paying on their behalf in premiums (which is no guarantee), that will increase the employees’ tax hit. > > But this would not be a thing under the bill Bernie wrote, and which Warren is also supporting. MFA isn’t really Medicare at all, but a “Cadillac” single payer plan (something that exists nowhere else in the world) co-opting Medicare branding. There are no premiums, no deductibles, no copays even on prescriptions, and everything under the sun is fully covered. It’s the worst of both worlds, because it could never work fiscally, and the prospect of it is damaging to Democrats. I think whatever replaces the Cadillac plans will happen PDQ. After all, the reason for such plans will still be there. Any employer who has a need to offer such plans, will come up with an alternative quickly. And unless they want to see their best current employees jump ship for better benefits or pay from their competitors, they will provide the plan to current employees. Whatever Bernie and Warren are supporting is only tangentially related to whatever actual legislation is proposed. I think true MFA – that is, offering the program as it is now to everyone – will become that proposed legislation. ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [July 31, 2019, 3:53pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/22 "2019-07-31T15:53:09Z")
> [@Akaj](#): > > If you want to stick with your private plan, feel free. The problem with fulsomely promising that people can keep their plans is that it’s not something the government, let alone a presidential candidate in the primaries, can meaningfully promise in a way that people will understand as having been kept. Any major change is going to disrupt the market, and in any case, there’s no _current_ guarantee that you can keep your plan: Health insurance policies are not permanent arrangements with unchanging costs and benefits, and beyond that, most private plans are benefits of _at-will employment_. Obama fell into this trap (although he may not have had much of a choice) and it was a major controversy of his administration. Honestly, I’m just tired of hearing about specific plans for health insurance legislation at all, but I’m pretty pessimistic about the legislative side of things. 52 Democratic senators (which, to be clear, is at the _good_ end of possible outcomes) are going to have a damn hard time finding their way to passing anything big at all (on anything, but especially health insurance reform). I realize that you can’t actually campaign on that reality, but I’d like to hear more about executive policy and less about legislation, from the entire spectrum of candidates. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [July 31, 2019, 4:02pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/23 "2019-07-31T16:02:05Z")
> [@Anny\_Middon](#): > > I think whatever replaces the Cadillac plans will happen PDQ. After all, the reason for such plans will still be there. Any employer who has a need to offer such plans, will come up with an alternative quickly. And unless they want to see their best current employees jump ship for better benefits or pay from their competitors, they will provide the plan to current employees. > > Whatever Bernie and Warren are supporting is only tangentially related to whatever actual legislation is proposed. I think true MFA – that is, offering the program as it is now to everyone – will become that proposed legislation. That would be a lot better, but it is much different from what they are proposing. And they defend the tax increases involved by saying there will be no premiums and copays and the plan will be better than what people already have. ---
**Author:** ![Akaj](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/akaj/32/145_2.png) [@Akaj](https://boards.straightdope.com/u/Akaj)\ **Post date:** [July 31, 2019, 6:01pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/24 "2019-07-31T18:01:09Z")
> [@Lord\_Feldon](#): > > The problem with fulsomely promising that people can keep their plans is that it’s not something the government, let alone a presidential candidate in the primaries, can meaningfully promise in a way that people will understand as having been kept. Any major change is going to disrupt the market, and in any case, there’s no _current_ guarantee that you can keep your plan: Health insurance policies are not permanent arrangements with unchanging costs and benefits, and beyond that, most private plans are benefits of _at-will employment_. Obama fell into this trap (although he may not have had much of a choice) and it was a major controversy of his administration. You’re right about promises biting Obama in the ass, and this one faces the same pitfall: just because the government doesn’t deny you access to your favored health plan doesn’t mean your employer will still pay for it, or that the insurer will keep the same plan available. That’s why MFAnyone has to be sold, not just promised. It will be simpler. It will be seamless when you change jobs. It will unleash entrepreneurs who don’t have to stay in their jobs to get affordable healthcare coverage. Etc. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 31, 2019, 8:08pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/25 "2019-07-31T20:08:15Z")
> [@Akaj](#): > > I’m pleased that so many of the candidates are pushing back on the idea of abolishing private health insurance, for all the reasons stated upthread. > > To emphasize the point, I suggest changing “Medicare For All” to “Medicare For Anyone.” If you want to stick with your private plan, feel free. If you want Medicare, it’s available. That’s the public option, letting people buy into Medicare (which includes making employers offer subsidized Medicare as an option). I’d be open to that, but I think all uninsured should be auto enrolled in medicaid, private insurance should have all payer rate setting, elimination of networks, capping total out of pocket expenses including premiums, etc. We don’t need single payer to have a humane universal health care system. The Netherlands, Israel, Germany, Switzerland, etc do not have single payer but they all have universal health systems. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 31, 2019, 8:14pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/26 "2019-07-31T20:14:48Z")
> [@SlackerInc](#): > > Something that is really key about this that I don’t see journalists addressing when questioning candidates, probably because they feel it will sound petty: it’s not at all just a question of whether people believe that the MFA replacement will be just as good or better than what they have now. If their union negotiated hard for this benefit or a “Cadillac health plan” was something that attracted them to take their white-collar job, equalizing everyone under the same national plan will take away their feelings of getting something significant there, unless the bill requires employers to substitute a pay raise or other benefit equal to the now redundant employer health plan—and I am sure it does not. > > Sadly, behavioral economics studies show that people would rather get a five dollar an hour pay cut while their neighbors get a $10 cut, than get a five dollar raise while their neighbors get a $10 raise. (These numbers may not be exactly accurate, but the gist is there.) People care more about their relative wealth than their absolute wealth, which is why they get so upset about income inequality: if they are doing a little better and the rich are doing a lot better, they feel like they are doing worse. > > So as unsatisfying as it would be for the progressive left, the best thing Democrats could do for now is to offer a universal benefit for anyone who is not insured, but make it less generous than a good union or white collar plan. Then the centrist voters we need can feel they are doing something nice for those who are struggling, without feeling like they have lost ground in terms of having something better than the “unfortunates” have. So Crabs on a bucket, anything that makes life better for others will breed resentment? That reminds me of people who opposed gay marriage because they felt it cheapened heterosexual marriage. Why not oppose a minimum wage hike because semi skilled workers who make $11 will be making the same as no skilled workers if the new minimum wage is $15. Why not just phase it in to give people time to adapt. Also what do you have against the ‘left’? America’s left is barely even leftist. ---
**Author:** ![Akaj](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/akaj/32/145_2.png) [@Akaj](https://boards.straightdope.com/u/Akaj)\ **Post date:** [July 31, 2019, 8:37pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/27 "2019-07-31T20:37:51Z")
> [@Wesley\_Clark](#): > > That’s the public option, letting people buy into Medicare (which includes making employers offer subsidized Medicare as an option). Right, I realize that’s the public option. I wasn’t proposing the idea so much as I was proposing the name: Medicare For Anyone. It sounds more choice-y and less impose-y. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [July 31, 2019, 8:46pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/28 "2019-07-31T20:46:42Z")
> [@Wesley\_Clark](#): > > So Crabs on a bucket, anything that makes life better for others will breed resentment? That reminds me of people who opposed gay marriage because they felt it cheapened heterosexual marriage. > > Why not oppose a minimum wage hike because semi skilled workers who make $11 will be making the same as no skilled workers if the new minimum wage is $15. > > Why not just phase it in to give people time to adapt. > > Also what do you have against the ‘left’? America’s left is barely even leftist. The minimum wage thing is an issue for that reason. And yes, i’ve heard all about how the left here is the center-right everywhere else or whatever. It’s a lot of hyperbole. I grew up in a left-wing family and they were legit left Marxists. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 31, 2019, 9:14pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/29 "2019-07-31T21:14:26Z")
> [@Akaj](#): > > Right, I realize that’s the public option. I wasn’t proposing the idea so much as I was proposing the name: Medicare For Anyone. It sounds more choice-y and less impose-y. Thats fair enough. I’ve also heard it called ‘medicare for anyone who wants it’ which is the same as what you describe. There were some good points in the debate though about how public insurance underfunds medical suppliers, and as a result there could be issues due to that. I know Washington recently passed a public option, but their reimbursement rate was 160% of medicares, which also kind of defeats the purpose. The reason public health insurance is cheaper is due to lower reimbursement and lower overhead. If you take away the lower reimbursement, much of the financial benefit of the public plans go away. The overhead benefit is still there, I think medicare is only 2-5% overhead while private insurance can be 20%. ---
**Author:** ![Kimstu](https://avatars.discourse-cdn.com/v4/letter/k/ecd19e/32.png) [@Kimstu](https://boards.straightdope.com/u/Kimstu)\ **Post date:** [July 31, 2019, 9:36pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/30 "2019-07-31T21:36:57Z")
> [@SlackerInc](#): > > And yes, i’ve heard all about how the left here is the center-right everywhere else or whatever. It’s a lot of hyperbole. Not if you’re talking about the actual political roles of the different ideologies. The part of the US “left” that actually plays a significant political role advocates positions that in, say, most western European countries would be considered far more centrist or rightist than they are here. > [@SlackerInc](#): > > I grew up in a left-wing family and they were legit left Marxists. But your family members weren’t elected to anything, nor did their support put any other “legit left Marxists” into any significant political office. Nobody’s denying that there exists a small number of individual Americans who espouse left-wing views just as radical as any of their counterparts in Europe or wherever. The point, though, is that in the US those extreme leftist types have far less real political power and influence than their counterparts in other developed-world democracies. Conversely, in the US the extreme right wing have much **more** real political power and influence than their counterparts in other developed-world democracies. ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [July 31, 2019, 9:40pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/31 "2019-07-31T21:40:40Z")
In real-life Medicare, the basic insurance is just that: basic. The private sector does a nice job with supplemental policies that have differing prescription management services, dental, eyeglasses, hearing aids and whatnot. Give the insurance industry a chance, and they will design a Medicare-compliant, super-luxury, “not just Cadillac, but Tesla combined with Rolls Royce” level supplemental policy that even Libertarians would approve of. ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [July 31, 2019, 9:55pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/32 "2019-07-31T21:55:49Z")
> [@Akaj](#): > > Right, I realize that’s the public option. I wasn’t proposing the idea so much as I was proposing the name: Medicare For Anyone. It sounds more choice-y and less impose-y. I like that. Good idea. ---
**Author:** ![SlackerInc](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slackerinc/32/275_2.png) [@SlackerInc](https://boards.straightdope.com/u/SlackerInc)\ **Post date:** [July 31, 2019, 10:00pm UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/33 "2019-07-31T22:00:24Z")
> [@Kent\_Clark](#): > > In real-life Medicare, the basic insurance is just that: basic. The private sector does a nice job with supplemental policies that have differing prescription management services, dental, eyeglasses, hearing aids and whatnot. > > Give the insurance industry a chance, and they will design a Medicare-compliant, super-luxury, “not just Cadillac, but Tesla combined with Rolls Royce” level supplemental policy that even Libertarians would approve of. How many times do I need to point out that Bernie’s bill is not Medicare at all but a single payer plan that is much more generous? There would be no market for the plans you describe because there is nothing left to supplement. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [August 1, 2019, 12:20am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/34 "2019-08-01T00:20:45Z")
> [@SlackerInc](#): > > How many times do I need to point out that Bernie’s bill is not Medicare at all but a single payer plan that is much more generous? There would be no market for the plans you describe because there is nothing left to supplement. Have you looked into John Dulaney’s plan? His plan seems to be more like a basic ACA plan for everyone as the public plan, then a variety of private plans on top of it you could buy as supplementals. > **[John Delaney Actually Perfectly Embodies How the “Medicare for All” Movement...](https://slate.com/business/2019/07/john-delaney-medicare-for-all-plan-chances.html)** > > And also how it will fail. > **[John Delaney has a plan for universal health care — but don’t call it...](https://www.vox.com/2019/2/11/18220118/2020-presidential-campaign-medicare-for-all-john-delaney)** > > Delaney probably won’t be president. But check out his universal health care plan anyway. > [@](#): > > Granted, there are a lot of details Delaney still needs to fill in, but the bones are pretty simple: > > [ul] > [li]Every American under 65 would be enrolled in a new public plan that covers a certain set of basic medical services, comparable to the essential health services covered by Obamacare.[/li][li]Employers and individuals could purchase supplemental insurance.[/li][li]Medicare for people over 65 would be untouched.[/li][li]The plan would be paid for mostly by maintaining the shared state-federal payments for Medicaid and by ending the unlimited tax break for employer health benefits.[/li][/ul] ---
**Author:** ![D\_Anconia](https://avatars.discourse-cdn.com/v4/letter/d/67e7ee/32.png) [@D\_Anconia](https://boards.straightdope.com/u/D_Anconia)\ **Post date:** [August 1, 2019, 12:28am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/35 "2019-08-01T00:28:20Z")
> [@carnivorousplant](#): > > Co-pay for my rheumatologist is $50 when I walk in the door, for my GP $25 when I walk out the door. I wonder why one guy is allowed to charge a larger co-payment. Because one is a specialist, and one is not? 😕 ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 1, 2019, 12:59am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/36 "2019-08-01T00:59:35Z")
> [@SlackerInc](#): > > ETA: RW, I hear this kind of argument about the future quite often. But this election will be held in 2020, not 2040. Alternatively, M4A will win, because we are living in the 21st Century, not the 20th. M4A is the rallying cry for those who want a revolution. It’s what a campaign to replace the ancient, corrupt pols in Congress will run on. Stop acting like the Presidential election exists in a vacuum. The real fight is over Congress, and the only way to fix the USA’s fiscal, environmental, & justice problems is to knock out as many corrupt “conservatives” and “centrists” as possible, M4A is how you get the reformers into those seats. But please, keep vocally opposing it. We need to know who our friends aren’t. ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [August 1, 2019, 1:39am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/37 "2019-08-01T01:39:28Z")
> [@SlackerInc](#): > > How many times do I need to point out that Bernie’s bill is not Medicare at all but a single payer plan that is much more generous? There would be no market for the plans you describe because there is nothing left to supplement. As many times as politicians keep calling it “Medicare for All.” ---
**Author:** ![DinoR](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dinor/32/2821_2.png) [@DinoR](https://boards.straightdope.com/u/DinoR)\ **Post date:** [August 1, 2019, 2:32am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/38 "2019-08-01T02:32:22Z")
> [@steronz](#): > > I was surprised in the debate last night how everyone was talking about MFA would “ban” private insurance. Maybe I haven’t been paying attention but that can’t possibly be part of the proposal, right? Other countries with single payer systems still have private insurance for those who want to pay extra for extra coverage, right? Why did all of the candidates allow this talk of banning private insurance go unchallenged? Bernie Sanders crafted the name Medicare For All during his 2016 campaign. He left open some small areas for private insurance like elective plastic surgery, at the time. Sanders introduced a Medicare For All bill in April of this year. The only allowed private insurance under that bill is for things not covered under MFA like elective plastic surgery and private hospital rooms. . The bill also prohibits cost sharing. ([Cite](https://www.washingtonpost.com/politics/2019/live-updates/general-election/fact-checking-the-first-democratic-debate/bennet-on-medicare-for-all/?utm_term=.6aba55d17541)) Bernie Sanders created the name. He introduced a bill named Medicare For All just a couple months ago. That bill really would ban most private insurance and prohibit the two-tiered approach used in some UHC countries. MFA is not a synonym for universal health care. The problem is that many are using it as a synonym and consider possibilities that Sanders proposal explicitly prohibits. That prompts confusion. It’s also not really Medicare as we know it if implemented. Medicare is a **multiplayer** system that offers universal coverage for those 65+. Sanders is effectively calling for a complete repeal of the current Medicare system with a totally new replacement system. Repeal and replace is probably a bad slogan for the Democratic primary, though. 😃 ---
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [August 1, 2019, 2:58am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/39 "2019-08-01T02:58:37Z")
> [@DinoR](#): > > Sanders introduced a Medicare For All bill in April of this year. The only allowed private insurance under that bill is for things not covered under MFA like elective plastic surgery and private hospital rooms. Why would private hospital rooms not be covered under MFA? It’s my understanding that the trend now in new hospitals to have only private rooms, and that many existing hospitals are reconfiguring to have mostly private rooms. There are a lot of advantages, including [financial ones](https://www.healthcarefinancenews.com/news/costly-private-hospital-rooms-save-systems-quality-links-cost-cornell-study-says) > [@](#): > > Because hospital-acquired infections are a common complication and extend inpatient stays, hospitals actually save money by building costly, single-patient rooms, according to a new study by Cornell University. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [August 1, 2019, 4:51am UTC](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922/40 "2019-08-01T04:51:46Z")
> [@SlackerInc](#): > > The second problem is that his proposed plan would have so many “bells and whistles”, there would be none left to supplement. Which of course would be unworkable fiscally, but that is what he is proposing: no premiums, no deductibles, no copays even for prescriptions, any doctor, etc. No premiums - Canada - check No deductibles - Canada - check No copays (for doctors / hospitals) - Canada - check Any doctor (if you mean no networks?) - Canada - check. Doesn’t seem unworkable here. And yes, there isn’t much left to supplement in primary health care. [Previous page](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922.md?page=1) [Next page](https://boards.straightdope.com/t/the-dangerous-politics-of-medicare-for-all/837922.md?page=3)