Americans deserve a more productive debate than the one that erupted recently after a George Mason University researcher estimated that a national “single-payer” health system — a reform pushed by Vermont Sen. Bernie Sanders — would require at least an additional $32.6 trillion in federal spending over 10 years.
The response to the paper, released by the university’s Mercatus Center, was entirely predictable. Political conservatives, including U.S. Rep. Jason Lewis, R-Minn., saw an opportunity to blast increasingly popular “single-payer,” sometimes known as “Medicare for All,” proposals to move everyone into a government-run insurance program. “This socialist, Democrat-supported idea is a fiscal burden on the American people and a threat to our current, patient-centric system,” Lewis said on Twitter.
Sanders responded by attacking the Mercatus Center’s financial ties to the controversial billionaire Koch family. Single-payer advocates also criticized the report’s methodology but put a spotlight on one surprising conclusion. Through efficiencies and the negotiation of better prices, such a shift could reduce total U.S. health expenditures by $2 trillion over the first decade of implementation vs. leaving the current system in place. The existing system’s annual expenditures, which include public and private costs, stood at $3.5 trillion in 2017, and federal officials project that figure to hit $5.5 trillion by 2026.
Health care consumers and voters are not well served by the “all or nothing” reactions to the Mercatus report from both single-payer advocates and critics. The eye-popping cost of a Sanders plan has critics dismissing any type of single-payer approach. Sanders’ fans often have this reaction: You’re either for this sweeping overhaul or for the status quo.
The reality is that there are other solid, less drastic proposals rooted in a Medicare-for-all approach that merit serious discussion, especially when all options must be considered to control medical costs without compromising quality. Leading proposals are well-developed and already have been introduced in Congress.
A theme is that they would allow consumers to buy into existing programs such as Medicare or Medicaid, the nation’s two large medical insurance programs serving the elderly and the needy. The “Medicare-X” plan from Sens. Tim Kaine, D-Va., and Michael Bennet, D-Col., would phase in the opportunity for consumers to voluntarily buy into Medicare, which serves those 65 and up.
Sen. Brian Schatz, a Hawaii Democrat, has proposed allowing consumers at any income level to buy into Medicaid, the low-income medical program jointly run by the states and federal government. Under the Schatz “State Public Option Act,” each state would make the decision on whether to allow the buy-in.
These middle-way approaches would build on the existing health care system, including employer-based coverage, rather than disrupting it, and would be potentially much less expensive. Those are major advantages.
Enrollees would also be familiar with these proven, decades-old public programs. At the same time, leveraging the government’s vast purchasing power could help lower premiums, improve benefits and widen provider networks. That is enticing when consumers who buy insurance on their own on the individual market often face high premiums, high deductibles and restricted provider access.
Both the Medicare X plan and the Medicaid buy-in need significant scrutiny and fine-tuning, particularly when it comes to provider reimbursement. Still, both hold promise as a practical option to improve coverage while controlling costs. These alternatives to the Sanders plan merit the spotlight, not a write-off, as the debate over the Mercatus Center report continues to simmer.