Perspective: Is “Medicare for All” the Right Answer?

There’s a lot of talk about “Medicare for All” these days—a catch-all label that has become a part of the political dialogue. Bills are being introduced in Congress, and 2020 presidential candidates are talking about it on the campaign trail.

But these proposals could do more harm than good to patient care.

First, a one-size-fits-all approach could disrupt the coverage of more than 180 million Americans who are covered through employer-provided plans. Our first priority should be fixing what’s broken instead of ripping apart our entire health care system and starting from scratch. 

Access could be impacted because physicians and other providers may limit the number of Medicare or Medicaid patients they see because of chronic government underpayment. Hospitals are already paid far less than the cost of caring for Medicare patients, and more patients with Medicare would strain hospitals even more, and could threaten hospitals’ survival. 

The truth: government can be an unreliable business partner. The uncertainty of Medicare rates and other policies prevents adequate planning, and government shutdowns create unpredictability when funding for HHS and CMS is put in jeopardy. Medicare and Medicaid are already subject to politicization and micromanagement by Congress—including making policy changes that are driven by external factors with no relationship to these programs or sound health policy. Example: reducing provider payments to offset funding for other priorities.

America’s hospitals and health systems strongly support improving patient access to health coverage for all Americans. That’s why we’ve joined with the American Medical Association and others as part of the Partnership for America’s Health Care Future to build on the strength of the existing reforms to expand coverage, improve quality and encourage delivery system innovation that were the foundation of the Affordable Care Act. We must also ensure the long-term sustainability of Medicare, Medicaid and other programs that so many Americans depend on for coverage. 

More work certainly needs to be done in this regard. We need to expand Medicaid in the non-expansion states, including providing 100 percent of the federal matching rate for the first three years. We need to strengthen the marketplaces to improve their stability and the affordability of coverage so more people will get covered. We need to increase enrollment efforts to reach people who need coverage and keep them enrolled. And we need to maintain the employer mandate to retain this critical access point to coverage.    

As a politically practical matter, we need to focus on finding consensus to improve the system we have rather than subject the nation to yet another polarizing debate on health care. 

America’s hospitals and health systems are committed to advancing health in America, and we’ll keep working to make it easier for people to access high-quality care in their communities.