The Center for American Progress (CAP) — a progressive organization, as their name implies — has produced a new single-payer health plan called Medicare Extra for All. Like other government-centric healthcare proposals, this plan rests on the fatal conceit that the government can manage the health care needs and choices of all of its citizens.
Single-payer, in any form, ought to be rejected as a bad idea, but today’s health policy debate has become so dishonest that many Americans are tempted by it.
This latest plan would create a beefed-up version of Medicare (“Medicare Extra”) and allow all Americans to enroll, paying premiums on a sliding scale from $0 up to 10 percent of income. Premiums would not cover the costs of the plan; the authors want it to be financed by reduced health care costs and increased tax revenue.
The cost reduction piece would primarily come from government price controls on the healthcare treatments and services that we all consume. While of course today’s bloated, opaque payment pipeline leads to waste and is in need of serious reform, Americans ought to think carefully before allowing Uncle Sam to dictate how much doctors and hospitals are reimbursed for their services. If the government doesn’t pay providers enough, the result will be shortages. Who cares if something is free or affordable if it’s not available?
In spite of the very serious flaws of all single-payer proposals, the popularity of the idea appears to be increasing. One reason for this is a change in terminology: Single-payer supporters use other terms, like “Medicare for all” or “universal coverage” to push the idea, moving away from the term “socialized medicine,” which appropriately calls to mind images of rationing, control, and reduced quality of care.
But despite the words they use, the ideas are the same.
Tellingly, the new CAP government healthcare plan would essentially eliminate the popular Medicare Advantage program, replacing it with “Medicare Choice,” which is Orwellian doublespeak. Medicare Choice would be optional, yes, but unlike Medicare Advantage, there would be no choice in plan. It would simply be a government-administered add-on to the “Medicare Extra” plan.
The plan also promises to allow employers to opt into Medicare Extra or continue to sponsor different coverage. The implication is that Medicare Extra would compete alongside private plans as a “public option” — at least for some time.
Again, the language — and idea — of greater choice and competition is bastardized here: With subsidies and other favorable treatment, a public option would unfairly out-compete private options. When private options fold in the face of this, the public option becomes the only option (i.e. the “single” option, or, with the auto-enrollment feature suggested in the CAP plan, not optional at all).
A public option for health insurance was included in one of the drafts of the 2010 Affordable Care Act, but not the version that finally passed (as lawmakers could not even find enough support for it among the Democrat majorities in both houses). But a lot has changed since 2010: The Affordable Care Act (or ObamaCare) shifted what is known in public policy as the “Overton window” or the policy alternatives that are acceptable to the public.
For one thing, the ACA legitimated the premise that the federal government should be responsible for the health care — or at least the health “coverage” — of all 300+ million Americans.
For another, the ACA did a poor job executing on this premise, and in the process sent a confusing message: it instituted government control over practically all facets of health care, but maintained private insurance companies, leaving in place a mirage of market-based capitalism (to be used as a scapegoat for the law’s many failures).
But the real reason the ACA has failed is the same reason that any single-payer program would ultimately fail: The government simply doesn’t have the capacity to know and make decisions about what’s best for millions of individual people. Health care is one of the most personal services we consume, and the choice ought to lie with us, as patients, about whom to see, when, and how to value different services. That's something that a single-payer system can never deliver — no matter how cleverly named.