Testimony on Medicare for All

by Grace-Marie Turner

The House Rules Committee held what many are calling an “historic hearing” on the Medicare for All bill introduced by Rep. Pramila Jayapal, H.R.1384.  I was invited to testify and these are some of the key points I will make…

Link to my full testimony

Millions of Americans are frustrated with the current system.  Care costs too much, and many are simply priced out of the market. Others with insurance say premiums and deductibles are so high they might as well be uninsured.
Those on public programs like Medicaid struggle to find physicians, especially specialists, who can afford to take the program’s low payment rates. 
People are hurting, and they feel powerless as cogs in the $3.6 trillion health sector with little power to impact choices or costs. 
But it is hard to see how consumers would be more empowered when dealing with a single government payer. In a country that values diversity, will one massive program with one list of benefits and set of rules work for everyone? 
I was in the gallery the night the House passed the Affordable Care Act in March of 2010 and heard member after member talk about the importance of passing the bill in order to “finally achieve universal coverage” and lower costs.  Nine years later, with millions still uninsured and costs doubling in the individual market, our nation still is struggling to achieve those goals. 
In calling this hearing today, the committee acknowledges the growing interest in bold reform.  But when people learn that Medicare for All would mean higher taxes and losing the coverage they have now, support plummets. That happened recently when Colorado and Vermont tried and failed to create their own single-payer systems.  

Too much government 
I believe the growing presence of government is a significant contributor the dysfunction in our health sector.  

  • Government officials, not consumers, increasingly determine what services can or must be covered, how much will be paid, and who is eligible to both deliver and receive these services.  

  • Third-party payment systems lead to significant disruptions. Insurers and others must respond to government rules and regulations shoving consumers to the bottom of the health care totem pole. 

Rather than dramatically expanding the role of government, I believe we need to look more carefully at these problems and target appropriate solutions that empower consumers and build on what works.  

The Medicare model
Medicare for All’s promise of unrestricted access to benefits is virtually unprecedented, and it is difficult to anticipate the impact of this new system.  Rep. Jayapal’s bill implies a recognition of the cost risk by imposing global budgets to cut spending.

But paying doctors and hospitals at Medicare rates would force many to close or significantly cut back on services and would worsen the existing physician shortage.  

The high price of free care 
We do know from the experience of other countries that global budgets and centrally-determined benefit structures lead to rationing, waiting lines, and lower quality of care, as I describe in my testimony. Tragically, it is often the most vulnerable who are left behind when demand for services outpaces resources.

Employer-sponsored health insurance: 

A central pillar in our health sector 
Many Americans would see it as severely disruptive to lose their current coverage when public programs as well as job-based insurance would be shut down under Medicare for All.  

173 million Americans get their health coverage through the workplace—a highly-valued benefit. 

My colleague Doug Badger explains this employer-based system is a central pillar in our health sector.  

  • It produces a nearly 3-1 ratio in value to tax expenditures.

  • And employer plans pay doctors and hospitals more than Medicare and Medicaid do, providing the margins most need to maintain quality and even keep their doors open.  

  • Employers also have more flexibility to tailor insurance to the needs of their workforce, to advocate for them, and provide education and incentives about good health.

Other options to solve the problems in our health sector 
I describe in my testimony targeted solutions already underway to give individuals and workers more, not fewer, choices, and to provide states with more resources and flexibility to help their health insurance markets recover. I also describe work by the Health Policy Consensus Group in developing a plan to reduce the cost of health insurance, while protecting the poor and the sick, including those with pre-existing conditions.

An analysis by the Center for Health and Economy has shown the Health Care Choices Plan would reduce premiums by one third while keeping coverage numbers level. 

Americans want more, not fewer choices in health coverage, yet Medicare for All would put them all on a single government program.  When government officials are making decisions about what services will be covered, how much providers will be paid, and how much citizens must pay in mandatory federal taxes, consumers will have even fewer choices and less control than they do today.  It will reduce access to new technologies, stifle innovation, and result in a near-doubling of the tax burden.

I would hope we could work together to achieve the goals of better access to more affordable coverage and better protection for the vulnerable.