# 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:** 5
**Author:** ![dorvann](https://avatars.discourse-cdn.com/v4/letter/d/df705f/32.png) [@dorvann](https://boards.straightdope.com/u/dorvann)\ **Post date:** [July 4, 2018, 8:04pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/81 "2018-07-04T20:04:57Z")
It’s common for people to argue that Medicare for All or other government run healthcare is unconstitutional . Frankly I don’t buy this argument at all. Let’s look at Article 1, Section 8, Clause 1 of the United States Constitution: “The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States;” It’s blatantly stated above that Congress has authority to provide for the general welfare of the United States. I think ensuring the citizens of the United States are in good health would constitute providing for the general welfare of the United States as a whole. And for people who argue that’s not what the Founding Fathers intended, you should keep in mind George Washington himself pressured Congress to grant funds to ensure that people could get vaccinated from smallpox. The Founding Fathers were also aware of bubonic plague and that it caused almost a third of Europe’s population to die in the 1400’s. So it’s extremely unlikely they would been opposed to government intervention in order to prevent a second occurrence of that event. ---
**Author:** ![E-DUB](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/e-dub/32/403_2.png) [@E-DUB](https://boards.straightdope.com/u/E-DUB)\ **Post date:** [July 4, 2018, 8:15pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/82 "2018-07-04T20:15:33Z")
Wild idea here, folks. Do a test case where we drop the medicare age from 65 to 60. This will do two things. It will take the oldest (and likeliest of those on the private insurance market to be sick) and sickest people out of the private insurance market. And it will put them onto Medicare where they will now be the _youngest_ and likeliest to be healthy. Seems that both private insurance and Medicaid will benefit. Evaluate in a few years. Lather, rinse, repeat. ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [July 4, 2018, 8:34pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/83 "2018-07-04T20:34:42Z")
> [@Flyer](#): > > Regarding your second question– > FDR decided that he was going to flat-out ignore the Constitution. And a great many people were happy to let him do so. The situation has not improved since. Article I, Section 8 gives Congress the power to regulate interstate commerce. Like it or not, we’ve got a very complex, interdependent society these days; FDR hadn’t seen nothin’ yet. If you walk into a burger joint and order a cheeseburger, chances that every part of that cheeseburger came from in state are somewhere between slim and none. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [July 5, 2018, 11:45am UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/84 "2018-07-05T11:45:56Z")
> [@running\_coach](#): > > And it has a customer base that’s vastly more healthy than the current make up. > Medicare(currently) is the ultimate in high risk groups, And therefore Tricare for All is probably no more extensible to everyone than Medicare for All. But that was part of the idea underlying Obamacare - that we would force a lot of folks who weren’t insured to be insured, they would pay premiums but not use the services, and that would reduce premiums. We all know how that worked out - premiums went up (not down by $2500 a year), [utilization and emergency room visits went up, not down](http://www.politifact.com/truth-o-meter/statements/2017/mar/10/tom-price/hhs-chief-tom-price-correct-er-use-obamacare/), and yet another government program founded on lies and [contempt for the American electorate](http://thehill.com/policy/healthcare/223578-obamacare-architect-lack-of-transparency-helped-law-pass) founders on the rocks of actuality. Regards, Shodan ---
**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:** [July 5, 2018, 1:23pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/85 "2018-07-05T13:23:35Z")
> [@E-DUB](#): > > Wild idea here, folks. Do a test case where we drop the medicare age from 65 to 60. This will do two things. It will take the oldest (and likeliest of those on the private insurance market to be sick) and sickest people out of the private insurance market. And it will put them onto Medicare where they will now be the _youngest_ and likeliest to be healthy. Seems that both private insurance and Medicaid will benefit. Evaluate in a few years. Lather, rinse, repeat. I don’t think this is crazy at all. If the Dems can win back Congress, the qualifying age of Medicare can be gradually lowered until the tipping point of general support is reached. A phase-in will also have the benefit of easing the transition on the federal bureaucracy which will be charged with administering it, and which will need to grow larger to handle the details of a universal system paying for 325 million of us. I contend that this is the big coming issue and will face the sternest opposition since Social Security. Conservatives know that this is a battle for the nation’s fundamental structure that they cannot afford to lose (well, they can, they just don’t know it). ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [July 5, 2018, 1:59pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/86 "2018-07-05T13:59:41Z")
> [@Magiver](#): > > We already have Medicaid for the poor. Perfect or not, nobody objects to it. Your projection of what other people think is based on your biases and not reality. > > We can see the problems we’ve had with VA medical system in the US as well as those in other countries with UHC. The argument as I see it revolves around delays in healthcare. Republicans have been trying to kill Medicare and Medicaid for 60 years and Social Security for 80 years. Killing Medicaid is the wettest of all Paul Ryan dreams. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [July 5, 2018, 2:12pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/87 "2018-07-05T14:12:10Z")
> [@senoy](#): > > When you talk about the cost savings in Europe, it is heavily due to the fact that healthcare wages are about 2/3 of what they are here. So are wages in general, so that argument is moot. ---
**Author:** ![Hermitian](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hermitian/32/470_2.png) [@Hermitian](https://boards.straightdope.com/u/Hermitian)\ **Post date:** [July 5, 2018, 2:20pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/88 "2018-07-05T14:20:56Z")
> [@elucidator](#): > > Shit! That’s getting right up there with the Toxic Asset Relief Program! And not even given to banks, but squandered on people! Yea, well the banks pay it back. The government profited $15.3B from TARP. See if you get that kind of return from Medicare patients. Bonus: The economy didn’t collapse. I am no fan of banks and I don’t think they were taken to task like they should have been, but blows my mind when TARP is brought up as poster boy of Government waste for the rich. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [July 5, 2018, 3:21pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/89 "2018-07-05T15:21:23Z")
> [@wolfpup](#): > > I’ve noticed in the past in these discussions that all evidence that supports the benefits of universal health care is deemed irrelevant by those who oppose it. I provided a real-world example of a UHC system with very low rates of fraud, and an explanation for why an integrated universal system can have a much better handle on fraud detection than today’s Medicare, which is an almost mind-bogglingly complicated system of partial coverages and intertwined shared obligations. You just continue to insist that Medicare will always have big fraud problems because it has those problems today. This is just like insisting that UHC will always have big cost problems because US health care has big cost problems today, despite the fact that UHC does a far better job of cost containment everywhere in the world without exception. You are trying to compare the current system versus a hypothetical Medicare that has fixed all its problems. It is easy to imagine a healthcare system that is better than Medicare at fraud detection, is much cheaper, and more effective. But the problem is the idea is not to create a hypothetical system from scratch or to import a better working system from abroad. The idea is to take the current actually existing Medicare and add several hundred million people to it. A better idea would be to fix Medicare, fix the scores of billions of fraud, fix the wait times and problems with physicians not taking it, and fix its effectiveness and only then consider expanding it. After all fixing a small program should be easier than fixing a huge program. ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [July 5, 2018, 3:30pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/90 "2018-07-05T15:30:43Z")
> [@](#): > > Quoth **puddleglum** : > > Medicare fraud is not people pretending to be old to get free coverage. It is people setting up clinics or using existing doctors to bill Medicare for procedures that were never performed. Why would that increase _at all_ if Medicare were expanded? ---
**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:** [July 5, 2018, 3:37pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/91 "2018-07-05T15:37:10Z")
> [@puddleglum](#): > > After all fixing a small program should be easier than fixing a huge program. Except of course, when it is the very economies of scale that we are trying to take advantage of. It’s easy, prosecute the hell out of people who set up clinics for the purpose of defrauding the govt. It’s not that hard to detect, really, and is only hidden at all due to the layers of bureaucracy that the private/public market hybrid causes. If there isn’t these multiple levels of coverage and care that has to be determined individually for each and every patient, then it would be much easier to see the clinic that is billing for patients, but that patients aren’t actually going there. When I hear about fraud, though, the speaker is almost invariably talking about people lying about their means or their ability to pay in order to get services that they would not be entitled to under current law. With universal coverage, this fraud is entirely eliminated. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [July 5, 2018, 3:42pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/92 "2018-07-05T15:42:24Z")
> [@Chronos](#): > > Why would that increase _at all_ if Medicare were expanded? If Medicare covers more people, more people are going to try to defraud it. Same reason that Willie Sutton supposedly robbed banks - because that’s where the money is. Unless you think that those who are currently trying to defraud private insurance companies would never consider trying to defraud whatever replaces private insurance companies. Regards, Shodan ---
**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:** [July 5, 2018, 5:10pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/93 "2018-07-05T17:10:20Z")
> [@Shodan](#): > > If Medicare covers more people, more people are going to try to defraud it. Same reason that Willie Sutton supposedly robbed banks - because that’s where the money is. > > Unless you think that those who are currently trying to defraud private insurance companies would never consider trying to defraud whatever replaces private insurance companies. People defraud medicare because they are not eligible for it, so they fraudulently claim that they are in order to get medical care to save their life or increase the quality of same. If everyone is covered, then what fraud would someone be committing in trying to get medical care? To put it another way, the reason that people fraud medicare is because it doesn’t cover them, if they are covered, then can you explain why (and how) would they commit fraud? ---
**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:** [July 5, 2018, 5:47pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/94 "2018-07-05T17:47:14Z")
> [@k9bfriender](#): > > To put it another way, the reason that people fraud medicare is because it doesn’t cover them, if they are covered, then can you explain why (and how) would they commit fraud? People with good private health insurance don’t go see their doctor for every minor sniffle, but 38% of Americans believe that people with government-paid health insurance will do precisely that. I’m not sure if this is because the people government insurance would cover are “the wrong sort of people.” Or if it’s because the “right sort of people” will overuse Medicare as deliberate sabotage to remind us all what a Marxist monstrosity it is. ---
**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:** [July 5, 2018, 6:29pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/95 "2018-07-05T18:29:00Z")
> [@Shodan](#): > > If Medicare covers more people, more people are going to try to defraud it. Same reason that Willie Sutton supposedly robbed banks - because that’s where the money is. > > Unless you think that those who are currently trying to defraud private insurance companies would never consider trying to defraud whatever replaces private insurance companies. > > Regards, > Shodan Who do you think is involved with Medicare fraud? Is it patients - or providers who bill for nonexistent services. Since any provider who wants to commit fraud is signed up already, why do you think more people signing up is going to change anything? I don’t think people signing up fraudulently is a big problem. First, the gummint knows your birth date (they never looked at my birth certificate when I signed up,) and identity theft would result in multiple signups for the same SSN, easy to detect. Not to mention a 30-year old giving a Medicare card to a provider is a dead giveaway. Medicare, btw, pays a $1,000 bounty for reporting fraud - which is getting a statement that Medicare paid for services you never got. Alas I suspect the fraudsters do this for the very old, so it might not be that effective, but putting young people in the system is not going to increase this type of fraud either. ---
**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:** [July 5, 2018, 6:30pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/96 "2018-07-05T18:30:45Z")
> [@septimus](#): > > I’m not sure if this is because the people government insurance would cover are “the wrong sort of people.” Or if it’s because the “right sort of people” will overuse Medicare as deliberate sabotage to remind us all what a Marxist monstrosity it is. “I’m sitting here in this depressing waiting room surrounded by contagious people to smash the state. Achoo!” ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [July 5, 2018, 6:48pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/97 "2018-07-05T18:48:36Z")
> [@k9bfriender](#): > > Except of course, when it is the very economies of scale that we are trying to take advantage of. > > It’s easy, prosecute the hell out of people who set up clinics for the purpose of defrauding the govt. It’s not that hard to detect, really, and is only hidden at all due to the layers of bureaucracy that the private/public market hybrid causes. > > If there isn’t these multiple levels of coverage and care that has to be determined individually for each and every patient, then it would be much easier to see the clinic that is billing for patients, but that patients aren’t actually going there. > > When I hear about fraud, though, the speaker is almost invariably talking about people lying about their means or their ability to pay in order to get services that they would not be entitled to under current law. With universal coverage, this fraud is entirely eliminated. If it is easy why hasn’t it been done already? People lying about their ability to pay is not relevant to Medicare because it is age dependent and not means tested. The three most common types of Medicare fraud are: Phantom Billing, Patient Billing, and Upcoding. None of these would be diminished by having more people sign up. Patient Billing, in which a patient provides the provider their information in exchange for some money so that the provider can make phantom charges with them, would likely increase as more people would be eligible for it and many of those would be more desperate for money than old people. One of the reasons that fraud is so prevalent is that people doing the billing for the government are drinking from a water hose. There is so much paperwork that it is easy to hide fraud and since it is not their money no one has a reason to stop it. Quadrupling the program would mean more paperwork which would make fraud easier to hide, it would also mean hiring alot more bureaucrats would would be inexperienced and easier to fool. The reason Medicare is so vulnerable is that it pays firsts and investigates later. The so called Pay and Chase model is used because it prevents politically unpopular delay in being seen. Giving Medicare patients more political power would make reform less likely. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [July 5, 2018, 7:07pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/98 "2018-07-05T19:07:03Z")
> [@septimus](#): > > People with good private health insurance don’t go see their doctor for every minor sniffle, but 38% of Americans believe that people with government-paid health insurance will do precisely that. > > I’m not sure if this is because the people government insurance would cover are “the wrong sort of people.” Or if it’s because the “right sort of people” will overuse Medicare as deliberate sabotage to remind us all what a Marxist monstrosity it is. People with [insurance](http://www.econ.ucla.edu/mcgarry/papers_pdfs/JHE_hurd.pdf)go to the doctor 50% more than those without insurance. ---
**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:** [July 5, 2018, 7:08pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/99 "2018-07-05T19:08:24Z")
> [@puddleglum](#): > > If it is easy why hasn’t it been done already? Good question. Why hasn’t anyone done this already? Anyone at all? Oh, wait, I know the answer, and it is that it has been done already, by every industrialized nation on earth except for us. > [@](#): > > People lying about their ability to pay is not relevant to Medicare because it is age dependent and not means tested. The three most common types of Medicare fraud are: Phantom Billing, Patient Billing, and Upcoding. None of these would be diminished by having more people sign up. Patient Billing, in which a patient provides the provider their information in exchange for some money so that the provider can make phantom charges with them, would likely increase as more people would be eligible for it and many of those would be more desperate for money than old people. > One of the reasons that fraud is so prevalent is that people doing the billing for the government are drinking from a water hose. There is so much paperwork that it is easy to hide fraud and since it is not their money no one has a reason to stop it. Quadrupling the program would mean more paperwork which would make fraud easier to hide, it would also mean hiring alot more bureaucrats would would be inexperienced and easier to fool. The reason Medicare is so vulnerable is that it pays firsts and investigates later. The so called Pay and Chase model is used because it prevents politically unpopular delay in being seen. Giving Medicare patients more political power would make reform less likely. You are correct that I conflate the arguments against medicaid and medicare, but What is wrong with prosecuting people who commit fraud? Throw them in jail. As Shodan said, the reason that people rob banks is because that is where the money is. Unless you are saying that that is an argument for getting rid of banks, rather than prosecuting bank robbers, then being worried about people breaking the law in regards to medicare is the same thing, just an excuse, not a reason. ---
**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:** [July 5, 2018, 7:13pm UTC](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997/100 "2018-07-05T19:13:10Z")
> [@puddleglum](#): > > People with [insurance](http://www.econ.ucla.edu/mcgarry/papers_pdfs/JHE_hurd.pdf)go to the doctor 50% more than those without insurance. What’s your point? That private health insurance is just as unsustainable as Medicare? Or that under Medicare for all, some people will get (heaven forbid!) the medical attention they need? [Previous page](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997.md?page=4) [Next page](https://boards.straightdope.com/t/what-are-the-arguments-against-medicare-for-all/816997.md?page=6)