What are the arguments against Medicare for all?

[survinga]

@wolfpup

Been there, done that. Every one of those arguments was made when the province of Saskatchewan was switching over to the first single-payer health care coverage system in Canada. Every single one. Except that “drive a lot of doctors out of the profession” was “drive every last doctor out of Saskatchewan”. None of them turned out to be true. Not one. OK, except for some people in the private insurance industry losing their jobs, but the unfortunate fact is that those people work for a parasitic industry that is a cancer on the practice of health care, sucking away resources and adding absolutely no value. They need to find honest work.

And if not saving a lot of money is the “main argument” against UHC, then the argument is already hopelessly lost. Every universal health care system in the world operates at just a fraction of the exorbitant per-capita cost of US health care. Canada’s system costs about half as much per capita, the OECD average is barely more than a third as much.

It’s fine from the provider side, as long as it’s well regulated. What meaningful medical innovation has ever emerged from the insurance side? What people want from a bill-payer is to pay the bills. It’s not complicated. When they need medical care, they expect it to be covered. It’s not a complicated model and doesn’t require innovation. Paying the bills is the one thing that you need and are entitled to expect your health care insurer to do, consistently and unconditionally, and it’s the one thing that private insurance fails to do. Whenever they question a claim, cut down a claim, or deny a claim, they are failing in that essential obligation. It’s the nature of their business, which is why they shouldn’t be in that business.

I don’t think Saskatchewan would be very analogous to the US. I think that it’s a very different situation, with much more of a diversity of experience & coverage in healthcare in the US. It’s such a huge part of our economy, I wonder if the dislocation is worth it, and how easy could costs actually be cut in a sector that’s so ingrained in our economy.

And I noticed you didn’t address my point about state-based regulation being preferable as part of “Trump-proofing” a system. I’m worried about a nationwide single-payer system being under the thumb of people like Trump or McConnell. I think having a diversity of approaches via the states is uniquely American, and I’d prefer that to Medicare for everyone. When the federal government forces everyone into one system, I worry about how well that holds up over time as the politics of the nation ebbs and flows.

I think private insurance schemes have been very helpful at times to help control costs, experimenting with networking, contracting, care organizations, and the like. It’s also allowed different employers to attract good employees. It’s different than just paying bills. Companies have come up with a variety of approaches that can help. And having private providers and insurers gives an opportunity for more experimentation, especially within different state markets.

If I were designing something from scratch, I wouldn’t have the US system. But it’s what we have, and I think it’s not as bad as people make it out to be. 90% of people are covered with something, and about 85% of them are happy with what they have. In any other issue, that’s a strong consensus.