# What are the arguments against Medicare for all? **URL:** \ **Category:** Great Debates\ **Created:** [June 29, 2018, 3:13pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997 "2018-06-29T15:13:17Z")\ **Posts on this page:** 20\ **Page:** 18
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [August 26, 2018, 12:22pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/341 "2018-08-26T12:22:45Z")
> [@wonky](#): > > People are fucking dying. I think some goddamned cursing is appropriate. …In your world, it might be appropriate. But it does not convince people to agree with your arguments, and is counter-productive… ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [August 26, 2018, 12:38pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/342 "2018-08-26T12:38:03Z")
> [@survinga](#): > > …In your world, it might be appropriate. But it does not convince people to agree with your arguments, and is counter-productive… As opposed to this, which is super cool and productive. 🙂 ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [August 26, 2018, 1:27pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/343 "2018-08-26T13:27:47Z")
> [@Banquet\_Bear](#): > > …if you hold the belief that all Obama did to get Obamacare passed was “cheering a bit from the sidelines and signing it proudly” then I don’t have a hope in hell convincing you otherwise. Because you have nothing. I was there, I saw all of it. Obama said to Nancy & Harry, “_cook me up some healthcare reform_”, and that was about the extent of his involvement in the process. > [@](#): > > You believe whatever the fuck you want to believe: I have no interest in trying to convince you otherwise, the point is not material to the debate. Nor was your post. You speak of how we failed to have Obama’s back, when, in reality, he failed us on the frontside. If he had had the skill and guile of an LBJ (or the even just right staff), we would at the very least have the Public Option and at best a ratcheting down of the age of eligibility for Medicare. If he had been sharp, there would have been a counter-strategy in place moments after the astroturfers had started Teaing on his leg, but he just watched like a deer-in-headlights. So your post was little more than a heap of bollocks. If the American Left has failed Barack Obama, it is because he did little to inspire or support leftist causes, or even his own. Which is not less (or more) relevant to the thread than the nonsense you posted. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [August 26, 2018, 1:56pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/344 "2018-08-26T13:56:57Z")
> [@Budget\_Player\_Cadet](#): > > As opposed to this, which is super cool and productive. 🙂 LOL. Sometimes, people think that if they yell, curse, and stomp their feet, we’ll all agree with them and completely re-org 1/6 of our economy. I’m amazed at that type of thinking. I can talk about finalizing the implementation of the ACA, improving on its weak points with a few technical markups, and how it’s reduced the uninsured population, and how health care cost growth has slowed since 2010. And I can talk about how 3/4 of the country is satisfied with their healthcare. But people are “f’ing dying”, so I have to fall in line with single-payer. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [August 26, 2018, 1:58pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/345 "2018-08-26T13:58:29Z")
> [@survinga](#): > > …In your world, it might be appropriate. But it does not convince people to agree with your arguments, and is counter-productive… Yes, yes. The tone police will totally give me a citation for all of the totally, completely, endlessly persuadable people the word “fuck” will frighten away because of the assault on their delicate ears. Your concern is noted, good citizen of the world! ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [August 26, 2018, 2:14pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/346 "2018-08-26T14:14:31Z")
> [@wonky](#): > > Yes, yes. The tone police will totally give me a citation for all of the totally, completely, endlessly persuadable people the word “fuck” will frighten away because of the assault on their delicate ears. Your concern is noted, good citizen of the world! Look, you work in health policy according to an earlier post in this thread. Give me your version of single-payer that you want, assuming you do want it. Or is there another option you’d accept that would get us to UHC? I’m more impressed with that than I am with screaming about people dying. I’m interested in states that are pursuing the medicaid buy-in. I’m interested in states that have made a real effort on the ACA and their uninsured population has dropped significantly. I’m interested in keeping what we have and adding a public option to the exchanges that people can buy in certain situations. I’m interested in consumer-driven healthcare that some companies have experimented with. What are you working on that you could bring to this thread? I’d like to hear it. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [August 26, 2018, 3:27pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/347 "2018-08-26T15:27:40Z")
> [@survinga](#): > > Look, you work in health policy according to an earlier post in this thread. Give me your version of single-payer that you want, assuming you do want it. Or is there another option you’d accept that would get us to UHC? I’m more impressed with that than I am with screaming about people dying. Just out of curiosity, is this you when you’re being persuasive? In any case: > [@wonky](#): > > FTR, I work in health care policy, specifically Medicare, so I tend to view threads like this as more work–and therefore unappealing–unless someone is asking interesting questions. ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [August 26, 2018, 5:16pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/348 "2018-08-26T17:16:19Z")
> [@survinga](#): > > LOL. Sometimes, people think that if they yell, curse, and stomp their feet, we’ll all agree with them and completely re-org 1/6 of our economy. I’m amazed at that type of thinking. If one sixth of our economy amounts to a great deal of throwing money in the toilet, expect some pretty rank shit to be flying around as we calmly discuss it. ---
**Author:** ![nelliebly](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/nelliebly/32/5422_2.png) [@nelliebly](https://boards.straightdope.com/u/nelliebly)\ **Post date:** [August 26, 2018, 6:02pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/349 "2018-08-26T18:02:54Z")
> [@survinga](#): > > OK, I’m sorry for your situation. I just wanted to get more understanding, and it sounds like your conditions were more expensive than your coverage was able to fund. Is your exchange policy a silver, bronze, gold? What’s the level you bought on the exchange? > > I support more changes to the system to make it better. I think step one was the ACA. Step two is finishing implementing it as it was intended (all states expanding Medicaid, more states running their own exchanges, more subsidies so that middle class aren’t screwed on this, etc). I think at that point, more people would choose to go on the exchanges voluntarily, and over time, the system would shift away from employer-based to individual-based. There were parts of the ACA that were implemented specifically to control costs (ACO’s, IPAC, etc). I think over time, we could monitor that and adjust as needed. > > HSA’s should be beefed up to make them larger if people wanted them. Singapore has them, and the government provides it if the person can’t fund it themselves. I bought the level I could afford. The Supreme Court has already ruled that states cannot be compelled to expand Medicaid coverage. (See _NFIB_ v. _Sebelius_,) I heartily agree, though, that the HSA maximum should be increased. The issue then becomes how many people could contribute that much. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [August 26, 2018, 6:48pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/350 "2018-08-26T18:48:52Z")
> [@Banquet\_Bear](#): > > …these are questions that are unimaginable about basic healthcare anywhere else in the Western World. My mum just spent about eight days in hospital. Cost to us out of pocket? $6.00 a day for carparking when we went to visit. > > “How bad is your debt situation?” Do you realize how mad that question must sound to people outside of the United States, in the context of a discussion about healthcare? We pay less than what you do for healthcare. On average other countries spend half of what the US do on healthcare. I don’t have to pay separately for health insurance … > > … the idea that you should go into personal debt for something like healthcare is simply madness. Is that something you are willing to accept? I just want to say, in light of the attack that was directed against you, that I fully concur with your position on this. Living as I do in a civilized country my experience and that of my family and relatives has been the same as yours (except that we’ve been ripped off for as much as $15 a day in hospital parking fees! :D). And for comparison I have many relatives in the US who, despite being financially well off, passionately hate the US health insurance system, because they have standards to compare it to. The mystery to me is why Americans put up with a system that is so fundamentally dysfunctional, and fail to recognize that it’s dysfunctional because its whole structure is so fundamentally wrong. And I suspect it’s because it’s just evolved around them over so many years and they’ve never known anything different. The idea that health insurance should be like car insurance has become ingrained, and with that, the idea that health care itself should be treated as a commodity, available to those with the means to buy it in the proportion and quality commensurate with their means, as if it was a new car or a new washing machine. And that, just like car insurance claims, it’s perfectly acceptable to have insurance bureaucrats examining every claim, adjusting payable amounts or denying them entirely. This is not just absolute madness when it comes to health care, it’s fundamentally immoral and inhumane. When I see a doctor I’m concerned about health care and nothing else, and money doesn’t enter into it. It doesn’t cost a dime. When I go to a hospital I’m concerned about health care and nothing else, and money doesn’t enter into it. It doesn’t matter how long I have to stay, or what the procedure(s) cost. The health care system pays, directly, in full, without quibbling about it. It’s a fundamental part of the social contract, quite literally a fundamental value of the society I live in, and how that society values and treats its citizens. That’s why bullshit over minutiae like increasing HSA contributions or tweaking the ACA is just that – bullshit. It doesn’t address the absurdly inappropriate structural fundamentals. Neither does Medicare expansion – Medicare is so limited, so bureaucratic, so structured along the existing private-enterprise model, that the best that can be said for it is that it’s better than nothing. Quite a lot better than nothing, to be sure, but a very long way and quite philosophically different from true single-payer. The basic philosophical disconnect here is incredible. And the responsibility for it lies at least in part with those unwilling to stand up for principles, the ones who use pragmatism as an excuse, the very ones who have allowed the present system to develop and fester, including the political dominance of the health insurers, the Republican majorities, and the current embarrassment of a president. The pragmatists should perhaps ask themselves why no other industrialized country on earth has these issues. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [August 26, 2018, 7:51pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/351 "2018-08-26T19:51:48Z")
> [@wolfpup](#): > > That’s why bullshit over minutiae like increasing HSA contributions or tweaking the ACA is just that – bullshit. It doesn’t address the absurdly inappropriate structural fundamentals. Neither does Medicare expansion – Medicare is so limited, so bureaucratic, so structured along the existing private-enterprise model, that the best that can be said for it is that it’s better than nothing. Quite a lot better than nothing, to be sure, but a very long way and quite philosophically different from true single-payer. > > The basic philosophical disconnect here is incredible. And the responsibility for it lies at least in part with those unwilling to stand up for principles, the ones who use pragmatism as an excuse, the very ones who have allowed the present system to develop and fester, including the political dominance of the health insurers, the Republican majorities, and the current embarrassment of a president. The pragmatists should perhaps ask themselves why no other industrialized country on earth has these issues. As a pragmatist, I do disagree a bit. We have a system, and that system needs to be changed and adapted to provide better outcomes and universal coverage. We cannot just start over with a new system. The ACA was a step in the right direction, and would have been a better, bigger step, had it not been watered down to appease republicans who refused to vote for it anyway. Not having a public option was really what made it fairly pointless, and I did not share in any of the concern that a public option would hurt insurance companies. It was better though. As an individual with minor pre-existing conditions, I could get health insurance at an affordable cost that covered my needs for the first time. Better is better than not better, even if it is not good, and good is good, even if it is not perfect. If we had managed to get people to turn out in 2010 midterms, it is likely that the ACA would have been bolstered. There is no bill ever, especially one of this scope, that does not need revisions, that doesn’t have unintended consequences, that doesn’t need some tweaking. Instead, republicans got power, and did everything they could to sabotage it, rather than to improve it. Canada’s healthcare system was not written and rolled out overnight. It had many alterations as it grew, needs changed, loopholes were closed, and cracks were mended. The reason that we cannot have this is not because the pragmatists are willing to work within the system that we have, it is because a substantial portion of our country wants to destroy the systems that we already have in place to help those who are less fortunate, and certainly don’t want to add any more. ---
**Author:** ![andros](https://avatars.discourse-cdn.com/v4/letter/a/e480ec/32.png) [@andros](https://boards.straightdope.com/u/andros)\ **Post date:** [August 26, 2018, 8:00pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/352 "2018-08-26T20:00:38Z")
> [@k9bfriender](#): > > …We cannot just start over with a new system… Point of order: _Will_ not, rather than _cannot_. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [August 26, 2018, 8:26pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/353 "2018-08-26T20:26:18Z")
> [@andros](#): > > Point of order: > > _Will_ not, rather than _cannot_. Did Canada just start over with a new system, or was their system built up over time? Make me king, and we can and will start over with a new system. Short of that, we cannot and will not. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [August 26, 2018, 8:55pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/354 "2018-08-26T20:55:57Z")
> [@k9bfriender](#): > > Did Canada just start over with a new system, or was their system built up over time? Every complex system gets incremental improvements over time, so that isn’t a point of contention. The real question is, did it start from a foundational set of new principles, what is variously called a blank sheet, “green field”, and various other terms denoting a complete redesign from the ground up? And the answer is, yes it did, and so did the National Health Service in the UK. The system in Canada arose from the innovation and political will of the CCF party in Saskatchewan which undertook a total reform of the province’s hospitalization insurance system. The NHS in the UK arose from the post-war impetus for large-scale social reforms. Your points in #351 are duly noted, and I can hardly disagree that tweaks that improve the existing system in positive ways should be promoted and encouraged and lauded. What I’m saying, however, is that it’s a mistake to believe that such incremental tweaks should be the end goal; to believe that they will achieve anywhere near the same results as the rest of the world in terms of efficacy and cost savings when they’re built on the essentially rotten foundations of a grossly inappropriate economic model. “Inappropriate” meaning one that is well suited to car insurance, automotive accident repair, and writeoffs where the car is hauled off to the dump, but entirely unsuited to the moral and practical imperatives of human health care. The conventional business model where health premiums are charged according to individual risk, claims individually adjudicated and premiums and policies adjusted accordingly, and health care provided in accordance with such arbitrary insurance carrier approval, just simply doesn’t work except in niche markets. When health care is funded as a universal human right, the entire model is fundamentally different. ---
**Author:** ![Banquet\_Bear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/banquet_bear/32/373_2.png) [@Banquet\_Bear](https://boards.straightdope.com/u/Banquet_Bear)\ **Post date:** [August 27, 2018, 3:47am UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/355 "2018-08-27T03:47:05Z")
> [@survinga](#): > > The reason I asked nelllie about her debt situation was that I was trying to get an understanding of how bad the bills were hitting her. She brought up her situation, so I wanted to engage with her on that. It’s not condescending to ask for more information when people volunteer on this forum wrt their own lives, so stop pretending otherwise. You’re the one being condescending with your political lectures, as if people can snap their fingers and get Trump un-elected. > > I tried to keep Trump out of office with my vote, and will do so again in 2020. Momentum is building in the country to throw him out, and potentially to flip the congress against his party in 2018. Stay tuned. …my point, in case you had forgotten, is how mad your question looks to people from the outside looking in. Because the entire situation is, to be blunt, quite mad. It is the most inefficient system you could possibly devise. Its Monty Python’s Flying Circus. The ACA, as good as it is: is a “work-around.” It doesn’t fix the fundamental problems with your system. When I people how do you fix the problem of people begging on twitter for $175 a week to keep their spouses alive they can’t give me an answer. Because, to put it quite bluntly, your system is fucked. (No apologies for my potty mouth.) So my question to you is: how do you fix a system that has large numbers of Americans taking to social-media to beg for enough money to be kept alive? Do you really think a few tweaks to the ACA will be enough to fix the system? > [@](#): > > Finally, in that incredibly long, and rambling pile of nonsense, I don’t know how many times you used the F-word. But you might consider dialing back on that word. It makes you sound like a 12-year old who has discovered curse words, and is trying to impress his buddies. This entire response to me has been off-topic. But this right here is [tone-policing](https://en.wikipedia.org/wiki/Tone_policing). An ad-ad hominem. A fallacy. If you want to respond to the substance of my post then feel free. But I’m not going to stop using the word fuck because it upsets your sensibilities. ---
**Author:** ![Red\_Wiggler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/red_wiggler/32/13190_2.png) [@Red\_Wiggler](https://boards.straightdope.com/u/Red_Wiggler)\ **Post date:** [August 27, 2018, 12:32pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/356 "2018-08-27T12:32:38Z")
[Here’s a recent Reuters poll (at the bottom of the story)](https://www.reuters.com/investigates/special-report/usa-election-progressives/)showing, when given the option of “supporting” or “opposing” medicare for all, Americans vote 70% in favor of support. Now, wording is always important in a poll and this gives but binary options, but it also makes one view in a slightly different light the previous claim that a large majority of Americans are satisfied with their health insurance plan. My take from that is while most Americans feel that they have good insurance, they are still aware that there are far better systems available to us if we have the political will. This issue appears to be following the trends of gay rights and cannabis legalization, where support zoomed upwards in a relatively short period of time and overcame inertia and entrenched political and financial opposition. Advocating for the maintenance of our current nightmare in light of the evidence provided by the more advanced industrial world will soon appear as ridiculous as railing against evolution being taught in public schools. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [August 27, 2018, 12:54pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/357 "2018-08-27T12:54:00Z")
> [@Red\_Wiggler](#): > > [Here’s a recent Reuters poll (at the bottom of the story)](https://www.reuters.com/investigates/special-report/usa-election-progressives/)showing, when given the option of “supporting” or “opposing” medicare for all, Americans vote 70% in favor of support. Now, wording is always important in a poll and this gives but binary options, but it also makes one view in a slightly different light the previous claim that a large majority of Americans are satisfied with their health insurance plan. My take from that is while most Americans feel that they have good insurance, they are still aware that there are far better systems available to us if we have the political will. I think some of it is also people who have good insurance knowing that others don’t. I have great insurance, with an employer-funded HRA. If everyone had my insurance, I’d be content. They don’t. Many people have incredibly high deductibles or premiums, are uninsured, or (given the new STLDI and AHP rules) will soon be underinsured. ---
**Author:** ![Bookkeeper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bookkeeper/32/281_2.png) [@Bookkeeper](https://boards.straightdope.com/u/Bookkeeper)\ **Post date:** [August 27, 2018, 2:13pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/358 "2018-08-27T14:13:37Z")
One other issue with US healthcare that hasn’t really been touched upon is the whole “out of network” thing. As a Canadian, the idea that my health care might be limited not only by how much my insurer is willing to pay, but also limitations on who they are willing to pay it to, is mind-boggling. My health care “network” is every doctor and hospital in Canada. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [August 27, 2018, 2:43pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/359 "2018-08-27T14:43:01Z")
> [@Bookkeeper](#): > > One other issue with US healthcare that hasn’t really been touched upon is the whole “out of network” thing. As a Canadian, the idea that my health care might be limited not only by how much my insurer is willing to pay, but also limitations on who they are willing to pay it to, is mind-boggling. My health care “network” is every doctor and hospital in Canada. In many (perhaps most) cases the “out of network” limitations are less “who the insurance company is willing to pay” and more "which doctors are willing to accept the amount my insurer is willing to pay ". There used to be HMOs where the doctors were actually employed by the HMO and worked at centers run by the HMO. I don’t know if they still exist, but for the most part, it’s doctors and hospitals that decide whether or not to affiliate with an insurance company network , not the other way around. ---
**Author:** ![andros](https://avatars.discourse-cdn.com/v4/letter/a/e480ec/32.png) [@andros](https://boards.straightdope.com/u/andros)\ **Post date:** [August 27, 2018, 3:14pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/360 "2018-08-27T15:14:33Z")
Relevant to that, [a teacher in Texas got hit with a $100k bill](https://www.npr.org/sections/health-shots/2018/08/27/640891882/life-threatening-heart-attack-leaves-teacher-with-108-951-bill) for his massive heart attack and related treatment…_on top of_ the amount his insurance paid out. Because while getting to the nearest hospital may have saved his life, it wasn’t the _right_ hospital. [Previous page](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997.md?page=17) [Next page](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997.md?page=19)