# 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:** 25
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [September 17, 2018, 5:29am UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/481 "2018-09-17T05:29:53Z")
Anyone on Social Security at 65 (which I suspect are most of those who might not know about Medicare) gets signed up automatically. But I can’t conceive of too many people who don’t know someone over 65. Now, some might not want to pay for it and delay signing up, but that is different. Optimizing Plan D is tough if you take lots of drugs. Adding so much involvement from insurance companies does take it further from single payer, true. And while it might be easy to predict your usage incorrectly, you get to change once a year. I’m definitely not saying it is better or even equal to true single payer. ---
**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:** [September 17, 2018, 7:16am UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/482 "2018-09-17T07:16:20Z")
> [@eschereal](#): > > There are many ways that US Medicare is not like single-payer UHC, even for those over 65. But those who advocate Medicare-for-All see the present program as a good foundation upon which to build out to a sensible solution to our current FUHC. Well, some do. The “Medicare for All” label does not necessarily mean that the plan would extend (or even retain) the existing Medicare system. The Sanders version would basically abolish Medicare and replace with a whole new thing also called Medicare. ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [September 17, 2018, 12:21pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/483 "2018-09-17T12:21:50Z")
> [@Grim\_Render](#): > > The 600 000 are just the people who work in the health insurance industry. Laying off 600,000 workers would certainly save a lot of money, but would it be possible politically? What you do with those workers? give them 12 months of unemployment comp? And what about the shareholders of the insurance companies? Are they just screwed? Obviously having insurance companies design government-funded programs — which is how we do it in the U.S.A. :smack: — is a recipe for inefficiency, but if rational thought were the priority, how should we cope with layoffs in the private health insurance industry? ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [September 17, 2018, 12:58pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/484 "2018-09-17T12:58:55Z")
> [@septimus](#): > > Laying off 600,000 workers would certainly save a lot of money, but would it be possible politically? What you do with those workers? give them 12 months of unemployment comp? And what about the shareholders of the insurance companies? Are they just screwed? > [@](#): > > Over the 12 months ending in July, hires totaled 66.7 million and **separations totaled 64.2 million** , yielding a net employment gain of 2.5 million. [https://www.bls.gov/news.release/pdf/jolts.pdf](https://www.bls.gov/news.release/pdf/jolts.pdf) 600,000 is roughly 1% of the total separations in a year which is a very small percentage. Universal Medicare is going to require a significant administrative burden (claims processing and fraud prevention…) so there will be a significant number of jobs there. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [September 17, 2018, 1:11pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/485 "2018-09-17T13:11:08Z")
Well, in general I didn’t think the American system was set up to employ very, very large numbers of people doing busywork. Or more accurately, work that not only does not need doing but which actively impairs task completion. At least if you got them building roads or something you’d get some kind of infrastructure in return. or if you just paid them the same amount of money as a welfare payout they would not get in between healthcare and people. In general, America seems to assume it is a more capitalist setup than Scandinavia, but it seems to practice only half of capitalism. More accurately, everything involving letting unfit businesses go under gets regarded with horror and cries of “too big to fail”. Whereas stuff involving people versus businesses there tends to be great pressure to favor businesses. Vacation time, maternity leave, etc It seems a given that businesses cannot survive if they have to compete on equal terms with other developed nations. > [@PastTense](#): > > Universal Medicare is going to require a significant administrative burden (claims processing and fraud prevention…) so there will be a significant number of jobs there. Serious question: Why? ---
**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:** [September 17, 2018, 7:14pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/486 "2018-09-17T19:14:02Z")
[quote=“Grim\_Render, post:485, topic:816997”] In general, America seems to assume it is a more capitalist setup than Scandinavia, but it seems to practice only half of capitalism. [/QUOTE=Grim Render;21212348] The US financial system is operated by an enormous casino: marketplace healthcare is just one of the metaphorical tables. That may be the literal definition of “capitalism”. Or not. > [@Grim\_Render](#): > > > [@PastTense](#): > > > > Universal Medicare is going to require a significant administrative burden (claims processing and fraud prevention…) so there will be a significant number of jobs there. > > Serious question: Why? Given that around a fifth of the US population is covered by government-operated services, it seems likely that MFA would involve at least a doubling of bureaucratic overhead – in which (edge) case, the overall savings to the public would be huge. As far as fraud goes, a well-designed UHC system would most likely have a much smaller attack surface than the FUHC system currently in place. We can assume that fraud will happen (as it does everywhere anyway), we will just have to do our best keep it in check and not let the investagatory machine get out of hand. ---
**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:** [September 17, 2018, 8:04pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/487 "2018-09-17T20:04:33Z")
But are you and **Past Tense** saying there would be an increase in Gov’t jobs, but with a decrease in private jobs, so it could net out to a decrease overall? Or are you saying that there would be a net increase in admin jobs overall, even if private insurers go away under MFA? ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [September 17, 2018, 9:16pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/488 "2018-09-17T21:16:23Z")
> [@](#): > > According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue. [https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/](https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/) So I would expect a substantial net decrease in administrative overhead. But equally important is administrative overhead among the health care providers. Doing paperwork for 1 insurance payer is going to be a lot simpler than paperwork for 100 (plus individually billing all the uninsured). ---
**Author:** ![Projammer](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/projammer/32/559_2.png) [@Projammer](https://boards.straightdope.com/u/Projammer)\ **Post date:** [September 17, 2018, 9:31pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/489 "2018-09-17T21:31:20Z")
> [@Grim\_Render](#): > > The 600 000 are just the people who work in the health insurance industry Wouldn’t a good portion of these people still be needed under whatever new plan is implemented? It’s not like computers and automation will be taking over all these positions. ---
**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:** [September 17, 2018, 11:53pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/490 "2018-09-17T23:53:12Z")
> [@Projammer](#): > > Wouldn’t a good portion of these people still be needed under whatever new plan is implemented? It’s not like computers and automation will be taking over all these positions. Hospitals have substantial staff who spend their time negotiating with insurance companies, each of which has different policies regarding payment, which is handled by claims adjusters who put a lot of effort into not giving money to hospitals. This is why the $50 aspirin and band-aid charges exist: hospitals have to charge ridiculous rates to compensate for the foot-dragging and denials that insurers are notorious for. With a MFA, these rates should drop considerably, due to reduced uncertainty, delays and accounts specialist staff. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [September 18, 2018, 7:57am UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/491 "2018-09-18T07:57:06Z")
> [@eschereal](#): > > Given that around a fifth of the US population is covered by government-operated services, it seems likely that MFA would involve at least a doubling of bureaucratic overhead – in which (edge) case, the overall savings to the public would be huge. I am not sure of that. The thing is, a large fraction of the US excess spending -I’ve heard ‘a third’- is the way it requires a lot more bureaucracy than other setups. The reason it needs so much bureaucracy is because of the interface between providers and a large number of insurance systems, gatekeeping, billing etc. I think it would be a reasonable goal to do not worse than other developed nations. > [@Projammer](#): > > Wouldn’t a good portion of these people still be needed under whatever new plan is implemented? It’s not like computers and automation will be taking over all these positions. Well, what do you mean by “needed” ? The job they do is one most systems do largely without. Its just not relevant. You could certainly design a system that needs them though. Basically building in half a million extra jobs. The way to think about it is, a lot of other nations provide healthcare like basic education. Build a school, employ teachers. When a family moves into the area, they sign their kids up for school. People do not buy “education insurance” in case of having kids. Schools do not employ vast numbers of staff to negotiate costs with insurers. They don’t pass bills between departments. You do not have to worry about which classes are covered and which schools are in-network for your insurer. No-one worries about their kids not being allowed to go to school. Half a million people are not involved in education insurance. It may even sound mad to think about doing education like that. That is how the rest of the world regard the US healthcare system and all its expensive, unnecessary bells and whistles. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [September 18, 2018, 8:07am UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/492 "2018-09-18T08:07:20Z")
> [@Grim\_Render](#): > > The way to think about it is, a lot of other nations provide healthcare like basic education. Build a school, employ teachers. When a family moves into the area, they sign their kids up for school. > > People do not buy “education insurance” in case of having kids. Schools do not employ vast numbers of staff to negotiate costs with insurers. They don’t pass bills between departments. You do not have to worry about which classes are covered and which schools are in-network for your insurer. No-one worries about their kids not being allowed to go to school. In many countries, you have both a public system and a private system (which always must cover at least the same services as the public system); schools both public and private offer ‘out of school activities’ which are clearly identified as not “covered”. So actually, even in the school systems we’re used to, there is a certain level of coverage everybody must comply with (which would be equivalent to the UHC system of healthcare) and additional stuff you can pay for. ---
**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:** [September 18, 2018, 11:47pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/493 "2018-09-18T23:47:03Z")
> [@Grim\_Render](#): > > I am not sure of that. The thing is, a large fraction of the US excess spending -I’ve heard ‘a third’- is the way it requires a lot more bureaucracy than other setups. The reason it needs so much bureaucracy is because of the interface between providers and a large number of insurance systems, gatekeeping, billing etc. I think it would be a reasonable goal to do not worse than other developed nations. > > Well, what do you mean by “needed” ? The job they do is one most systems do largely without. Its just not relevant. You could certainly design a system that needs them though. Basically building in half a million extra jobs. > > The way to think about it is, a lot of other nations provide healthcare like basic education. Build a school, employ teachers. When a family moves into the area, they sign their kids up for school. > > People do not buy “education insurance” in case of having kids. Schools do not employ vast numbers of staff to negotiate costs with insurers. They don’t pass bills between departments. You do not have to worry about which classes are covered and which schools are in-network for your insurer. No-one worries about their kids not being allowed to go to school. > > Half a million people are not involved in education insurance. > > It may even sound mad to think about doing education like that. That is how the rest of the world regard the US healthcare system and all its expensive, unnecessary bells and whistles. That is exactly the point I keep harping on: it’s a substantial change in the political paradigem, to think of health care as a government service, like police / fire / roads /schools, rather than an insurance based-model. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [September 19, 2018, 4:20pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/494 "2018-09-19T16:20:17Z")
> [@Northern\_Piper](#): > > That is exactly the point I keep harping on: it’s a substantial change in the political paradigem, to think of health care as a government service, like police / fire / roads /schools, rather than an insurance based-model. I prefer to think of all of them as public or community services, for which the government of the day is the temporary custodian of the finances. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [September 25, 2018, 5:43pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/495 "2018-09-25T17:43:06Z")
Census Bureau just came out with their updated tracking of the uninsured. It’s at 8.8% in 2017, which I expect will uptick in 2018, post-Trumpian sabotage. > **[p60-264.pdf](https://www.census.gov/content/dam/Census/library/publications/2018/demo/p60-264.pdf)** > > 1324.83 KB They have it split out various ways in an interesting report. I think it’s interesting by state. Massachusetts is at 2.8%, which is the lowest, and then Texas is at 17%, i.e., the highest. Massachusetts made a real effort to get to UHC. They run their own exchange. They took the Medicaid expansion. They pioneered the ACA concept a decade ago. So, I think what they need is richer subsidies on the exchange to close it down to zero, as well as an individual mandate with some teeth. There are a dozen or so states within striking distance of Massachusetts, mostly states that are blue, and that took the Medicaid expansion. ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [September 25, 2018, 7:19pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/496 "2018-09-25T19:19:48Z")
> [@survinga](#): > > Census Bureau just came out with their updated tracking of the uninsured. It’s at 8.8% in 2017, which I expect will uptick in 2018, post-Trumpian sabotage. It’s not just Trump; there are also significant flaws in Obamacare–for example the penalties for not joining were probably not strong enough. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [September 25, 2018, 8:52pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/497 "2018-09-25T20:52:20Z")
> [@PastTense](#): > > It’s not just Trump; there are also significant flaws in Obamacare–for example the penalties for not joining were probably not strong enough. Agreed. The original ACA didn’t have a strong enough mandate, and it didn’t have strong enough subsidies. Those two items could’ve been handled with a technical mark-up, the way bills used to be “fixed”. But then, nothing is done the way it used to be done in the US. So, the best we can hope for is for individual states to try and make their own ACA exchanges work, and to accept the Medicaid expansion (16 or so are still not on board)…and even that is a tall order, as many states are just as dysfunctional as DC. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [September 26, 2018, 10:31am UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/498 "2018-09-26T10:31:43Z")
> [@Scylla](#): > > A first question then, is healthcare a right or a commodity? If it’s a right, than we should all have free access to multimillion dollar procedures that might extend our lives slightly when we face grave, likely fatal illness. Thanks to the advancement of medecine this is becoming an increasingly common issue. People want that for their loved ones. UHC systems do provide exactly this on a basis of medical need rather than ability to pay, did you imagine it was otherwise? > [@](#): > > No matter what we would like to think healthcare should be, the immutable fact is that it is a commodity, not a right. It has all the properties of a commodity and virtually none of rights. If the goal is to provide the greatest quality of healthcare to the greatest number of people at a reasonable price, we have to stop engaging in the fallacy that healthcare is a right, and start treating it like what it is, a commodity. > > Food and electricity are not treated like rights. They are treated like commodities that everyone has reasonable access to at reasonable prices. We need to treat healthcare like that. Healthcare is not a commodity and comparing it to true commodities is idiotic. There is an inherent asymmetry of real, pressing need and ability to pay that commodifying simply can not overcome. No-one suddenly wakes up and finds out they will die or be crippled or be in non-stop agony if they don’t get caviar instead of an apple. …or a Beverly Hills mansion instead of a one-bedroom apartment …or a Ferrari instead of a Micra …or first class air travel instead of Easyjet …or 1.21 gigawatts or electricity instead of a standard 240v domestic supply …or silk shirts instead of a Gap cotton Tee For food, shelter, power, heat, transport etc. it is really easy to establish a baseline that provides you with enough to comfortably survive. It is easy to define “enough”. You will never physically suffer if you can’t get more. In caps, for clarity and emphasis. HEALTHCARE IS NOT LIKE THAT God forbid but you may wake up tomorrow and find out that only a multi-million pound treatment will save your life, you can’t predict it and you can’t avoid it. That is the fundamental difference. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [September 30, 2018, 8:06pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/499 "2018-09-30T20:06:15Z")
> [@Novelty\_Bobble](#): > > UHC systems do provide exactly this on a basis of medical need rather than ability to pay, did you imagine it was otherwise? > > Healthcare is not a commodity and comparing it to true commodities is idiotic. There is an inherent asymmetry of real, pressing need and ability to pay that commodifying simply can not overcome. > > No-one suddenly wakes up and finds out they will die or be crippled or be in non-stop agony if they don’t get caviar instead of an apple. > …or a Beverly Hills mansion instead of a one-bedroom apartment > …or a Ferrari instead of a Micra > …or first class air travel instead of Easyjet > …or 1.21 gigawatts or electricity instead of a standard 240v domestic supply > …or silk shirts instead of a Gap cotton Tee > > For food, shelter, power, heat, transport etc. it is really easy to establish a baseline that provides you with enough to comfortably survive. It is easy to define “enough”. You will never physically suffer if you can’t get more. > > In caps, for clarity and emphasis. > > HEALTHCARE IS NOT LIKE THAT > > God forbid but you may wake up tomorrow and find out that only a multi-million pound treatment will save your life, you can’t predict it and you can’t avoid it. > > That is the fundamental difference. So what. It’s still a service that requires money to perform. Doctors and Nurses don’t work for free. Pharmaceuticals aren’t generated out of thin air. Hospital beds aren’t created by snapping a finger. So, whether we call healthcare a commodity or not doesn’t really matter, does it? ---
**Author:** ![fedman](https://avatars.discourse-cdn.com/v4/letter/f/278dde/32.png) [@fedman](https://boards.straightdope.com/u/fedman)\ **Post date:** [October 1, 2018, 12:01am UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/500 "2018-10-01T00:01:22Z")
> [@Velocity](#): > > There are many billions of dollars in Medicare fraud annually. > > [Medicare Fraud: A $60 Billion Crime - CBS News](https://www.cbsnews.com/news/medicare-fraud-a-60-billion-crime-23-10-2009/) > [The $272 billion swindle](https://www.economist.com/united-states/2014/05/31/the-272-billion-swindle) > [Fraud and billing mistakes cost Medicare — and taxpayers — tens of billions last year – Center for Public Integrity](https://www.publicintegrity.org/2017/07/19/21011/fraud-and-billing-mistakes-cost-medicare-and-taxpayers-tens-billions-last-year) > Now imagine that on a scale 6-8 times greater. so there’s no fraud elseware? [Previous page](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997.md?page=24) [Next page](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997.md?page=26)