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‘Medicare for All’: The Impossible Dream

There’s no plausible route from here to there.

The Brits and Canadians I know certainly love their single-payer health care systems. If one of their politicians suggested they should switch to the American health care model, they’d throw him out the window.

So single-payer health care, or in our case “Medicare for all,” is worth taking seriously. I’ve just never understood how we get from here to there, how we transition from our current system to the one Bernie Sanders has proposed and Elizabeth Warren, Kamala Harris and others have endorsed.

Despite differences between individual proposals, the broad outlines of Medicare for all are easy to grasp. We’d take the money we’re spending on private health insurance and private health care, and we’d shift it over to the federal government through higher taxes in some form.

Then, since health care would be a public monopoly, the government could set prices and force health care providers to accept current Medicare payment rates. Medicare reimburses hospitals at 87 percent of costs while private insurance reimburses at 145 percent of costs. Charles Blahous, a former Social Security and Medicare public trustee, estimates that under the Sanders plan, the government could pay about 40 percent less than what private insurers now pay for treatments.

If this version of Medicare for all worked as planned, everybody would be insured, health care usage would rise sharply because it would be free, without even a co-payment, and America would spend less over all on health care.