b' Wordw w w. w m i m u t u a l . c o m MEDICARE for All .The Answer or A Pipe Dream?By David Leo, Ahealth care and health insuranceThere are as many variations on the Medicare for All As politicians and the media ramp up to President of Campaign 2020, concept as there are candidates running for office. Per-WMI Mutual are taking center stage. On the conservative right,haps the most popular version is the one championed Insurance Company by Senator Bernie Sanders (I-VT). Senator Sanders & WMI TPAwe continue to hear the oft-repeated mantra Repealuniversal health care plan to cover all residents calls Obamacare. On the liberal left, the new buzzphrasefor a sweeping overhaul of the countrys current Medicare for All is becoming integral to theirhealth care system. Like Senator Sanders program, platform. All this pre-election noise makes me wonderthe other major proposals have certain basic similari-whether Medicare for All is the answer to Americasties and common elements. In general, those include: health care crisis or if its merely a pipe dream. (1) universal coverage for all U.S. residents with auto-While expanding government-sponsored healthenrollment at birth and lifetime enrollment;insurance to all citizens is a worthy and altruistic goal(2) the elimination and replacement of employer-on its face, dismantling a decades-old market-basedbased health insurance;health care system and replacing it with a govern- (3) an expansion of benefits and coverage (e.g., no ment-run program would be a massive undertaking.cost sharing, no balance billing, and the provision of The costs of a government-run health care system anddental, hearing and vision coverage);the resources required to implement it would be as- (4) no premium (due to a reallocation of federal health tronomical. Many proposals oversimplify the costs tospending and tax increases);transition from a market-based health care system to(5) government-established provider reimbursement a government-run system, and they underestimate therates and negotiated prescription drug costs; andrequired reallocation of resources to operate the new(6) various tax increases on corporations andprogram. Those proposals also tend to underreportwealthy individuals.the negatives and overstate the positives of replacingIn the United States, we spend $3.2 trillion each year our current health care system with one run by theon health care. More than $2 trillion of the countrys government. Nonetheless, because the ultimate goalhealth care expenditures is spent on publicly-financed of these programs is so noble, the question of whetherhealth care programs like Medicare and Medicaid, Medicare for All is right for our country is worth criti- the government program that provides coverage for cal examination and serious consideration. the impoverished. This enormous health care spend Medicare is a well-known and generally trusted brandcomprises 18% of the countrys gross domestic prod-that provides government health insurance coverageuct (GDP), a figure that is expected to grow to 20% to the elderly and disabled. When people use the termin the next decade if nothing is done. Many people Medicare for All, however, they arent really refer- believe this is unsustainable and are willing to take ring to traditional Medicare as we know it. Instead,bold and aggressive action to reign in these costs and what they really mean (even though they dont neces- to provide health care coverage to all Americans.sarily realize it) is a single-payer government-runThere are many diverse options and proposals, but the health care system for all Americans. main arguments for and against can generally be sum-While the average voter may have a basic understand- marized as follows:ing of Medicare and how it works, very few are ableArguments in Favor of Medicare for Allto explain how Medicare for All would work. In fair-ness, the specific framework of any given Medicare ALL U.S. RESIDENTS WILL BE PROVIDEDfor All insurance program is dependent on a multitudeUNIVERSAL ACCESS to meaningful health care of components and the devil is in the details. Its fairas a basic right. This expanded coverage would to say, however, that all Medicare for All programsensure health care coverage for the 9% of the U.S. are based on the single-payer health care model,population that is currently uninsured and the 26% despite the fact that they may seek to implement it inthat is considered underinsured.different ways and to varying degrees.20 www.wpma.com / Summer 2019'