2020 Focal Point: Medicare for All

Medicare for All is going to be one of the battlegrounds in the 2019 Democratic primaries and in the 2020 presidential campaign. Most Republicans don’t want it. Some Democrats do.

There are two opinions about Medicare For All (MFA). Proponents of MFA believe that it is a moral necessity. MFA opponents claim that it will destroy America’s health care system. Who’s telling the truth?

Let’s knock off the Republican pretense right off the bat. The Republicans don’t care about protecting Medicare as it now exists. They want to kill off Medicare as it now exists because that would mean more business for private insurance conglomerates who are among the largest contributors to the Republican campaign coffers. The more honest Republicans will privately admit that it is all about protecting the shareholders who hold stock in private insurance providers. It’s all about the money.

Let’s also dispell the myth that the Democrats are all about providing free stuff in exchange for votes. Well, no, actually, that’s exactly what they are doing. Most Democrats really don’t care about insuring everyone fairly and equally. If they did, they would have done it in 2008–2010, when they held the presidency and both houses of Congress. For Democrats, Medicare for All is all about getting votes.

First of all, proponents of a single-payer system tell us that the United States is the only “first world” country that doesn’t have a single-payer health care system.

That statement is blatantly false.

In fact, a 2017 study published on the NASDAQ website lists 32 countries that have a single-payer system. A 2017 CIA Factbook study quoted by The World Population Review lists 31 “First World” countries that were qualified as such because their per capita Gross Domestic Product exceeded $15,000 per person.

For the statement that “all first world countries except the United States have a single-payer health system” to be correct, the same countries would have to be on both lists. They are not. Only 27 of those 31 First World countries have single-payer systems.

The outliers — the First World countries that did not have a single-payer system in 2017 — were the Czech Republic, Estonia, Turkey and, of course, the United States. It might be argued with some accuracy that the first three outliers are only barely First World countries, while others might argue that they don’t even qualify at all.

There are also five countries on the list of the Single-Payer nation who are not considered First World countries: Bahrain, Brunei, Hong Kong, Kuwait, and the United Arab Emirates. (Well, maybe Hong Kong qualifies, but not recently, judging from the unrest there.)

There are also several “First World” countries that are missing from the list, including China and Russia. China doesn’t make the list because it’s per capita GDP was $8,827 in 2017, while Russia’s per capita GDP was $10,743 that year. Any list that does not include China and Russia as First World countries is clearly biased.

Curiously, neither China nor Russia are listed as countries with single-payer systems even though Russia has what is in effect a single-payer system and China is expected to reach the goal of universal health care in 2020.

Wait a minute! What’s missing from these numbers? There are 197 countries on this planet, but ONLY 32 have single-payer health care systems. That’s only 17% of the countries in the world.

Who’s missing? All of Central and South America, which includes such powerhouse economies as Brazil and Mexico. All of Africa, including South Africa. Much of the Middle East, and approximately half of Asia.

Single-payer health care systems turn out to much less common that we have been led to believe…but that doesn’t make them a bad idea. Or does it?

In a recent interview with Yahoo ‘s “Finances on the Move,” eHealth CEO Scott Flanders asserted that adding another 180 million Americans to the 156 million Americans who are already on the Medicare rolls would collapse the system while costing at least $3 trillion annually.

This statement is also blatantly false.

In 2018, the Trump Administration budgeted $579 billion for Medicare. With 156 million Americans currently covered by Medicare, that works out to a per capita cost of $3,117 ( $579 billion divided by 156 million.) Adding another 180 million to the Medicare rolls would actually cost $561 billion (calculated by multiplying the per capita cost of $3,117 by 180 million.) That’s a hefty sum of money but it is still a real far cry from $3 trillion!

The problem with the single-payer health care system proposed by declared Democratic Party presidential candidate Bernie Sanders, and others, is that they are trying to achieve three very different objectives with the same bill by a) trying to provide coverage for all Americans, which is a good thing, while b) trying to redefine what Americans will get under the new plan, which is a bad thing and c) trying to make health care free of charge for the consumer, which is very, very stupid.

Whenever a politician attempts to achieve three different goals with the same bill, the bill usually fails. When it passes, it usually turns out to be a disaster, as we saw with the Affordable Care Act, which just about everyone now agrees was a pretty bad blunder.

The Crucial Blunder the Democrats are Making

All of the polls and all of the studies indicate that Americans are not happy with their health care. It costs too much and, on average, the quality is too low. (Everyone doesn’t live within driving distance of Mass General or Johns Hopkins.)

Americans want full coverage. They want no exceptions for pre-existing conditions. They want affordable drug prices…and they are willing to pay for it…but they don’t want to give up their company paid and union-sponsored health plans if they don’t want to.


The evidence for this is self-evident. According to the Kaiser Family Foundation, 49% of the American people, or 160 million people, are currently covered by group health insurance provided by either their employers, their unions, or some association to which they belong. Another seven percent of the population, or 22.75 million people, have private health insurance. Altogether, then, around 183 million Americans are currently paying for health insurance.

Some of these people have their health insurance costs subsidized by their employers, but that trend is decreasing: employees are being required to pick up a bigger percentage of their health care costs.

So, ask yourself this question: Would these people be amenable to paying less for a better health plan, one that was more affordable, completely portable from job to job and state to state, had no exclusions for pre-existing conditions, and no physical examinations requirements?

Most honest people would answer that question in the affirmative. More honest people would say, “Are you nuts? Of course, they would.”

The average cost per month for a company-sponsored health care plan(also called group insurance plans) according to figures attributed to the Kaiser Family Foundation is around $574 per month for an individual and $1,634 for a family. Figures attributed to eHealth.com in the same article indicate private health insurance costs an average of $473 per month for an individual and $1168 for a family.

Right away, the eHealth.com statistics should raise some eyebrows because company-sponsored group insurance programs are supposed to be subsidized at least to some extent by the employer, which raises the question of how eHealth.com can report that private (also called individual) health plans are so much cheaper than company-sponsored plans. If these numbers were correct why would anyone opt into the company-sponsored plans when private insurance is cheaper?

Putting that question aside for a moment, let’s focus on the actual affordability of a single-payer health plan system for the United States.

If the per capita cost for the delivery of services to current Medicare recipients is $3117 per year for an individual, the monthly cost for those services works out to around$ $260 per month, which is significantly cheaper than either company-sponsored group health plans or privately purchased individual plans. For a family of four, the monthly cost would be $1,040, which is still cheaper than either group or individual plans.

Therefore, the simplest — and most economical — solution for the problem of providing health care for all would be to allow any American to buy into Medicare at the same cost per unit of service for current over-65Medicare recipients.

The mistake that proponents of single-payer plans keep making is that they want their single-payer plans to be free for all. They ignore the fact that the Medicare plans that now exist aren’t free for all. Some Medicare recipients actually pay from $150 to $1500 a month for their Medicare plans, depending up which plan they choose, while others pay nothing at all based upon their choices.

A truly affordable Medicare for All plan would allow anyone to buy into the plan for a basic fee equal to the per capita cost of Medicare for current recipients. This would result in a zero fund balance differential. On a prorated average costs basis, Medicare would take in an amount equal to the increased cost of providing services for the 180 million additional enrollments.

You see that, right? You buy-in, you pay your fair share, you save money over company-sponsored health plans or privately purchased health plans, and you get the same basic level of service that all Medicare recipients get.

Opponents of the single-payer plan claim that adding 183 million people would sink Medicare.


Get this straight in your head. Medicare picks up when most people retire, at age 65, which is exactly when the body begins to break down. If Medicare didn’t exist, the private health insurance industry would go bankrupt in a matter of months.

  1. Universal health care results in the earlier detection of medical problems.
  2. Universal health care also increases lower-cost preventive treatment measures that reduce or delay the onset of more serious medical problems.
  3. Universal health care promotes earlier detection and identification of emerging health care emergencies such as epidemics and outbreaks of new diseases and conditions.
  4. It destroys private health insurance companies because no one will need them anymore. This is a good thing because it removes the profit motive from health care.
  5. Millions of shareholders will lose the value of their investments in health care insurance providers. Hundreds of thousands of health care insurance agents and their support systems will lose their jobs because they won’t be needed anymore if they ever were. This was the risk they took when they invested in those companies. We, the people, have no obligation to protect them from their mistakes.
  6. A single, national, standardized payment system has the power to establish standardized, regionally adjusted rates for medical services
  7. Health care costs would DECREASE because a significant percentage of our health care costs are consumed by stock dividends paid to shareholders.
  8. Health care costs would DECREASE even more because standardized record-keeping and billing systems would further reduce the non-operating overhead costs for the whole medical system.
  9. Medicare fraud would decrease because, with only one standard payer system on the playing fields, it would be a lot harder for cheaters to hide their cheats. Bad numbers would stick out like sore thumbs in a single-payer system.
  10. A single-payer system would eliminate the problem of patients with pre-existing conditions being denied coverage. Medicare cannot refuse to cover patients with pre-existing conditions. This ends employers’ ability to hold hostage those workers or their dependents had pre-existing conditions/
  11. Ending employee dependence on employer-sponsored health plans would encourage workers to change jobs more frequently, which would strengthen, not weaken, the labor movement, and give unions more clout in collective bargaining situations.
  12. Portable health care coverage would also encourage workers to develop their own businesses since being enslaved by employer-sponsored health plans is one of the major reasons that workers don’t take those risks.


Yes, lots of them. Medicare for All will result in longer wait times for non-emergency surgical procedures and increasing costs for everything. That’s what happens when demand increases: costs increase to meet the demand.

This is the conundrum no one is willing to face. The United States isn’t France, Germany or Great Britain. None of the “single-payer” countries are as large or as heavily populated as the United States. Our size and scope problems put us in the same class as Russia, China, and India, which are either not considered first world nations (which, I am sure, will be news to them) or not single-payer countries (which will also be news to Russia and China.)


If the Democrats win in 2020, they will never be able to deliver a single-payer plan because they still won’t have enough votes in the Senate. It will take six to eight years to get that legislation enacted.

If the Republicans win in 2020, there will never be a single-payer health plan.

Alan is a poet, journalist, short story writer, editor, website developer, and political activist. He is the executive editor of BindleSnitch.com.

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