Should We Want Medicare for All?

If you've been watching the news lately (and I wouldn't blame you if you weren't), healthcare has, to put it mildly, been a subject of note in the Senate. We just saw the demise of the Republicans' latest attempt to repeal Obamacare through Graham-Cassidy, so some are wondering about the future of Bernie Sanders' bill, Medicare for All. A number of prominent senators, mostly Democrats with their eyes on a 2020 presidential run, have co-sponsored the bill, and a lot of citizens are getting excited at the prospect of universal healthcare.

Let's take a breath for a moment. Firstly, the bill doesn't have the slightest chance of passage. I'm open to being wrong on this, but I sincerely doubt that the Republican leadership of congress are looking to hand Democrats any kind of win, and even if it miraculously passed both the Senate and House intact, Trump would likely not sign it (although he's pretty unpredictable). This is what makes it so attractive for those prominent Democrats to sign it - they get to say they're for it without having to make monetary or political commitments. It's a symbolic gesture on all sides.

However, it gives us the opportunity, as employees, business owners and citizens, to ask the question: is this something we want? Should we be rooting for this? Should we start lighting up the phones and begging our elected officials to back it? Let's explore it a bit further.

Business: There isn't much upside for a business owner to get into the medical benefit game, and this is true the smaller the business gets. For an entrepreneur wearing multiple hats, this usually means making a best-guess decision for their employees or working with a broker that deals with so many clients that you can't be sure they've done much more for you year-on-year other than forward you your plan increases. Your employees are saying they want benefits, but they are expensive, and what's your ROI? It's hard to say.

This might not have been a problem previously, except that the Affordable Care Act has suddenly made healthcare an issue for smaller and smaller businesses. A business with as few as 50 employees needs to think about benefits, and considering their margins versus the costs of those benefits, it is a difficult calculation to make. In addition, smaller and smaller benefits find themselves having these conversations with their employees, because citizens don't necessarily know the business-size cutoff - they just think that job=benefits, so they turn up the pressure on their bosses to offer them. The helpfulness of the healthcare marketplaces was that it solved the challenge of employees seeking benefits, but not of the need for companies to either offer them or pay the price. Medicare for All could change that.

Verdict: Win

Employees: If you have a full-time job, it is likely you have insurance through either your employer or your spouse's. It's a pretty good system as long as you don't lose that job, or become unable to work for a long period of time. Then your choices become a bit limited. You have COBRA available to you, which will allow you to access those benefits after you've left your employer, but it's at significant expense, and it's not forever. For some, it's outright prohibitively expensive. You can look for another job that offers benefits, and there are plenty, but the trend among large employers to offer freelance or long-term temporary roles with no benefits attached has shifted the burden of benefit costs more and more to the employee.

In this situation, Medicare for All is a nice option. You can buy into a program that isn't contingent on anything other than being an American. You get access to healthcare without worrying about gaps in coverage. It should be said, though, that the model of how doctors are reimbursed would change, which could change how doctors choose to treat patients. For example, doctors get reimbursed based on the treatments they give, and insurers at this point often get a say as to what they will cover based on whether they feel it is necessary (which is odd). This is where the rubber really meets the road - the private ensurer market, and many other industries, will undergo major shifts if this passes, and many jobs will be lost. If you work for one of these companies, you may not be very excited at this prospect. On the other hand, not having to have medical benefits be a factor in the kind of job you take is a good kind of freedom.

Verdict: Split Decision

Citizens: This is a tough call to make, and I'm sure I won't solve this problem in one ambitious blog post. There are some cold facts here: we spend a lot more than most other developed nations with universal healthcare, and we get a lot less for our buck, including less healthy people. Surely that's a sign that we have something to learn from our peers. This bill would essentially introduce us to universal healthcare - it's called Medicare for All, but it's a much enhanced program that would not only cover medical, but also dental and a host of other benefits. That's not to say that universal health care would end the debate; the UK still has robust discussions about the purpose, stability and future of its own NHS. But it goes without saying that we won't get very far with the system the way it is - under threat, unstable and unsettled.

Verdict: Undecided - but only because we have yet to have a substantive, bicameral, bipartisan debate on this matter. Let's let all the facts come to light and let many voices be heard on this subject so we can decide without the breathless, political nonsense whether this is feasible and sensible.

As always, I'm keen to hear your thoughts, from any of these perspectives. What would you like to see come of this debate?