Medicare for All

Sen. Ted Kennedy and Rep. John Dingell filed their Medicare for All bill this week (again) — more than two years after Kennedy started talking about it.  The general idea is to phase in coverage for all over five years, save $300 billion plus annually by reducing administrative costs, and finance the other $300B in annual costs mostly through increased payroll taxes on employers and employees.  Employees can stick with their existing plans, or can opt in to federal employee health benefit plans.  (Get the same health care coverage as the President!)

Considering that Kennedy swore off single payor a while back, this is an interesting approach — not technically single payor, but mighty close.

The big questions for me are:

(1) Does this plan really result in universal coverage once it’s fully phased in? (The answer might be clear if I were to read the bill once it’s posted, and not just the on-line summary.)

(2) Would a plan like this preempt state experiments like the one underway here in Massachusetts?  Is it definitely better than the plans it might preempt?  (See my thoughts on two other national plans vs. Massachusetts plan in a recent CommonHealth post.)

(3) Are the anticipated savings really there?  (For example, the $300B figure includes $150B savings attributable to universal EHR adoption; is that realistic?)  While the notion that Medicare is more efficient than private sector insurance companies strikes some of us as counter-intuitive, the federales seem to keep a lid on administrative costs.  For a discussion of administrative costs and whether we’re comparing apples to apples, see Jason Shafrin’s post and the comments following at Healthcare Economist.

(4) The biggest question, of course, is this: Coverage is good, but how about cost control?  (Even without this proposed influx of covered lives, the chunk of GDP consumed by Medicare continues to increase.)  The summary offers preventive care (as well as administrative savings and EHR-related savings) as a means to help control costs.  To my mind, these are necessary, but not sufficient.

— David Harlow