While some citizens and lawmakers believe a Medicare-for-all plan is the best way to implement a single-payer system in the U.S., The Nation columnist Joshua Holland argues this belief is based on a fundamental misunderstanding of Medicare and the American healthcare system.
Mr. Holland points out that roughly one-third of all Medicare participants purchase additional Medicare Advantage and medigap policies, and that providing all citizens with Medicare coverage would not eliminate the need for private insurers. He argues that this system does not offer the simplicity of single-payer coverage that many idealize. He also argues that no proposed Medicare-for-all bills address the logistics of how difficult it would be to transition to this system, even if it did receive public support.
An important structural point, according to Mr. Holland, is that those countries who do have single-payer systems implemented them long before healthcare expenses were high and then used cost-control methods to keep them down. In the U.S., provider costs are already so high it would be nearly impossible for government regulation to lower them, which would make an American single-payer system far more expensive than in any other country.
Mr. Holland argues that more practical solutions include a possible Medicare buy-in that would give those without affordable insurance options the choice to buy Medicare plans, or a system where every citizen is enrolled in Medicare from birth but can purchase their own plans if they desire.
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