Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The conservative appeal of Medicare for all

Peter Ubel, MD
Policy
November 6, 2018
Share
Tweet
Share

Everyone thinks of “Medicare for all” as a liberal idea, an extremely liberal one embraced by the socialist wing of the Democratic Party. It’s an idea Democrats were hesitant to embrace in the Obama era, for being too far out of mainstream political thought. It was thought of as an idea that was too easy to demonize as socialism.

What everyone seems to be forgetting is that “Medicare for all” could end up being a politically moderate way to bring more market competition to the U.S. health care system. Think I’m kidding? Give me a chance to explain myself.

Deciding whether Medicare is “socialism”

When we call a health care system socialized, we need to clarify what part of the system we are talking about. For example, Canada has a socialized payment system, which they (unoriginally) call Medicare. But Canada doesn’t have a socialized provider system. Instead, Canadian hospitals and clinicians work in private enterprises, billing Medicare for their services.

By contrast, the United Kingdom has a fully socialized system, with payment coming from the government, providers working with government employees, and hospitals and clinics owned and operated by the government.

In keeping with this view of socialism, “Medicare for all” is not the same as a fully socialized health care system. Under Medicare, providers are still free to operate as private enterprises, and can decide whether to operate as nonprofit organizations – like the Mayo Clinic – or as for-profit ones – like the Hospital Corporation of America.

Even more important, we can’t even call “Medicare for all” a socialized payment system. I’ll explain more about that in a short while.

Deciding whether Medicare is “single payer”

When Americans promote “Medicare for all,” many point to the benefits they perceive will follow from having a single-payer system. But we have to be careful not to equate Medicare with single-payer. Currently, Medicare is available to Americans 65 or older, as well as to those with kidney failure or chronic disability. But Medicare is not a single-payer. That’s because Americans are increasingly receiving Medicare coverage through private insurance companies, in a program known as Medicare Advantage. In 2005, 13% of Medicare enrollees chose private insurance plans; that number rose to 33% by 2017. By 2027, experts predict that more than 40% of Medicare coverage will be through private insurers.

Under Medicare Advantage, private insurers have an opportunity to compete for business. A plan might offer expanded coverage: adult daycare, for example, or subsidization of the cost of installing bars in a person’s bathroom to reduce the risk of falling.

In theory, private insurers can test ways of providing health care more efficiently to their enrollees, thus making health care more affordable and/or more generous than it would be under a government-only Medicare program. Private insurers have been exploring a wide range of ways to simultaneously lower health care spending while improving health care quality, leveraging their enormous reams of data and their close-working relationships with providers. Now admittedly, the efficiency of Medicare Advantage is controversial. Insurers seem to be better at lowering health care spending in theory than in reality. But moving to a single-payer would reduce variation in how third-party payers function, leading to less room for innovation in this part of the health care market.

The bipartisan appeal of “Medicare for all”

Most Democrats abhor the idea of letting low-income Americans go without medical care for lack of coverage. That’s why “Medicare for all” is becoming a Democratic rallying cry. However, most Republicans hate the idea of a single-payer system. Fortunately, as we have seen, “Medicare for all” is not a single-payer plan.

ADVERTISEMENT

That’s why in thinking through whether “Medicare for all” is a good idea, we have to remember the following facts:

  1.  “Medicare for all” would expand the marketplace for health care insurance and delivery.
  2. “Medicare for all” would allow people to choose among health care insurers, both public and private, and both for-profit and nonprofit.
  3. “Medicare for all” would allow people to seek care at private hospitals and medical clinics – public or private, for-profit or not-for-profit.
  4. “Medicare for all” would give both parties something they dislike. Republicans would see more tax dollars going to health care, while Democrats would see a health care market still dominated by large insurance companies.
  5. “Medicare for all” would give both parties something they like. Republicans would see a more robust private insurance market, while Democrats would finally have the universal health care coverage they crave.

Let’s not too readily dismiss “Medicare for all” as a socialist idea. It can be much more than that.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel. He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together. This article originally appeared in Forbes.

Image credit: Shutterstock.com

Prev

A physician's experience with time stress

November 5, 2018 Kevin 0
…
Next

There are moments as an anesthesiologist you can’t erase

November 6, 2018 Kevin 0
…

Tagged as: Medicare, Public Health & Policy, Washington Watch

Post navigation

< Previous Post
A physician's experience with time stress
Next Post >
There are moments as an anesthesiologist you can’t erase

ADVERTISEMENT

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

Related Posts

  • Medicare for all and the problem of health care on demand

    Michael Brant-Zawadzki, MD
  • Why this physician supports Medicare for all

    Thad Salmon, MD
  • Instead of Medicare for all, how about Medicare for more?

    Brian C. Joondeph, MD
  • A physician suggests how to improve Medicare

    Niran S. Al-Agba, MD
  • Don’t underestimate the appeal of a Trump “health plan”

    Bob Doherty
  • Expensive Medicare patients aren’t who you think

    Peter Ubel, MD

More in Policy

  • Who gets to be well in America: Immigrant health is on the line

    Joshua Vasquez, MD
  • Online eye exams spark legal battle over health care access

    Joshua Windham, JD and Daryl James
  • The One Big Beautiful Bill and the fragile heart of rural health care

    Holland Haynie, MD
  • Why health care leaders fail at execution—and how to fix it

    Dave Cummings, RN
  • Healing the doctor-patient relationship by attacking administrative inefficiencies

    Allen Fredrickson
  • The hidden health risks in the One Big Beautiful Bill Act

    Trevor Lyford, MPH
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why clinical research is a powerful path for unmatched IMGs

      Dr. Khutaija Noor | Education
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
    • How to advance workforce development through research mentorship and evidence-based management

      Olumuyiwa Bamgbade, MD | Physician
    • The truth about perfection and identity in health care

      Ryan Nadelson, MD | Physician
    • Civil discourse as a leadership competency: the case for curiosity in medicine

      All Levels Leadership | Physician
    • Healing beyond the surface: Why proper chronic wound care matters

      Alvin May, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 16 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Why clinical research is a powerful path for unmatched IMGs

      Dr. Khutaija Noor | Education
    • Addressing menstrual health inequities in adolescents

      Callia Georgoulis | Conditions
    • How to advance workforce development through research mentorship and evidence-based management

      Olumuyiwa Bamgbade, MD | Physician
    • The truth about perfection and identity in health care

      Ryan Nadelson, MD | Physician
    • Civil discourse as a leadership competency: the case for curiosity in medicine

      All Levels Leadership | Physician
    • Healing beyond the surface: Why proper chronic wound care matters

      Alvin May, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The conservative appeal of Medicare for all
16 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...