During recent Democratic presidential candidate debates, the issue of Medicare for All was a major focus of attention. While progressive candidates Sen. Bernie Sanders, D-Vermont, and Sen. Elizabeth Warren, D-Massachusetts, have championed Medicare for All mandating universal coverage, others running for the White House – including former Vice President Joe Biden, and a few marginal self-declared moderate candidates – have attacked Medicare for All as too costly, too complicated and politically unpopular.
Vice President Biden proposed a plan in July that builds on President Obama’s Affordable Care Act, which retains a central role for insurance companies while establishing a new public option. California Democratic Sen. Kamala Harris’ health care plan also retains a continuing role for private insurance, while pledging to reach universal coverage in 10 years.
Between The Lines’ Scott Harris spoke with Robert Pollin, distinguished professor of economics and co-director of the Political Economy Research Institute at the University of Massachusetts, Amherst. Here, Pollin talks about PERI’s comprehensive 18-month study on the feasibility of Medicare For All, which refutes criticism leveled at the program’s costs and viability coming from both Republicans and centrist Democratic presidential candidates.
ROBERT POLLIN: The question we wanted to ask is, “Can we think about Medicare for All in a way that would provide a good quality universal coverage for all residents of our society? And if we can do that, can we do it in a way that also reduces costs?” And the answer to both questions is yes. That’s basically it. And even though this study is very detailed, it really wasn’t that hard to reach this conclusion because, as I noted before, other countries are already doing it. Now I’m not saying we just copy Canada or just copy UK or France or Germany, but we see that there are features of these various other medical systems and these other countries that are easy to think about how we could replicate them in the U.S. and deliver better quality care at low cost. And it’s guaranteed care. It’s universal. People don’t have to deprive themselves of necessary treatments as they are now – as roughly 85 million people with insurance now regularly, annually deprive themselves of required treatments because they can’t afford it, to say nothing of the people that are uninsured. So that’s basically it. Can we design a system that can deliver guaranteed good quality care for everyone? And can we do it and still lower costs? The answer is yes.
BETWEEN THE LINES: One of the major questions that comes up by most everybody who is interested in Medicare for All is how much will it cost the individual taxpayer, because people realize if they’re going to trade in their private costly, loophole-riven private health insurance, and they get a government single-payer system, what will be the cost to them in terms of, you know, higher annual taxes?
ROBERT POLLIN: We estimate that you can deliver good quality universal coverage and still operate the system at about 9 percent less than what we’re spending now on health care. So that’s the average, 9 percent less. Now, there’s a simple way to think about that is to say, Okay, everybody in society now is going to pay 9 percent less into health care than they’re paying now. Yes, they will have taxes go up, but the extent to which taxes go up will be much smaller than the savings they gain by not having to pay premiums, deductibles, co-pays, and out of pocket. Let’s take a household that is middle income, let’s say $70,000 a year income, and they buy health insurance on the exchange, an individual exchange as opposed to getting it through their employer. So in that case, we estimate that moving to a single-payer, Medicare for All system would save this family something like $9,000 a year.
So that’s like 12 percent of their income. That’s getting 12 percent more income a year, lowering their cost by $9,000 if you have a $70,000 income. The amount of savings would be achieved would vary by the type of income you already have. But to those that are on private insurance, you’re going to see quite substantial savings. Now they say this over and over and over again in these presidential debates – the journalists want the candidates to say the taxes will have to be raised. And that’s true, so Biden keeps saying that over and over again, but Biden says the system is going to cost $3 trillion and taxes have to go up. Well, taxes go up, but the amount you spend goes down. That’s the point. Like I’m saying, it goes down by $9,000, it’s really disingenuous for a candidate like (former Vice President) Biden to keep saying that taxes are going to go up without also recognizing that people have more money in their pockets. That’s what they really care about. Do you really care about whether you’re paying out to a private health insurance company or to a public one? The real issue is: “How much money am I going to have to spend? Am I going to get good quality care? Do I get to choose my provider?” And those are the things on which Medicare for All gives really positive answers.
BETWEEN THE LINES: Professor Pollin, many of the presidential candidates in the Democratic primary who don’t support Medicare for All, their fallback position is a public option, the kind of public option that was debated when the ACA / Obamacare was being passed through Congress. Give our listeners a short response to the idea that somehow the public option should be the next step in reforming the U.S. healthcare system.
ROBERT POLLIN: The problem with the public option is you don’t get any of the savings of operating a drastically simplified single-payer system. And we’re talking big money here. Our estimate, which I think was a conservative estimate in our study, was moving to Medicare for All would save $300 billion in our system. That’s putting $1,000 in the pocket of every man, woman and child in the country. So that’s the starting point with the problem with public option.
For more information, visit at the Political Economy Research Institute at peri.umass.edu.