The Medicare-for-all trade-offs socialists aren't talking about, according to experts
Michigan Democratic Senate candidate Abdul El-Sayed is one of several socialist candidates making Medicare-for-all a centerpiece of their midterm campaigns, defending the policy even as El-Sayed acknowledged Sunday that it would require Americans to pay more in taxes in exchange for coverage untethered from employment.
The stakes extend beyond who pays the insurance bill. A nationwide single-payer system would substantially change how healthcare is financed, what providers are paid and the role of private insurance, while potentially affecting employment and access to care under a framework radically different from the existing "Medicare" model its name invokes, according to experts.
Cato Institute health policy studies director Michael Cannon and Heritage Foundation health policy expert Ed Haislmaier, who has worked with lawmakers on Obamacare alternatives, argue those trade-offs are often obscured by the "Medicare-for-all" label.
"As the late P. J. O’Rourke liked to say, ‘if your healthcare is expensive now, wait until you see what it costs when it's free,'" Cannon said.
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In his NBC interview, El-Sayed defended Medicare-for-all by saying that the average person's second-largest W-2 deduction "is [paid] to your health insurance company."
"So imagine, instead of paying that to your health insurance company, whose CEO makes $20 million a year, instead, you paid a little bit more in taxes for healthcare that you wouldn’t lose if you lost your job or turned 26 or got married or got divorced."
One of the central questions is how much providers would be paid. Medicare currently pays hospitals and physicians substantially less than private insurers for many services, while a single-payer system would dramatically expand the number of patients whose care is financed at government-set rates.
Cannon warned that policymakers could face a choice between raising substantially more federal revenue and holding down payments at the risk of some providers reducing their participation.
Canada and England have long been cited by critics as cautionary tales against implementing socialized medicine because of concerns about long wait times, including waits of weeks for MRIs in Canada, limited access to prompt care and well-to-do Westerners seeking care in the U.S. to avoid waiting at home.
Still, Cannon argued the U.S. system is critically flawed and that market competition, including taking employers and the government out of the equation and putting spending choices in patients' hands, could provide the closest framework to universal healthcare.
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Haislmaier dubbed single-payer Medicare-for-all a "solution in search of a problem."
"[Medicare-for-all proponents] haven't got a solution for the real question, which is not the coverage, but the cost. Are we going to force competition so that people who provide better care at a lower price get more of the business? That's our vision," he said of conservatives.
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Instead of giving the government more authority, President Donald Trump "stumbled onto something that might work," in Haislmaier's words, by proposing a shift away from letting health insurers manage the pool of money for each American and instead depositing funds into a restricted personal account that could be used only to buy or retain insurance.
Meanwhile, several pieces of the current American system can be found within the various "socialized" models that El-Sayed, Sen. Bernie Sanders, I-Vt., and others want to replicate in the U.S. Socialized healthcare also does not describe a single international model.
The Department of Veterans Affairs draws parallels to the British NHS, while employer-sponsored insurance is a key feature of the German system, Cannon noted. And Obamacare's framework for ensuring eligibility for care is similar to systems in Canada and Scandinavia, he said.
But the U.S. may already have the developed world beat on socialized medicine, the experts said. Cannon argued that the Medicare system for seniors referenced in the left's platform is unique to the U.S.
"When Medicare-for-all supporters say that they want a European-style Medicare system, they're already telling you they don't know what they're talking about because no European nation has something like [our] Medicare Program," he said.
Cannon also resisted labeling Medicare-for-all supporters socialists, arguing the existing U.S. system already contains extensive government intervention through Medicare, Medicaid, employer-sponsored insurance tax policy and Obamacare.
In that way, he said, the far-left Medicare-for-all crowd and Republicans appear to be vying for the title of who cares least about healthcare.
"If you think this is a question between should we have a government controlling our healthcare sector or not, you've already missed the boat. The government already controls the U.S. Health sector."
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The Medicare model outlined in the socialists' platform is also not "free" healthcare because beneficiaries face premiums, deductibles and cost-sharing.
Some current Medicare-for-all proposals discourage or appear to prohibit private insurance coverage, which could affect physicians' ability or willingness to provide access to all patients, particularly if demand increases as out-of-pocket costs decline, according in part to an analysis by the Congressional Budget Office.
Maintaining such broad access to care while creating a one-size-fits-all model or keeping provider payments near current Medicare rates could cause hospitals to reduce participation, Cannon warned.
Financing is the other side of the equation. Moving most healthcare spending onto the federal government's books would require an enormous increase in federal revenue, even though some of that would replace premiums and other healthcare expenses currently paid by employers and households.
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Cannon said that would double or triple federal taxes.
If Medicare-for-all proponents want coverage to be as close to universal as possible, the model should remove, not add, government barriers, Cannon said. He noted that Americans one year away from Medicare eligibility and those in their first year of eligibility each spend twice as much on healthcare as people in other developed countries.
"Medicare is not the solution here," he said.
Fox News Digital reached out to El-Sayed for comment but did not immediately receive a response.