We’re Done Talking About Medicare for All Now, Right?

As we approach the final stretch of the 2024 election, Medicare for All is once again part of the health care conversation. But here’s the reality: even some of its previous champions, like Vice President Kamala Harris, have moved on. Harris was a strong supporter of Medicare for All during her 2020 campaign, but as of recently, it’s no longer part of her platform.¹ That’s because, when you dig deeper, it’s clear that this proposal is more of a campaign talking point than a practical solution to our health care challenges.

This week let’s explore why Medicare for All, despite its appeal, isn’t likely to become a reality—and why it’s time to focus on more realistic approaches.

What is Medicare for All?

For those unfamiliar, Medicare for All proposes a single-payer system where the government would provide health care for every American, replacing private insurance. The idea is modeled after the current Medicare program, which serves individuals over 65 years of age, but it would expand to include everyone.

On paper, it sounds straightforward. But the complexities of implementing such a sweeping change reveal why this concept, while popular in campaign speeches, is far from feasible.

Cost and Funding Challenges

One of the biggest hurdles is cost. Estimates suggest Medicare for All could run upwards of $32 trillion over 10 years. That’s a staggering number and finding the funding for it would require significant tax increases. Despite the enthusiasm from some corners, it’s difficult to imagine Congress, particularly in its current divided state, agreeing on how to pay for this plan (we’re also looking at a divided 119th Congress as well, with likely narrow majorities in both the House and Senate).^2,3

And that’s not the only economic disruption. The $1.2 trillion private health insurance industry wouldn’t simply disappear without reverberations; shutting down such a massive sector would impact millions of jobs, sparking concerns that go well beyond health care reform (and imagine the litigation! PBMs would absolutely be at the forefront of lawsuits against HHS to reverse this hypothetical.).²

Implementation Hurdles

Even if we set aside the financial challenge, the logistical hurdles are daunting. Transitioning 330 million Americans to a new system isn’t as easy as flipping a switch. Medicare was designed for a specific population—mainly seniors—and expanding it to cover everyone would require overhauling health care IT systems, payment structures, and administrative processes nationwide.

For a comparison, consider the Medicare Prescription Payment Plan rolled out under the Inflation Reduction Act. That program, which is optional, is still a massive undertaking and created widespread confusion across stakeholders about how to track payments, apply rebates, ensure proper billing, and update legacy systems to comply with the new regulation. Now, imagine moving the entire country to a new system—it’s an enormous task, with no easy path forward.^1,2

Additionally, Medicare reimburses health care providers less than private insurers. If those lower rates applied across the board, we could see shortages in certain areas, as providers might limit the number of patients they see. While Medicare’s simpler billing process might be appealing, it won’t make up for reduced income.^1,2

Political Realities

Politically, Medicare for All faces even more resistance. It lacks bipartisan support, and even within the Democratic Party, there’s division. Harris has shifted from her earlier support and now advocates for more gradual reforms like strengthening the Affordable Care Act (ACA).^1,2

Public opinion is also mixed at best; many Americans are satisfied with their employer-sponsored insurance, and polls show that they’re hesitant to give that up for a government-run system. This reluctance, along with opposition from the health care industry, makes passing Medicare for All in any form highly unlikely.³

Alternative Approaches

So, where does that leave us? Instead of focusing on Medicare for All, there are more practical solutions that can expand access without upending the entire health care system:

• Public Option: A public option would allow individuals to buy into Medicare or Medicaid, expanding coverage without dismantling private insurance. It’s a more realistic alternative that could serve as a steppingstone toward broader reform.
• Strengthening the ACA: The Biden-Harris administration has made progress by increasing subsidies under the ACA, leading to record enrollments and lower uninsured rates. Expanding Medicaid in the remaining states could further reduce coverage gaps.³
• Targeted Reforms: Specific reforms, such as lowering prescription drug prices and addressing surprise medical billing, would tackle some of the most pressing health care costs without requiring a complete system overhaul. The IRA already made strides in these areas, capping insulin costs for Medicare beneficiaries and allowing the government to negotiate certain drug prices (though we know that has not been an easy path, either).³

At this point, Medicare for All is more of a campaign sound bite than a realistic policy solution. The cost, logistics, and political resistance make it clear that we’re not likely to see this plan implemented anytime soon. As we move forward, it’s time to focus on reforms that can actually happen—incremental changes that will make health care more affordable and accessible without turning the entire system upside down.

Remember, regardless of your political affiliation, staying informed about health care policy is crucial. Let’s keep pushing for the substantive policy discussions we deserve.

Happy voting!

Join me on Wednesdays as I highlight key court decisions, review notable health policies, and analyze what’s behind the bill in health care.

References

1. Payne D. Harris isn’t pushing Medicare for All anymore. Progressives say that’s OK. Politico. August 19, 2024. Accessed October 15, 2024. https://www.politico.com/news/2024/08/19/medicare-for-all-harris-progressives-2024-elections-00174447

2. Weiland N. Despite Trump’s accusations, Democrats have largely avoided Medicare for All. The New York Times. August 22, 2024. Accessed October 15, 2024. https://www.nytimes.com/2024/08/22/us/politics/harris-medicare-for-all.html

3. Levitt L. The politics of health care and the 2024 election. KFF. Updated September 4, 2024. Accessed October 15, 2024. https://www.kff.org/health-policy-101-the-politics-of-health-care-and-the-2024-election/?entry=table-of-contents-introduction