Opinion: When Democrats want universal coverage, they have to give up the fantasy of ‘Medicare for all’

The once-quixotic initiative of Sen. Bernie Sanders to eliminate private health insurance in the U.S.— mostly funded by the employer — in the name of “Medicare for all” has now become the leading liberal litmus test for anyone seeking the presidential nomination of the Democratic Party. In different versions, twelve of the remaining candidates adhere to it.

This disregards what other countries are doing to achieve near-universal healthcare access; underestimates the financial consequences of such dramatic reform for Americans, and fails to recognize how much easier it would be to achieve the same — and better — healthcare outcomes by expanding on the Affordable Care Act rather than repealing it.

Although Sanders is right that most advanced countries provide access to health care to almost all of their residents, they do not automatically do this through a comprehensive single-payer system like Medicare. Britain has the United States counterpart. Service system “for all” for veterans’ affairs, with the national government directly supporting hospitals and healthcare providers.

Medicare’s financial support for all is based on the assumption that substantial reductions will be made through the reduction of the private insurance industry’s income and administrative costs and that its total cost will be less (or at least not more) than actual combined public and private expenditure. Some proponents argue that any additional taxes needed will be offset by reductions in out-of-pocket expenses and health insurance premiums.

Each assumption is unfounded.

The ACA also shielded millions of pre-existing health conditions from lack of coverage, allowed young adults to be covered by their parents ‘ policies, and made the benefits available to most Americans more robust and reliable. And — in a provision also endorsed by the Trump administration — it has allowed states to explore ways to use their Medicaid grant allocations to provide more efficient healthcare.